BLADDER NEOPLASM OF

DELYVONNE M. WHITEHEAD · 2026 · Case ID: A26033306

MIXED

Summary

The veteran, who served in the U.S. Army from March 1958 to March 1960, appeals the denial of increased ratings for bilateral knee disabilities and the denial of service connection for several conditions. The Board granted service connection for bladder cancer, hypertension, Bowen's disease (skin condition), hypothyroidism, a back disability, left hip condition, osteopenia/osteoporosis, and a right foot vascular disorder. The Board found bladder cancer, hypertension, Bowen's disease, and hypothyroidism to be related to herbicide exposure during service, resolving reasonable doubt in the veteran's favor for hypertension and herbicide exposure. The back, left hip, osteopenia/osteoporosis, and right foot vascular disorder claims were granted as secondary to the veteran's service-connected bilateral knee disabilities, based on a private medical opinion. The Board denied increased ratings for the bilateral knee disabilities, finding the evidence did not support a higher rating based on limitation of motion or other criteria. The case was remanded for further development regarding peptic ulcer disease and GERD due to unclear medical evidence and for a respiratory disability (rhinitis) due to inadequate VA opinions on etiology and the scope of the claim. The Board found the veteran's service in Korea was outside the presumptive period for herbicide exposure, requiring a facts-found basis for direct service connection, which was established through a balance of evidence including TERA memorandums and a private opinion.

Rationale

Conceded herbicide exposure during service in Korea; Balance of evidence established exposure on facts found basis; Bladder cancer is a presumptive herbicide-related disease

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250723-558170

Full Decision Text

Citation Nr: A26033306
Decision Date: 04/09/26 Archive Date: 04/09/26

DOCKET NO. 250723-558170
DATE: April 9, 2026

ORDER

Entitlement to service connection for bladder cancer, to include as due to herbicide exposure, is granted.

Entitlement to service connection for hypertension, to include as due to herbicide exposure, is granted.

Entitlement to service connection for Bowen's disease, claimed as carcinoma (skin condition), to include as due to herbicide exposure, is granted.

Entitlement to service connection for a thyroid condition, claimed as hypothyroidism and hyperthyroidism, to include as due to herbicide exposure, is granted.

Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral knee disability, is granted.

Entitlement to service connection for left hip condition, to include as secondary to service-connected bilateral knee disability, is granted.

Entitlement to service connection for osteopenia/osteoporosis, to include as secondary to a service-connected disability, is granted.

Entitlement to service connection for right foot vascular disorder, to include as secondary to a service-connected disability, is granted.

Entitlement to an increased rating in excess of 10 percent for a left knee disability is denied.

Entitlement to an increased rating in excess of 10 percent for a right knee disability is denied.

REMANDED

Entitlement to service connection for peptic ulcer, also claimed as stomach ulcers, to include as secondary to a service-connected disability, is remanded.

Entitlement to service connection for a gastrointestinal disability, to include gastroenteritis and gastroesophageal reflux disease (GERD), to include as secondary to a service-connected disability, is remanded.

Entitlement to service connection for a respiratory disability, claimed as sinuses and to include chronic rhinitis, as due to herbicide exposure, is remanded.

FINDINGS OF FACT

1. The weight of the evidence of record is in approximate balance with regards to establishing the Veteran's toxic exposure during service to industrial solvents, fuels, noise, CARC paint, and herbicides, to include Agent Orange. All reasonable doubt is resolved in favor of the Veteran in this regard.

2. Bladder cancer is presumptively related to herbicide agent exposure.

3. Hypertension is among the presumptive conditions granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022. Prior to the PACT Act, the evidence shows that his hypertension is at least as likely as not related to his exposure to herbicide agents.

4. The weight of the evidence is in favor of the finding that the Veteran's Bowen's disease, claimed as carcinoma (skin condition), and hypothyroidism, are due to his active service, to include as due to herbicide exposure.

5. The weight of the evidence establishes that the Veteran's back disability, left hip disability, osteoporosis, and right foot vascular disorder are secondary to his service-connected bilateral knee disability.

6. The Veteran's right and left knee disabilities are both productive of limitation of motion of, at worse, flexion of 130 degrees, normal extension, and no ankylosis.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bladder cancer, presumed due to herbicide agent exposure, have been met. 38 U.S.C. §§ 1116(a)(2)(J), 1131; 38 C.F.R. §§ 3.102, 3.104 3.303, 3.304, 3.307, 3.309.

2. The criteria for an award of service connection for hypertension under the PACT Act have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309; PACT Act, Pub. L. 117-168, 136 Stat. 1759 (2022).

3. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for hypertension on a basis other than as pursuant to the PACT Act have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for Bowen's disease, to include residuals scars, as secondary to herbicide exposure, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C
-168, 136 Stat. 1759 (2022).

4. The criteria for service connection for Bowen's disease, to include residuals scars, as secondary to herbicide exposure, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for service connection for a thyroid condition, to include hypothyroidism, as secondary to herbicide exposure, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for service connection for a back disability, as secondary to service-connected bilateral knee disability, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

7. The criteria for service connection for a left hip disability, as secondary to service-connected bilateral knee disability, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

8. The criteria for service connection for osteopenia/osteoporosis, as secondary to service-connected disability, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

9. The criteria for service connection for right foot vascular disorder, as secondary to service-connected disability, have been met. 38 U.S.C. §§ 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

10. The criteria for an increased rating in excess of 10 percent for a right knee disability manifested by limitation of motion have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5260.

11. The criteria for an increased rating in excess of 10 percent for a left knee disability manifested by limitation of motion have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from March 1958 to March 1960.

This case comes before the Board of Veterans' Appeals (Board) on appeal from June 2025, and July 2025 Rating Decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO), the Agency of Original Jurisdiction.

In July 2025, the Veteran perfected appeal to the Board by filing a VA Form 10182 Notice of Disagreement, selecting the Hearing Lane. By choosing the Hearing Lane, the Veteran opted for the Board to review evidence of record at the time of the Agency of Original Jurisdiction's (AOJ) decision on the issues on appeal and the opportunity to testify at a personal hearing before the Board and submit additional evidence within 90 days of the hearing. A hearing was held before the undersigned Veterans Law Judge in October 2025; a transcript of the proceeding is of record. In this case, the Board may only consider the evidence of record at the time of the Rating Decisions on appeal for the respective issues and that received within 90 days of the October 2025 hearing.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury;
before the undersigned Veterans Law Judge in October 2025; a transcript of the proceeding is of record. In this case, the Board may only consider the evidence of record at the time of the Rating Decisions on appeal for the respective issues and that received within 90 days of the October 2025 hearing.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

With respect to service connection based on herbicide exposure, VA laws and regulation provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii).

A veteran who, during active military, naval, or air service, served between September 1, 1967, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iv).

Once exposure to herbicides has been established by the evidence of record, the presumption of service connection found in 38 C.F.R. § 3.309(e) for herbicide-related diseases is applicable. If a veteran was exposed to an herbicide agent during active service, certain diseases, including prostate cancer, will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service. 38 U.S.C. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e).

Where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The National Defense Authorization Act for Fiscal Year 2021 (NDAA) went into effect on January 1, 2021. Pub. L. No. 116-283. The NDAA amended 38 U.S.C. § 1116(a)(2) to add bladder cancer among the list of diseases eligible for presumptive service connection based on herbicide agent exposure. 38 U.S.C. § 1116(a)(2)(J).

It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102.

1. Entitlement to service connection for bladder cancer, to include as due to herbicide exposure

The Veteran asserts that currently diagnosed bladder cancer is the result of herbicide agent exposure while serving in Korea. The Board finds that the evidence is in approximate balance with regards to establishing that the Veteran was exposed to herbicide, to include Agent Orange, during his active service. Therefore, service connection for bladder cancer is granted.

As a preliminary matter, the Veteran was not in Korea during the presumptive period for herbicide agent exposure at the DMZ. He was discharged from active duty in March 1960. This is more than seven years before the applicable presumptive period for exposure to herbicide agents at the DMZ began on September 1, 1967. Therefore, the Veteran must establish to an approximate balance standard that he was exposed to herbicide agents during military service on a facts found basis. 38 U.S.C. § 5107(a).

The crux of the
the Veteran was exposed to herbicide, to include Agent Orange, during his active service. Therefore, service connection for bladder cancer is granted.

The crux of the Veteran's case is that he was exposed to herbicide agents when working near the 38th parallel while restoring a bridge. He asserts that as part of his military occupational specialty (MOS) as a combat engineer, he worked in advanced areas, to include the DMZ, building/restoring bridges in Korea where he witnessed the spraying of herbicides during his deployment of over a year. Service records confirm not only the Veteran's MOS, as part of the 11th Engineer Battalion in Korea, and confirm the Veteran's deployment to Incheon, Korea, which is less than 80 miles from the DMZ, between September 1958 to September 1959. The Veteran's lay statements and testimony, provided during several Board hearings, have continuously and consistently asserted he worked near the DMZ to include being stationed in Uijong-bu, which is less than 20 miles from the DMZ. The Board will resolve reasonable doubt in his favor and concede that he worked on a bridge somewhere on or near the DMZ.

The Board notes, however, that the Veteran's service on or near the DMZ does not translate to an exposure to herbicide agents, as the Veteran's time of service in this area is outside the presumptive period noted above. As such, actual exposure to herbicides must be demonstrated by the evidence of record. To this end, the Board finds that evidence of record is in approximate balance in establishing exposure during his active service.

To this end, the RO attempted to corroborate the Veteran's exposure to herbicide agents during his time in Korea. The RO requested a review of records as to "whether herbicides were stored or utilized in the area in Korea at the time and place the Veteran served." A VA researcher requested records from the National Archives and Records Administration (NARA) for the Veteran's unit from September 1958 to December 1958, but NARA was unable to locate relevant records confirming or rebutting any claimed exposure during that time. The Board finds that such report to be both inconclusive and incomplete, as it fails to assess and provide analysis regarding herbicide exposure for the period in which the Veteran actually served in Korea, which included the period up to September 1959. As such, the Board finds such report to be inadequate.

In March 2023, the RO acquired a Toxic Exposure Risk Activity (TERA) memorandum, to which it was found that the Veteran did not participate in any TERA during his active duty, to explicitly include herbicides. The Veteran's claims for service connection, to include bladder cancer, were denied in an October 2023 Board's decision, based, in part, on the fact that there was no finding of TERA and/or herbicide exposure during the Veteran's active service, as noted in NARA report and the TERA memorandum.

The Veteran, however, filed a timely Supplemental claim, and in development as such, additional TERA memorandums were acquired in November 2023. In both memorandums, TERA exposure was confirmed, to include herbicides, and non-deployment related exposure based on his MOS, to various contaminants such as Agent Orange, industrial solvents, fuels, noise, vibrations, and CARC paint.

In April 2024, another TERA memorandum was obtained by the RO, and the report found no TERA participation, and noted no toxic exposure to include herbicide.

The Board finds that the evidence of record, to include the findings of fact via the TERA memorandums and the NARA report, to be in approximate balance. Consequently, the Board must find that in-service herbicide exposure has been found and established.

Here, as the medical records, to include multiple VA examinations, show a diagnosis for bladder cancer, and residuals thereof. To this end, binding and favorable finding by the June 2025 Rating Decision on appeal, also found that the Veteran was diagnosed with bladder cancer. As such a current diagnosis has been established and conceded by the VA.

Accordingly, the Board finds that the Veteran was exposed to herbicide agents
noted no toxic exposure to include herbicide.

Accordingly, the Board finds that the Veteran was exposed to herbicide agents during service in Korea, and as bladder cancer is recognized as a condition related to herbicide exposure, service connection, on a facts found basis, is warranted, and the Veteran's claim must be granted. 38 C.F.R. § 3.102.

2. Entitlement to service connection for hypertension, to include as due to herbicide exposure

The Veteran seeks to establish service connection for hypertension due to exposure to herbicide agents, which has been conceded above, during his service.

For veterans who have been exposed to herbicide agents such as Agent Orange, VA has established a presumption of service connection for certain diseases. 38 C.F.R. § 3.307(a)(6), 3.309(e). Pursuant to the PACT Act, hypertension is now a presumptive disease for in-service exposure to herbicide agents, effective from August 10, 2022. See Pub. L. No. 117-168, § 403(d)(2) (2022). Prior to the effective date of the PACT Act, the Board must consider whether service connection for hypertension is warranted under other theories of entitlement including as directly due to exposure to herbicide agents. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994).

As such, the Board will now discuss the evidence of record to establish service connection on a direct basis for prior to 2022. Here, the Board concludes that the evidence of record establishes that the Veteran's hypertension is at least as likely as not related to his in-service exposure to herbicide agents. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. Therefore, service-connection is warranted.

First, the Board finds that there is a current disability based on diagnosis of hypertension. VA/private treatment records show treatment for hypertension, to include medication, and VA examinations also show clinical diagnosis for hypertension. Therefore, the first element of service connection is established.

Second, the Board finds that in-service exposure has been established for herbicide, as noted above. Therefore, the second element of service connection is established.

Third, the Board finds that there is competent, credible evidence linking the Veteran's current disability to his in-service injury. Specifically, the Board finds that the evidence supports a medical nexus between the Veteran's in-service exposure to herbicide agents and the development of his hypertension.

Here, VA examinations and opinions obtained in January 2024 explicitly found that the Veteran's hypertension is at least as likely as not related to any exposures to herbicides during his active service. The supporting rationale was that the PACT Act identified hypertension as a condition related to exposure to herbicide agents, including Agent Orange. Likewise, private nexus opinion submitted by the Veteran, from Dr. F. G. also found that such toxic exposure during service caused his later development of hypertension. Although the private examiner's supporting rationale is limited and brief, examiners are presumed to have the medical knowledge to provide the opinion and that the examiners have kept abreast of the specific field of medicine; there is no requirement to explicitly cite any studies or sources of information which may be favorable or unfavorable to any particular theory. See Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012).

The Board is also cognizant of the Veterans and Agent Orange: Update 11 (2018), the National Academies of Sciences, Engineering and Medicine (NAS) as constructively in its possession and the NAS found "sufficient" evidence of an association for hypertension and exposure to Agent Orange and other herbicides. While the 2018 NAS report is not actually in the Veteran's claims file, based upon the United States Court of Appeals for the Federal Circuit holding in Euzebio v. McDonough, the Board finds that VA was in constructive possession of the above cited evidence as a part of the Veteran's claim, as the VA had actual knowledge of the evidence and such evidence is relevant and reasonably connected to the claim. See Id., 989 F.3d 1305, 1321-22 (Fed. Cir. 2021). Moreover, the Board notes that a February 2022 House committee report relied on the 2018 NAS Update's findings to support adding hypertension to the list of diseases presumptively caused by herbicide agent exposure, in support of the passage of PACT Act. See H.R. Rep. No. 117-249, pt. 1, at 8, 18, 32, 57-58 (2022).

The Board acknowledges that a March 2025 VA medical opinion concluded the Veteran's hypertension was less likely than not related to his service, noting no in-service element and/or exposure. However, the rationale for this opinion fails to consider herbicide exposure, as conceded by the Board herein. Such opinion was ostensibly based on the most recent April 2024 TERA memorandum, which noted no herbicide exposure. Based on such rationale, the Board must find that such opinion to be of limited probative value, as it failed consider such exposure.

Given the above VA-obtained favorable opinion in consideration with the 2018 NAS report, the Board finds that the Veteran's hypertension is at least as likely as not related to an in-service event, and service connection for hypertension, based on other than under the provisions of the PACT Act, is warranted.

Accordingly, the claim is granted.

3. Entitlement to service connection for Bowen's disease, to include as due to herbicide exposure

4. Entitlement to service connection for a thyroid condition, to include as due to herbicide exposure

With regards to the Veteran's claims for both Bowen's disease (skin condition/cancer), and a thyroid condition, the Board finds that, similar to the claims for hypertension, the evidence of record supports a finding that the conditions are related to the Veteran's service, and thus, service connection is warranted.

The Veteran was afforded VA examinations in March 2024, for both conditions. Upon examination, the VA examiner concluded clinical diagnoses for hypothyroidism and Bowen's disease, status-post removal, to include scars. When opining upon the etiology, the VA examiner concluded that both the Veteran's Bowen's disease and hypothyroidism were at least as likely as not etiologically related to the Veteran's herbicide exposure during service. With regard to Bowen's disease, the examiner noted that such is an "early form of squamous cell skin cancer" and such was likely due to exposure to Agent Orange.

Like with the Veteran's claim for hypertension, a later March 2025 VA examination was also obtained, which found against any etiological nexus to service for both conditions. However, in both cases, that examination also relied on the latter TERA memorandum noting no exposure to herbicides. As such, the Board finds that such opinion to be inadequate, especially in light of the findings of the Board herein, with regards to conceding herbicide exposure. Therefore, this opinion is of limited probative value.

Given the above VA-obtained favorable March 2024 opinion, the Board finds that the Veteran's Bowen's disease and hypothyroidism are at least as likely as not related to an in-service event of exposure to herbicide, and service connection for both are warranted. As such, the claims must be granted.

5. Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral knee disability

6. Entitlement to service connection for left hip condition, to include as secondary to service-connected bilateral knee disability

7. Entitlement to service connection for osteopenia/osteoporosis, to include as secondary to a service-connected disability

8. Entitlement to service connection for right foot vascular disorder, to include as secondary to a service-connected disability

The Veteran claims that
finds that the Veteran's Bowen's disease and hypothyroidism are at least as likely as not related to an in-service event of exposure to herbicide, and service connection for both are warranted. As such, the claims must be granted.

5. Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral knee disability

6. Entitlement to service connection for left hip condition, to include as secondary to service-connected bilateral knee disability

7. Entitlement to service connection for osteopenia/osteoporosis, to include as secondary to a service-connected disability

8. Entitlement to service connection for right foot vascular disorder, to include as secondary to a service-connected disability

The Veteran claims that his back, left hip, and osteopenia/osteoporosis disorders are all due to his active service, or in the alternative, they are secondary to his service-connected disabilities. The Board finds that while there is evidence against the finding that such conditions are due to any aspect of his active service, private medical opinions submitted by the Veteran do show that such conditions are secondary to his service-connect disabilities, to explicitly include his knees. As such, service-connection on a secondary basis is warranted.

In January 2026, the Veteran submitted, within the appropriate evidence window to his most recent Board hearing before the undersigned (within 90 days), an October 2025 private opinion letter from Dr. R. P. In the extensive opinion letter, the private examiner noted a comprehensive review and analysis of the Veteran's claims file and medical records/history. Dr. R. P. after noting such review, concluded that the Veteran's back disability, left hip disability, osteopenia, and right foot vascular disorder, were all as likely as not due to his service-connected bilateral knee disability, and treatment thereof.

With specific regards to his back disability, the examiner found that the diagnosed back disabilities, which include IVDS, was as likely as not due to the Veteran's injury sustained during his active service, as well as, secondary to his service-connected bilateral knee disabilities. To this end, the examiner noted that "medical and biomechanical evidence consistently supports that his current back pathology" is the permanent consequence of "compensatory adjustment" for his knee disability. The private examiner provided extensive rationale based on cited medical treatise, noting "altered lower limb kinematics" that culminate in lumbar spine stress, and shifts in posture to compensate for the knee requires the "increased activation of the paraspinal muscles to maintain an upright posture." The Board finds such opinion to be adequate and dispositive of the claim, in light of no other opinions of record speaking to secondary service connection to the Veteran's service-connected bilateral knee disabilities.

Likewise, in the same private opinion report from Dr. R. P. the October 2025 opinion letter concludes that the Veteran's diagnosed left hip disability is as likely as not, due to the Veteran's bilateral knee disability. Similar to the finding for the back, the examiner provided a rationale that "chronic pain, altered posture, and gait abnormalities resulting from these primary conditions [bilateral knee disability] have led to asymmetric biomechanical loading, sustained overuse, and progressive degenerative changes in the left hip join." Again, the examiner provided ample discussion and citation regarding the effects of the lower extremities, to include compensating for lower limb imbalance, causing mechanical strain on the ipsilateral hip. The Board, again, finds that the private examiner's opinion and finding to be comprehensive and dispositive of the claim in establishing a secondary nexus to his service-connected bilateral knees.

With regards to the Veteran's diagnosed osteoporosis, the private examiner noted that such condition is secondary to the culminating effect of his service-connected disabilities, to especially include those musculoskeletal conditions which caused long-term/chronic immobility and persistent inflammation. To this end, the examiner noted that between the Veteran's back, knees, and hip disabilities, the dramatic reduction in the Veteran's weight-bearing activity, let to progressive discus osteopenia, as well as promoted "osteoclastic bone resorption and impaired bone regeneration". The Board notes that this in combination with other factors such as decreased calcium absorption, caused, or at least aggravated the Veteran's development of osteoporosis. Here, considering the Veteran is already service-connected for his bilateral knees, and has been service-connected herein for his back and left hip, the Board finds that such finding to be well reasoned and based on a comprehensive analysis of the evidence; and as such, is considered highly probative and dispositive of the claim for service connection, on a secondary basis.

With regards to a right foot disability, Dr. R. P. also found that such condition was secondary to the Veteran's service-connected bilateral knee disability.
as promoted "osteoclastic bone resorption and impaired bone regeneration". The Board notes that this in combination with other factors such as decreased calcium absorption, caused, or at least aggravated the Veteran's development of osteoporosis. Here, considering the Veteran is already service-connected for his bilateral knees, and has been service-connected herein for his back and left hip, the Board finds that such finding to be well reasoned and based on a comprehensive analysis of the evidence; and as such, is considered highly probative and dispositive of the claim for service connection, on a secondary basis.

With regards to a right foot disability, Dr. R. P. also found that such condition was secondary to the Veteran's service-connected bilateral knee disability. Here, the Veteran's diagnosed vascular foot disorder of the right foot was found to be the consequence of, again, immobility caused by the Veteran's knee and back disabilities, collectively. The examiner noted that such condition results in "venous stasis, microvascular injury, and ischemic changes" which progresses into significant vascular disease, to include the Veteran's condition in his right foot. As such, the examiner found that such condition is as likely as not, secondary to his service-connected knee disability, as well as his back disability, which has been service-connected herein.

In making such findings, the Board is cognizant of other negative opinions and VA examinations of record. A close review of those opinions, however, reveals that none of such findings relate to a secondary nexus regarding the knees. Here, nearly all of such examinations and opinions related to service connection on a direct basis. Here, as the Board's finding is based on a secondary causation/aggravation basis to the Veteran's service-connected bilateral knee disability, the Board finds that such opinions are not contradictory to such finding.

The Board finds that October 2025 private opinion establishes a secondary nexus between the Veteran's claimed back disability, left hip disability, osteoporosis, and right foot disability, and his service-connected bilateral knee disability. Notably, there is no contrary evidence against such finding; specifically, no VA examination or medical evidence of record include any opinion with regard to secondary service-connection. Therefore, the Board finds that opinions highly probative and dispositive of the claims for service connection. Consequently, as the weight of the probative evidence is in favor of the claims, service connection is warranted, and the claims must be granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Increased Rating

Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for a higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The Veteran's entire history is reviewed when making disability rating decisions. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). However, where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See 38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55 (1994). "Staged" ratings (for periods when varying degrees of disability are shown) may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007).

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

The Veteran's knee disabilities are rated under Diagnostic Code 5260. 38 C.F.R. § 4.71a. Under DC 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. The standard ranges of motion of the knee are zero degrees of extension and 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II.

9. Entitlement to an increased rating in excess of 10 percent for a left knee disability

10. Entitlement to an increased rating in excess of 10 percent for a right knee disability

The Veteran contends that his right and left knee disabilities warrant a higher rating than his current 10 percent ratings. Specifically, the Veteran contends that he has pain and limited motion in his knees, which interferes with his activities and work. The Board notes that the competent medical evidence of record, to include VA and private treatment records and a VA examination, show that the Veteran's right and left knee disabilities are manifested by range of motion limited to, at worst, 130 degrees of flexion and normal extension, with evidence of pain. The Board finds that level of disability does not warrant a higher rating based on limitation of motion, or a separate rating under any other diagnostic codes for the knees not already service connected. Therefore, the claims for increased ratings must be denied.

The Veteran was provided a VA examination in March 2024 to assess the nature and severity of his service-connected right and left knee disabilities. A close review of these VA examination report reveals no objective evidence of limitation of motion that even approaches the requisite 30 degrees of flexion (or to 10 degrees on extension) required for a higher rating, or any evidence of ankylosis. In this VA examination, the VA examiner noted the Veteran's report of bilateral knee pain, especially after activity such as hiking, and reported no flare-ups. Upon testing, both knees showed range of motion was limited only to 135 degrees of flexion, and normal extension (zero). Repetitive motion testing revealed no additional loss of range of motion; however, when considering repeat motion over time, the examiner estimated the Veteran's knee range of motion would decrease to 130 degrees of flexion
of these VA examination report reveals no objective evidence of limitation of motion that even approaches the requisite 30 degrees of flexion (or to 10 degrees on extension) required for a higher rating, or any evidence of ankylosis. In this VA examination, the VA examiner noted the Veteran's report of bilateral knee pain, especially after activity such as hiking, and reported no flare-ups. Upon testing, both knees showed range of motion was limited only to 135 degrees of flexion, and normal extension (zero). Repetitive motion testing revealed no additional loss of range of motion; however, when considering repeat motion over time, the examiner estimated the Veteran's knee range of motion would decrease to 130 degrees of flexion, and normal extension. No instability was found upon examination, and there were no indications of ankylosis; to this end, the examiner found no evidence of functional loss or need for assistive devices. The Veteran was ultimately diagnosed with osteoporosis of the bilateral knees.

In addition to the March 2024 VA examination, the record contains voluminous amounts of VA and private treatment records for the claims period. A close review of all such records, however, reveals no additional conditions or more severe symptoms related to either the Veteran's right or left knee disability. While such records note some complaints and treatment for pain in the knees, the record does not contain any objective testing for range of motion or show diagnosis for any additional conditions such as ankylosis and/or instability for either knee.

The Board notes that these findings do not more nearly reflect the criteria for a higher rating based on limitation of motion. Here, the condition for both knees is only productive of limitation of flexion to 130 degrees and normal extension, even considering repeat motion over time. Even a review of the VA and private treatment records during the claims period reveal no additional evidence showing a disability that approaches the 30 degrees of flexion or 15 degrees of extension required for a 20 percent rating under the appropriate diagnostic codes. The Board finds that such findings by the VA examiner during the claims period to be highly probative and the findings dispositive of the claims. Therefore, as there is no evidence that the Veteran's disabilities meet the criteria for higher ratings, the Board must find that ratings in excess of 10 percent are not warranted.

Likewise, separate, or higher, ratings are not warranted for limitation of extension, under DC 5261. Here, again, the Board notes that the objective medical evidence of record ostensibly has noted that the Veteran's bilateral knee extension to be normal (zero degrees) throughout the claims period. As such, separate, or higher ratings under DC 5261 would not be warranted under the current facts of the claims.

The Board has also considered the other DCs pertaining to the knee and leg. Here, however, a higher or separate rating is not warranted under any other potentially applicable DCs. There is no lay or objective evidence of ankylosis (DC 5256); or frequent episodes of "locking," pain and joint effusion (DC 5258); or impairment of tibia and fibula (DC 5262); or genu recurvatum (DC 5263). As such, considering under these DCs would be inappropriate, and not warranted.

The Board has considered the Veteran's lay statements and complaints. To this end, the Veteran asserted, during his testimony before the undersigned, that his knees "give out," were unstable, and caused functional limitations, causing him to be unable to do daily activities. With regard to the lay statements, the Board notes that while the Veteran is competent to speak to lay observable symptoms such as pain, he is not competent to speak to the specific objective criteria of exact measurements for range of motion as it pertains to the applicable diagnostic code. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds that such lay assertions to be less probative in light of the VA examination report of record, which tested objective movement/range of motion, and instability of both knees. Here, the report not only noted no explicit complaint from the Veteran with regards to "giving out" or inability to perform daily activities, but findings by the medical professional showed no evidence of any functional loss as due specifically to his knees, and/or instability after objective testing, to include "giving out." Although his VA treatment records reflect his report of knee pain, giving out, and falls, especially for the right knee later in May 2024, the examiner made no finding of instability on the associated clinical examination, nor was the Veteran's reported symptoms found to result in functional impairment; notably, a June 2024 MRI show no evidence of a meniscus or tendon tear,
ange of motion, and instability of both knees. Here, the report not only noted no explicit complaint from the Veteran with regards to "giving out" or inability to perform daily activities, but findings by the medical professional showed no evidence of any functional loss as due specifically to his knees, and/or instability after objective testing, to include "giving out." Although his VA treatment records reflect his report of knee pain, giving out, and falls, especially for the right knee later in May 2024, the examiner made no finding of instability on the associated clinical examination, nor was the Veteran's reported symptoms found to result in functional impairment; notably, a June 2024 MRI show no evidence of a meniscus or tendon tear, with only evidence of inflammation. The Board, as such, assigns more probative weight to the objective medical evidence because of the experience and training of the examiners. While a February 2025 private opinion letter notes the Veteran to have bilateral knee instability, this assessment is not associated with an actual examination of the Veteran and is not supported by objective clinical findings to this end. Essentially, the medical evidence does not indicate that the Veteran's reported symptoms of "giving out" warrants separate ratings.

Accordingly, the Board finds that the weight of the probative evidence is against the claim for a higher rating for the right/left knee, or any separate rating, not already service-connected, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

REASONS REMAND

1. Entitlement to service connection for peptic ulcer, also claimed as stomach ulcers is remanded

2. Entitlement to service connection for a gastrointestinal disability, to include gastroenteritis and gastroesophageal reflux disease (GERD), to include as secondary to a service-connected disability, is remanded

The issues of entitlement to service connection for ulcers and GERD are remanded to correct a duty to assist error that occurred prior to the June 2025 Rating Decision on appeal. The Agency of Original Jurisdiction (AOJ) obtained a March 2025 medical opinions prior to the Rating Decision on appeal. However, these medical opinions do not provide an adequate rationale regarding whether the Veteran has an ulcer disability. As such, remand is required.

The Veteran contends that he is entitled to service connection for peptic ulcer disease and a gastrointestinal disability, to include gastritis and GERD, as secondary to this gastrointestinal condition developed during his active service, including due to his exposure to herbicides. The Board finds, however, that it is unclear as to whether the Veteran has a current disability of peptic ulcers, or ulcers of any type, to include residuals thereof.

Here, the Veteran was afforded VA examinations for the claimed ulcers in March 2024 and March 2025. In the 2024 VA examination, the VA examiner noted a diagnosis of gastric ulcers, with onset in the 1960's and progressing until the present. In the notation section, the VA examiner note continued symptoms throughout, to include progression until the present claims period. In the March 2025 VA examination, however, the VA examiner explicitly found no clinically diagnoseable ulcer condition, and noted that such was resolved in 2016. Here, the examiner noted that there was no evidence in treatment records of ongoing ulcers, and that his last ulcer was resolved in 2016 (outside the claims period, which started in 2019). To this end, the Board notes that private opinion letter obtained in October 2025, also notes that the Veteran's last diagnosis of ulcers was in 2016, with no indication of a current (from 2019) diagnosis of ulcers.

The Board finds that a close review of the medical evidence of record to be unclear and inadequate, with regards to demonstrating a current clinical diagnosis of any ulcer condition, and/or residuals thereof. Here, neither of the latter VA nor private medical opinions explicitly reconcile such findings with the March 2024 VA examination which explicitly noted a diagnosis for gastric ulcers, and ongoing symptoms. To this end, even if assuming the subsequent VA/private reports are correct, it is unclear if the Veteran's diagnosed GERD and gastritis, are separate disabilities/disorders, or only symptoms/residuals of his ulcers. As such, the Board must find that the current development with regards to the Veteran's claimed ulcer disability is incomplete and inadequate; and therefore, remand is required.

Further, as noted above, the Veteran's claim for a gastrointestinal disability to include GERD, is inextricably intertwined with the claim for ulcers, as it is unclear whether such condition is secondary and/or a symptom of residual of
March 2024 VA examination which explicitly noted a diagnosis for gastric ulcers, and ongoing symptoms. To this end, even if assuming the subsequent VA/private reports are correct, it is unclear if the Veteran's diagnosed GERD and gastritis, are separate disabilities/disorders, or only symptoms/residuals of his ulcers. As such, the Board must find that the current development with regards to the Veteran's claimed ulcer disability is incomplete and inadequate; and therefore, remand is required.

3. Entitlement to service connection for a respiratory disability, claimed as sinuses, to include chronic rhinitis, as due to herbicide exposure

As a preliminary matter, the Board has expanded the Veteran's claim for sinusitis, to a claim for all respiratory disabilities, to include his diagnosed chronic rhinitis. See Clemons v. West, 206 F.3d 1401, 1403 (Fed. Cir. 2000). The issue has been recharacterized accordingly as noted above.

The issue of entitlement to a respiratory disability is remanded to correct a duty to assist error that occurred prior to the June 2025 Rating Decision on appeal. The Agency of Original Jurisdiction (AOJ) obtained March 2024 and 2025 medical opinions prior to the Rating Decision on appeal. However, these medical opinions do not provide an adequate rationale regarding whether the Veteran's diagnosed chronic rhinitis is caused or aggravated by any aspect of his active service, to include his conceded exposure to herbicides.

Here, in the March 2024 VA examination for the Veteran's claimed respiratory disability, the VA examiner provided a negative nexus opinion regarding etiology of the condition. The VA examiner concluded that it was less likely than not that the Veteran's claims sinusitis was caused by his in-service herbicide exposure. As rationale, the examiner ostensibly noted that there was no evidence that the Veteran currently had clinically diagnosable conditions of sinusitis, and as such, no nexus could be established. The Board finds that such opinion to be inadequate, as the Veteran was diagnosed by the same examiner for chronic rhinitis, for which no opinion regarding etiology was provided.

Subsequently, in the March 2025 VA opinion regarding etiology, the VA examiner completely ignored the Veteran's exposure to herbicide during service in finding against any etiological nexus. Here, also again, the VA examiner noted the opinion regarding sinusitis, and not his diagnosed chronic rhinitis.

In an October 2025 opinion letter, Dr. R. P. provided a clear and comprehensive nexus opinion, linking the Veteran's diagnosed sinusitis, and the Veteran's active service exposure to herbicides and toxins. Here, again, such opinion does not speak to chronic rhinitis, but rather sinusitis, to which the Veteran has not been diagnosed with during the course of the claims period.

The Board note that a close review of the treatment records of record to include from both the VA and private physicians, show no clinical diagnosis for sinusitis. While repeated treatment records indicate "sinus" issues or "sinus" symptoms, to include congestions, coughing, and sneezing, none of such records show a clinical diagnosis for sinusitis. Instead, the Veteran has been repeatedly diagnosed with allergic and chronic rhinitis throughout the claims period, to include by the March 2024 VA examiner. While sinusitis and rhinitis may share some common symptoms, such are distinct and disparate respiratory conditions, and as such, the Board must find that VA and private examiner's opinions only referring to sinusitis to render any opinion inadequate and incomplete. Therefore, considering the expanded scope of the Veteran's claim, noted herein, and the concession of herbicide exposure, the Board must find that remand is required for an addendum opinion.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an examiner with sufficient expertise regarding the Veteran's GERD and ulcers. Whether an in-person examination is necessary should be determined by the examiner. The entire claims file must be provided to and reviewed by the examiner. The examiner should address the following: (a) Whether it is at least as likely as not that current diagnosed ulcers or GERD is related to an in-service injury or disease, to explicitly include herbicide and toxic exposure, which is conceded; (b) Whether it is at least as likely as not that any currently diagnosed ulcers or GERD is (1) proximately due to any service-connected disabilities, or (2) aggravated by any service-connected disabilities, to include medication and treatment. If the examiner cannot give an opinion without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training).

2. Schedule the Veteran for a VA examination for his claimed respiratory disability, to include rhinitis. The examiner must review the claims file and should note that review in the report. All testing deemed necessary should be performed. A complete rationale for all opinions should be provided in the examination report. The examiner is asked to provide opinions regarding the nature and etiology of any claimed respiratory disability, to include a current diagnosis. The examiner should opine it is at least as likely as not that any diagnosed respiratory disability was incurred in service or are the result of any incident in service, to explicitly include exposure to herbicides, which is conceded. To this end, it is not sufficient for the examiner to provide a rationale against an etiological nexus to service based solely on the legal criteria set out by the VA for presumptive service connection, such opinion must be based on the examiner's medical knowledge and research. The examiner is also advised that private treatment record and VA treatment records concurrent with the claims period has demonstrated diagnosis for rhinitis; as such, if no disabilities are diagnosed during this examination, the examiner must provide an opinion regarding etiology of those previously diagnosed respiratory conditions. In providing the opinions, the examiner must consider and discuss lay assertions from the Veteran. The Board has not made a credibility determination pending the examiner's opinion.

DELYVONNE M. WHITEHEAD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ziheng Zhu, 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.

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