ANXIETY DISORDER

RYAN T. KESSEL · 2026 · Case ID: A26034334

MIXED

Summary

The Veteran served from July 1971 to December 1971. The Veteran appeals the denial of service connection for several conditions and seeks service connection for others. The Board granted service connection for generalized anxiety disorder, hearing loss, tinnitus, GERD (secondary to anxiety disorder), lumbar strain, and bilateral sciatic nerve pain (secondary to lumbar strain). The Board remanded claims for a psychiatric disorder (other than anxiety, to include PTSD and depression), rhinitis, sinusitis, shortness of breath, type II diabetes mellitus, hypertension, liver cirrhosis, and prostate cancer. The Board found the January 2026 non-VA opinion probative and favorable for the granted conditions, establishing a nexus to service or to service-connected conditions, and applied the benefit of the doubt. For the remanded conditions, the Board identified duty-to-assist errors, including the failure to obtain service treatment records, conduct VA examinations, and properly develop claims related to environmental exposures like herbicides and asbestos. The Board noted that while the Veteran claimed herbicide exposure for rhinitis, sinusitis, shortness of breath, diabetes, hypertension, liver cirrhosis, and prostate cancer, the RO's finding of no toxic exposure risk activity (TERA) and the lack of development on asbestos exposure necessitated remand. The Board also found a duty-to-assist error regarding the PTSD claim, as the Veteran was not provided proper notice regarding corroborating evidence for the claimed personal assault stressor.

Rationale

Prior favorable finding of anxiety disorder by RO; Probative non-VA opinion linking condition to service stressors; Benefit of the doubt resolved in Veteran's favor

Special Benefit

NO SPECIAL BENEFIT

Docket No.

231020-387009

Full Decision Text

Citation Nr: A26034334
Decision Date: 04/14/26 Archive Date: 04/14/26

DOCKET NO. 231020-387009
DATE: April 14, 2026

ORDER

Service connection for generalized anxiety disorder is granted.

Service connection for hearing loss is granted.

Service connection for tinnitus is granted.

Service connection for gastroesophageal reflux disease (GERD), as secondary to service-connected generalized anxiety disorder, is granted.

Service connection for lumbar strain is granted.

Service connection for bilateral lower extremity sciatic nerve pain, as secondary to service-connected lumbar strain, is granted.

REMANDED

Service connection for a psychiatric disorder (other than generalized anxiety disorder), to include posttraumatic stress disorder (PTSD) and depression.

Service connection for rhinitis.

Service connection for sinusitis.

Service connection for shortness of breath.

Service connection for type II diabetes mellitus.

Service connection for hypertension.

Service connection for liver cirrhosis.

Service connection for prostate cancer.

FINDINGS OF FACT

1. The Veteran's generalized anxiety disorder is related to service.

2. The Veteran's hearing loss is related to service.

3. The Veteran's tinnitus is related to service.

4. The Veteran's GERD is caused by service-connected generalized anxiety disorder.

5. The Veteran's lumbar strain is related to service.

6. The Veteran's bilateral lower extremity sciatic nerve pain is caused by service-connected lumbar strain.

CONCLUSIONS OF LAW

1. The criteria for service connection for generalized anxiety disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303

2. The criteria for service connection for hearing loss have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385.

3. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for GERD, on a secondary basis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for service connection for lumbar strain have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for bilateral lower extremity sciatic nerve pain, on a secondary basis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1971 to December 1971.

This matter is on appeal from a September 2023 rating decision.

In an October 2023 notice of disagreement (NOD), the Veteran elected the hearing docket.

In November 2025, the Veteran withdrew the hearing request.

The Board may only consider the evidence of record at the time of the September 2023 decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38?C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the Regional Office (RO) issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. Regarding the remanded claims, any evidence the Board could not consider will be considered by the RO in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Legal Criteria

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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
20.801. Regarding the remanded claims, any evidence the Board could not consider will be considered by the RO in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Legal Criteria

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Certain chronic diseases, including organic diseases of the nervous system such as sensorineural hearing loss and tinnitus, are presumed to be incurred in or aggravated by service if manifest to a compensable degree within one year of separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015).

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310.

In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit-of-the-doubt when the competing evidence is in "approximate balance" or "nearly equal." That is, exact equipoise is not required to trigger the favorable benefit-of-the-doubt rule. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).

Analysis

1. Service connection for anxiety disorder.

The Veteran seeks service connection for anxiety. He maintains the condition is related to stress during service.

In the September 2023 rating decision, the RO determined the Veteran has anxiety. A June 2021 VA treatment record shows a diagnosis of anxiety. The Board is bound by this?prior favorable finding, which was not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

In a January 2026 non-VA opinion, which was received within the 90-day period following the Veteran's withdrawal of his hearing request, a physician stated that the Veteran's generalized anxiety disorder is at least as likely as not related to service. The opinion notes that the Veteran's mental health condition began during, and was materially aggravated by, the circumstances of his service, including the stressors surrounding his early separation from Advanced Infantry Training (AlT). The opinion states that the abrupt disruption of the Veteran's training, coupled with the physical injuries and uncertainty associated with his separation, created conditions consistent with the emergence of persistent anxiety symptoms. The opinion notes that in the Veteran's case, early termination from AIT represents a significant service-related stressor with the potential to disrupt identity formation, generate uncertainty, and induce acute psychological distress consistent with patterns described in the Occupational Stress Inventory (OSI) model. The opinion states that literature documents that preexisting vulnerability and early stress exposure are major determinants of anxiety trajectories in service members, with pre-service or early-service difficulties significantly increasing the risk of persistent anxiety disorders later in life. The opinion notes that those findings parallel the Veteran's clinical course. The opinion states that together, the service-related stress mechanisms, early termination from military training, and the longitudinal amplification of symptoms by later medical and psychosocial stressors provide a scientifically grounded explanation supported by the cited literature for the chronic anxiety disorder documented in the Veteran's medical history.

An opinion is adequate where it is based upon consideration of the Veteran's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. See D'Aries v. Peake, 22?Vet. App.?97, 104 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (an adequate medical examination must provide a rationale and explanation for its conclusions). It is a medical examiner's responsibility to provide a well-supported opinion so that the Board may carry out its duty to weigh the evidence of record. See Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 304 (2008) (concluding that medical opinion is not entitled to any weight "if it contains only data and conclusions"). Here, the January 2026 medical opinion is based upon review of pertinent medical records and consideration of the Veteran's reported history. The opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22?Vet. App. at 304.

Although the Veteran is not competent to diagnose himself with anxiety disorder or to provide a medical nexus opinion, he is competent to attest to the symptoms he experiences and the duration of those symptoms. See Jandreau v. Nicholson, 492?F.3d 1372 (Fed. Cir. 2007).

There is no opinion contrary to the conclusion that the Veteran's current anxiety disorder is related to service. As noted above, the Veteran's burden of proof is one of equipoise, not certainty. Lynch, 21 F.4th at 781.

The Board notes that the issue of service connection for a psychiatric disorder, other than anxiety disorder, is addressed in the remand section.

In sum, the Board determines the evidence is in favor of the claim of service connection for generalized anxiety disorder, particularly when reasonable doubt is resolved in the Veteran's favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for generalized anxiety disorder is warranted.

2. Service connection for hearing loss.

3. Service connection for tinnitus.

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The Veteran claims service connection for hearing loss and tinnitus related to noise exposure during service. See April 2023 claim.

Initially, in the September 2023 rating decision, the RO favorably found that the Veteran has hearing loss and tinnitus. A July 2023 audiological VA examination shows a diagnosis of hearing loss and tinnitus. The Board is bound by these?prior favorable findings, which were not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

The Board notes that the Veteran's DD Form 214 reflects an award of a Marksman Badge (Rifle M-16).

In addition, the Veteran's service treatment records (STRs), including a December 1971 separation examination, reflect a threshold shift of 10 decibels or greater in the right ear in each of the frequencies 500, 1000, 2000, 3000, 4000 Hertz and in the left ear in the frequencies of 500, 1000, 2000, 3000 Hertz at separation.

The Veteran was afforded a VA audiological examination in July 2023. The examination reflects a diagnosis of bilateral sensorineural hearing loss and tinnitus and states that excessive noise exposure during service was conceded. Although a negative nexus opinion was provided, the opinion was based, at least in part, on the absence of reference to hearing loss and tinnitus in the Veteran's STRs. A medical opinion based solely on the absence of documentation in the service treatment records or that fails to take into account lay statements is inadequate. See Buchanan v. Nicholson,
0, 4000 Hertz and in the left ear in the frequencies of 500, 1000, 2000, 3000 Hertz at separation.

In the January 2026 non-VA opinion noted above, the physician stated that the Veteran's bilateral hearing loss and tinnitus are related to in-service noise exposure. The opinion notes significant threshold shifts during service. The opinion states that the phenomenon of delayed onset hearing loss and tinnitus secondary to cumulative noise exposure during service is directly applicable to the Veteran, whose 1971 infantry weapons training involved repeated exposure to tanks, gunfire, grenades, and grenade launchers. The opinion states that high-intensity acoustic environments are well-documented occupational hazards. The opinion states that the Veteran's chronic exposure to hazardous noise levels during weapons training and field exercises contributed to the increased long-term risk of auditory dysfunction. The opinion notes that although acute acoustic trauma is widely recognized, the more insidious and cumulative effects of repeated noise exposure often remain undetected initially and may manifest years later as delayed onset hearing loss and tinnitus. The opinion states that that this latency pattern aligns with the Veteran's report of symptoms beginning in the 1980s, years after his 1971 exposure. The opinion notes that medical literature reflects delayed onset hearing loss is characterized by a gradual decline in auditory sensitivity that emerges months or years following repeated noise exposure, as consistently documented among military cohorts. The opinion states that the description fits the Veteran's clinical history, where his symptoms emerged long after service but follow a predictable physiological pattern.

As noted above, an opinion is adequate where it is based upon consideration of the Veteran's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. See D'Aries, 22?Vet. App.?at 104; Stefl, 21 Vet. App. at 120. See also Nieves-Rodriguez, 22?Vet. App. at 304. Here, the January 2026 medical opinion is based upon review of pertinent medical records and consideration of the Veteran's reported history. The opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22?Vet. App. at 304.

Although the Veteran is not competent to diagnose himself with hearing loss for VA purposes or to provide medical nexus opinions, he is competent to attest to the symptoms he experiences and the duration of those symptoms. See Jandreau, 492?F.3d at 1372.

There is no adequate opinion contrary to the conclusion that the Veteran's current hearing loss and tinnitus are related to service. As noted above, the Veteran's burden of proof is one of equipoise, not certainty. Lynch, 21 F.4th at 781.

In sum, the Board determines the evidence is in favor of the claims of service connection for hearing loss and tinnitus, particularly when reasonable doubt is resolved in the Veteran's favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for hearing loss and tinnitus is warranted.

4. Service connection for GERD.

The Veteran seeks service connection for GERD. He maintains the condition is secondary to anxiety disorder.

As noted above, the Board is herein granting service connection for generalized anxiety disorder.

In the September 2023 rating decision, the RO determined the Veteran has GERD. An August 2016 private treatment record shows a diagnosis of esophageal varices, which is a symptom of GERD. The Board is bound by this?prior favorable finding, which was not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

As noted above, the Board is herein granting service connection for generalized anxiety disorder.

In the January 2026 non-VA opinion noted above, the physician stated that the Veteran's GERD is at least as likely as not secondary to the Veteran's generalized anxiety disorder. The opinion notes that anxiety is well established in medical literature as a factor that increases gastric acid production, disrupts esophageal motility, and heightens visceral sensitivity, all of which contribute to GERD symptoms. The opinion states that several psychotropic medications commonly used to manage chronic anxiety and depressive features can impair lower esophageal sphincter function, alter gastrointestinal motility, or exacerbate acid reflux, creating a medically recognized mechanism linking long-term psychiatric treatment with chronic GERD. The opinion notes that in the Veteran's case, GERD symptoms were clinically evaluated and treated beginning in 2017, years after the onset and progression of his anxiety disorder, and the chronicity and treatment profile documented in his records support a secondary relationship between his long-standing anxiety disorder, the medications used to manage it, and the subsequent development and persistence of GERD. The opinion states that the overall clinical record and medical literature supports that the Veteran's GERD is at least as likely as not due to his chronic anxiety disorder and the medications used to manage it.

Although the Veteran is not competent to diagnose himself with GERD or to provide a medical nexus opinion, he is competent to attest to the symptoms he experiences and the duration of those symptoms. See Jandreau, 492?F.3d at 1372.

There is no opinion contrary to the conclusion that the Veteran's current GERD is secondary to service-connected generalized anxiety disorder. As noted above, the Veteran's burden of proof is one of equipoise, not certainty. Lynch, 21 F.4th at 781.

In sum, the Board determines the evidence is in favor of the claim of service connection for GERD, as secondary to now service-connected generalized anxiety disorder, particularly when reasonable doubt is resolved in the Veteran's favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for GERD, on a secondary basis, is warranted.

5. Service connection for a lumbar spine condition.

The Veteran seeks service connection for a low back disorder. In his April 2023 Form 21-526EZ, he asserted the condition is related to service, to include heavy lifting.

The September 2023 rating decision reflects the RO denied the claims based on no current diagnosis. However, private treatment records in June 2016 reflect sacroiliac joint derangement. The Board notes that for disability rating purposes, the lumbosacral and sacroiliac joints are considered one anatomical segment. 38 C.F.R. § 4.66.

Further, the January 2026 non-VA opinion noted above reflects lower lumbar strain. The opinion states that it is at least as likely as not that Veteran's current lower lumbar strain is directly related to the acute traumatic lifting injury and cumulative physical demands he experienced during service. The opinion notes that the Veteran's duties during service, to include carrying heavy equipment, repeated lifting of weapons, ammunition, and supplies, obstacle course training, and repetitive physical stress, represent a medically plausible mechanism for acute lumbar strain and chronic lumbar syndromes. The opinion states that it is considered within the well-established scientific framework showing how traumatic lumbar events progress into chronic mechanical low back pain through persistent tissue irritation, neuromuscular dysfunction, inflammatory sensitization, and central nervous system remodeling, the trajectory of his condition is medically consistent with a service-related origin. The opinion notes that the extreme physical demands of infantry training, a setting known to produce the very biomechanical and physiological cascades described in the literature, and the Veteran's chronic symptoms have continued in the pattern expected after such trauma. The opinion notes that based on the documented in-service mechanism of injury, the chronicity of symptoms, and the biological plausibility established by contemporary research, it is at least as likely as not that the Veteran's lumbar strain is a result of service.

Although the Veteran is not competent to diagnose himself with a low back disability, he is competent to attest to the symptoms he experiences and the duration of those symptoms. See Jandreau, 492?F.3d at 1372.

There is no opinion contrary to the conclusion that the Veteran's current lumbar strain is related to service. As noted above, the Veteran's burden of proof is one of equipoise, not certainty. Lynch, 21 F.4th at 781.

In sum, the Board determines the evidence is in favor of the claim of service connection for lumbar strain, particularly when reasonable doubt is resolved in the Veteran's favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for lumbar strain is warranted.

6. Service connection for sciatic nerve pain.

The Veteran seeks service connection for bilateral sciatic nerve pain. He maintains the sciatic nerve pain is secondary to lumbar strain.

As noted above, the Board is herein granting service connection for lumbar strain.

In the January 2026 non-VA opinion noted above, the physician stated that it is at least as likely as not that the Veteran's bilateral sciatic nerve pain is caused by his lumbar strain. The opinion notes that the AIT during service required heavy lifting, load-bearing marches, repetitive bending, twisting, and physically strenuous training drills, of which are known to place significant mechanical stress on the lumbar spine and its associated nerve roots. The opinion states that Veteran's pattern of symptoms involving radiating pain into the legs is medically consistent with lumbar strain-related nerve root irritation or compression. The opinion notes that the onset of sciatic symptoms is tied to the same documented in-service mechanism that produced his lumbar injury. The opinion states that the Veteran's sciatic nerve pain in is most consistent with radicular symptoms arising from mechanical and inflammatory involvement of the lumbosacral nerve roots following the lumbar strain he sustained during service. The opinion notes that contemporary research emphasizes that radicular pain almost always reflects nerve-root involvement rather than irritation solely from muscular strain, underscoring how an initial lumbar strain can reveal, trigger, or accelerate underlying structural and inflammatory processes that ultimately manifest as sciatica. The opinion states that even when an injury is initially described as a lumbar strain, the mechanical forces involved in repeated lifting and load bearing can create microtrauma to the intervertebral discs, reduce foraminal height, or destabilize the lumbar segments, all
states that the Veteran's sciatic nerve pain in is most consistent with radicular symptoms arising from mechanical and inflammatory involvement of the lumbosacral nerve roots following the lumbar strain he sustained during service. The opinion notes that contemporary research emphasizes that radicular pain almost always reflects nerve-root involvement rather than irritation solely from muscular strain, underscoring how an initial lumbar strain can reveal, trigger, or accelerate underlying structural and inflammatory processes that ultimately manifest as sciatica. The opinion states that even when an injury is initially described as a lumbar strain, the mechanical forces involved in repeated lifting and load bearing can create microtrauma to the intervertebral discs, reduce foraminal height, or destabilize the lumbar segments, all of which increase vulnerability to later radiculopathy.

Although the Veteran is not competent to diagnose himself with sciatica or to provide a medical nexus opinion, he is competent to attest to the symptoms he experiences and the duration of those symptoms. See Jandreau, 492?F.3d at 1372.

There is no opinion contrary to the conclusion that the Veteran's current bilateral lower extremity nerve pain is secondary to now service-connected lumbar strain. As noted above, the Veteran's burden of proof is one of equipoise, not certainty. Lynch, 21 F.4th at 781.

In sum, the Board determines the evidence is in favor of the claim of service connection for bilateral lower extremity sciatic nerve pain, as secondary to now service-connected lumbar strain, particularly when reasonable doubt is resolved in the Veteran's favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for bilateral lower extremity sciatic nerve pain, on a secondary basis, is warranted.

REASONS FOR REMAND

1. Service connection for a psychiatric disorder (other than generalized anxiety disorder), to include PTSD and depression.

The Board has recharacterized the issue with respect to a psychiatric disorder (other than generalized anxiety disorder) to encompass all potential psychiatric diagnoses. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

The Veteran seeks service connection for PTSD. He maintains the disorder is due to stress during service, to include having watched a fellow service member shoot himself in the leg in 1971 to get out of the military, and of having thought that the member was going to kill him, too. See April 2023 Form 0781a (Statement in Support of Claim for PTSD Secondary to Personal Assault).

In a June 2023 response to the RO's request for corroboration of the alleged stressor during service in 1971, the Records Research Center stated that the relevant database only goes back as far as 1972, and thus, there was no evidence to support the occurrence of the claimed in-service stressor.

Nonetheless, 38 C.F.R. § 3.304(f)(5) provides that evidence from sources other than a veteran's STRs or service personnel records (SPRs) may corroborate a veteran's account of a personal assault. In that regard, when VA knows or has reason to know that a veteran's claim is based on an in-service personal assault, VA must complete the following two steps: (1) advise the veteran that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor, and (2) allow the veteran an opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. See Gallegos v. Peake, 22 Vet. App. 329, 335-337 (2008). This timing defect will be cured only after the VA sends a special personal assault notification letter, allows for the Veteran to respond, and then subsequently re-adjudicates the claim using any new evidence. Id (citing
a veteran's claim is based on an in-service personal assault, VA must complete the following two steps: (1) advise the veteran that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor, and (2) allow the veteran an opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. See Gallegos v. Peake, 22 Vet. App. 329, 335-337 (2008). This timing defect will be cured only after the VA sends a special personal assault notification letter, allows for the Veteran to respond, and then subsequently re-adjudicates the claim using any new evidence. Id (citing Mayfield v. Nicholson, 444 F.3d 1328, 1333 (Fed. Cir. 2006)). Here, despite the Veterans' April 2023 Form 0781a (Statement in Support of Claim for PTSD Secondary to Personal Assault), prior to the rating decision on appeal, the Veteran was not provided such notice. Since VA's heightened duty was triggered, VA cannot deny the Veteran's claim until VA has met its statutory requirements to fulfill this heightened duty. 38 C.F.R. § 3.304(f)(5).

As noted above, evidence from sources other than the Veteran's records may corroborate the Veteran's account of the stressor incident. Examples of potentially useful evidence may include records from law enforcement, rape crisis centers, mental health counseling centers, hospitals, statements from family members, roommates, clergy, or other similar sources. Evidence of behavior changes following the claimed assault are also a type of relevant evidence that may be found from these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to, deterioration in work performance or unexplained social behavior changes. See 38 C.F.R. § 3.304(f)(5). Additionally, for personal assault PTSD claims, an after-the-fact medical opinion may serve as the credible supporting evidence of the reported stressor. Patton v. West, 12 Vet. App. 272, 280 (1999).

In addition, as noted above, the Board is herein granting service connection for generalized anxiety disorder based, in part, on the January 2026 opinion noted above reflecting in-service stress, to include in association with the nature of the Veteran's discharge.

The Board finds that the evidence of record, as indicated above, reflects at least a suggestion that the Veteran has signs or symptoms of a psychiatric disorder (other than generalized anxiety disorder) to include PTSD and depression, but there is insufficient evidence of record to adjudicate the claim. Thus, the low threshold under McLendon v. Nicholson, 20 Vet. App. 79 (2006) has been met. Therefore, the Board finds that remand to correct the above noted pre-decisional duty-to-assist errors, to include the RO's failure to afford the Veteran a VA examination, is warranted. 38 C.F.R. § 20.802(a).

2. Service connection for rhinitis.

3. Service connection for sinusitis.

4. Service connection for shortness of breath.

The Veteran seeks service connection for rhinitis, sinusitis, and shortness of breath. In his April 2023 Form 21-526EZ (Fully Developed Claim (Compensation)), he asserted the conditions are a result of environmental exposures during service, to include herbicides, such as Agent Orange, asbestos, and mustard gas, while stationed at Fort Jackson, South Carolina.

In the September 2023 rating decision reflects current diagnoses of rhinitis and shortness of breath. A March 2008 private treatment record shows a diagnosis of allergic rhinitis.

In addition, the January 2026 non-VA opinion noted above states that the Veteran's diagnosed sinusitis, rhinitis, and shortness of breath is related to herbicide exposure, such as Agent Orange, during service. However, the September 2023 rating decision specifically states the Veteran did not participate in a toxic exposure risk activity (TERA) during service. See also June 2023 other (VA Memorandum reflecting the Veteran does not qualify for a presumption of exposure to environmental hazards during service, to include herbicide agents). An opinion based on an inaccurate factual premise is of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Thus, the opinion is not adequate.

The Board notes that in an August 2023 letter, the RO notified the Veteran that for VA to acknowledge he was exposed to Agent Orange, additional information was needed as to the exposure locations. However, no such development was undertaken
specifically states the Veteran did not participate in a toxic exposure risk activity (TERA) during service. See also June 2023 other (VA Memorandum reflecting the Veteran does not qualify for a presumption of exposure to environmental hazards during service, to include herbicide agents). An opinion based on an inaccurate factual premise is of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Thus, the opinion is not adequate.

The Board notes that in an August 2023 letter, the RO notified the Veteran that for VA to acknowledge he was exposed to Agent Orange, additional information was needed as to the exposure locations. However, no such development was undertaken with respect to other exposures asserted, to include asbestos. See April 2023 Form 21-526EZ (Fully Developed Claim (Compensation)). Neither the June 2023 TERA Memorandum nor the September 2023 rating decision addresses the Veteran's assertion of exposure to asbestos. The RO's failure to undertake additional development as to the Veteran's assertions in that respect constitutes a pre-decisional duty to assist error that must be corrected on remand. 38 C.F.R. § 20.802(a).

The Board finds that the evidence of record, as indicated above, reflects diagnoses of rhinitis, sinusitis, and shortness of breath but there is insufficient evidence of record to adjudicate the claims. Thus, the low threshold under McLendon has been met. Therefore, the Board finds that remand to correct the above noted pre-decisional duty-to-assist errors, to include the RO's failure to afford the Veteran a VA examination, is warranted. 38 C.F.R. § 20.802(a).

The Board notes that the Veteran's April 2023 Form 21-4138 (Statement in Support of Claim), references the PACT Act. The PACT Act, among other things, expanded the scope of presumptions of exposure to herbicide agents for veterans who served in certain locations. The PACT Act did not provide any presumptive exposure areas for veterans stationed at Fort Jackson, South Carolina, and did not provide disabilities that may be presumed to have resulted from environmental toxins at Fort Jackson.

5. Service connection for type II diabetes mellitus.

6. Service connection for hypertension.

7. Service connection for liver cirrhosis.

8. Service connection for prostate cancer.

The Veteran seeks service connection for diabetes, hypertension, liver cirrhosis, and prostate cancer. As noted above, in his April 2023 Form 21-526EZ, he asserted the conditions are due to service, to include exposure to herbicides, such as Agent Orange, asbestos, and mustard gas, in association with his duties while stationed at Fort Jackson.

In the September 2023 rating decision, the RO favorably found that the Veteran has diabetes, hypertension, and liver cirrhosis. A July 2006 private treatment record shows diagnoses of diabetes and hypertension. A May 2018 record shows a diagnosis of liver cirrhosis. A February 2009 records reflect prostate cancer.

As noted above, although the Veteran's April 2023 Form 21-4138 references the PACT Act, the PACT Act did not provide any presumptive exposure areas for veterans stationed at Fort Jackson and did not provide disabilities that may be presumed to have resulted from environmental toxins at Fort Jackson.

In the January 2026 opinion noted above, the physician opined that the Veteran's diabetes mellitus, hypertension, liver cirrhosis, and prostate cancer are related to herbicide exposure, such as Agent Orange, during service. However, as noted above, participation in a TERA during service is not shown. See June 2023 other (VA Memorandum reflecting the Veteran does not qualify for a presumption of exposure to environmental hazards during service, to include herbicide agents). An opinion based on an inaccurate factual premise is of no probative value. See Reonal, 5 Vet. App. at 461. Thus, the opinion is not adequate.

As noted above, additional development was not undertaken with respect to the Veteran's claimed asbestos exposure. The RO's failure to develop the assertions by the Veteran constitutes a pre-decisional duty to assist error that must be corrected on remand. 38 C.F.R. § 20.802(a).

In addition, there is at least a suggestion that the Veteran's diabetes, hypertension, liver cirrhosis, and/or prostate cancer may be associated with service. Thus, the low threshold under McLendon has been met. As such, remand to remedy this pre-decisional duty to assist error and to afford the Veteran a VA examination, is also warranted. 38 C
, the opinion is not adequate.

Further, August 2010 private treatment records indicate that he was receiving treatment from Dr. Mathes, to include for his prostate cancer. However, evidence of treatment by Dr. Mathes for the Veteran's prostate cancer is not of record. As such, remand is also required to remedy the pre-decisional duty to assist error and to obtain all outstanding treatment records. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Obtain all outstanding treatment records provided by Dr. Mathes regarding the Veteran's prostate cancer. Send the Veteran a letter requesting that he provide a release for VA to obtain any outstanding private treatment records, or that, in the alternative, the Veteran may submit any such outstanding records directly to VA himself.

2. Undertake additional development with respect to the Veteran's assertion of asbestos exposure.

3. Send the Veteran a notification letter that contains all of the required information pertaining to a claim based on personal assault.

4. After completion of the above, schedule the Veteran for a VA examination and opinion by a qualified psychiatrist to determine the nature and etiology of the Veteran's diagnosed psychiatric disorder (other than generalized anxiety disorder), to include PTSD and depression. The examiner should review the entire claims file and this remand in conjunction with the examination.

The examiner should identify all current psychiatric diagnoses. For any identified psychiatric condition (other than generalized anxiety disorder), to include PTSD and depression, the examiner should opine as to whether it is at least as likely as not that the condition had its onset during service or is etiologically related to service, to include the Veteran's report of watching another service member shoot himself in the leg during service to get out of the military, and of having thought the service member would kill the Veteran, too.

If PTSD is diagnosed, the examiner should clearly identify the stressor used to support the diagnosis.

The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptoms did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant.

A rationale should be provided for opinions expressed. If an opinion cannot be offered without resorting to speculation, the reason for this should be fully explained in the opinion.

5. Schedule the Veteran for an examination by a qualified medical professional in connection with the rhinitis, sinusitis, and shortness of breath. The examiner should review the entire claims file and this remand in conjunction with the claims.

The examiner should state whether the Veteran's rhinitis, sinusitis, and shortness of breath had its onset during or within a year of separation or is otherwise, etiologically related to service.

The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptoms did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant.

A rationale should be provided for opinions expressed. If an opinion cannot be offered without resorting to speculation, the reason for this should be fully explained in the opinion.

6. Schedule the Veteran for a VA examination(s) and opinion by a qualified medical professional to determine the nature and etiology of the Veteran's diagnosed diabetes, hypertension, liver cirrhosis, and prostate cancer. The examiner should review the entire claims file and this remand in conjunction with the examination.

The examiner(s) should opine as to whether it is at least as likely as not that diabetes, hypertension, liver cirrhosis, or prostate cancer had its onset during service or is etiologically related to service, to include hazardous environmental exposures.

The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptoms did not occur, including why the fact would have normally
(s) and opinion by a qualified medical professional to determine the nature and etiology of the Veteran's diagnosed diabetes, hypertension, liver cirrhosis, and prostate cancer. The examiner should review the entire claims file and this remand in conjunction with the examination.

The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptoms did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant.

A rationale should be provided for opinions expressed. If an opinion cannot be offered without resorting to speculation, the reason for this should be fully explained in the opinion.

RYAN T. KESSEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Taylor

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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