ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD

ANTHONY C. SCIRÉ, JR · 2026 · Case ID: A26035377

MIXED

Summary

The veteran, who served in the U.S. Army from June 1977 to April 1982, appeals the denial of service connection for several conditions and the remand of others. The Board granted service connection for chronic adjustment disorder with anxiety and depressed mood, right ankle strain, lumbar radiculopathy of the bilateral lower extremities, right-hand disability, heart disability (congestive heart failure), allergic rhinitis, and type II diabetes mellitus. Service connection for hypercholesterolemia was denied as it is not considered a disability for VA compensation purposes. The Board remanded claims for cervical spine disability, right shoulder strain, and anemia. For the psychiatric disability, the Board found the evidence in equipoise, granting service connection with the benefit of the doubt, based on favorable opinions from a VA examiner and a private physician linking it to service-connected tinnitus and hearing loss. The right ankle strain claim was granted, with the Board finding the evidence in equipoise due to a favorable private medical opinion, despite a negative VA opinion. Similarly, lumbar radiculopathy and right-hand disability were granted based on a favorable private opinion linking them to an in-service back and hand injury, with the evidence found in equipoise. Heart disability was granted based on a favorable private opinion linking it to in-service hypertension. Allergic rhinitis was granted based on a favorable private opinion linking it to in-service symptoms. Type II diabetes mellitus was granted based on a favorable private opinion linking it to in-service exposure to organic solvents and aggravation by service-connected tinnitus. The hypercholesterolemia claim was denied as it is a laboratory finding, not a compensable disability. The cervical spine claim was remanded for an adequate VA examination, and the right shoulder strain and anemia claims were remanded to obtain outstanding SSA records.

Rationale

Favorable private medical opinion linking psychiatric disability to tinnitus/hearing loss; Favorable VA examiner opinion linking psychiatric disability to tinnitus; Evidence in equipoise, benefit of doubt applied

Service Branch

U.S. ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210114-133722

Full Decision Text

Citation Nr: A26035377
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210114-133722
DATE: April 16, 2026

ORDER

Entitlement to service connection for chronic adjustment disorder with anxiety and depressed mood (psychiatric disability) is granted.

Entitlement to service connection for a right ankle strain is granted.

Entitlement to service connection for lumbar radiculopathy of the bilateral lower extremities is granted.

Entitlement to service connection for a right-hand disability is granted.

Entitlement to service connection for congestive heart failure (heart disability) is granted.

Entitlement to service connection for allergic rhinitis is granted.

Entitlement to service connection for type II diabetes mellitus is granted.

Entitlement to service connection for hypercholesterolemia is denied.

REMANDED

Entitlement to service connection for a cervical spine disability is remanded.

Entitlement to service connection for a right shoulder strain is remanded.

Entitlement to service connection for anemia is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his psychiatric disability is caused by his service-connected tinnitus and bilateral hearing loss disabilities.

2. Resolving reasonable doubt in the Veteran's favor, his right ankle strain is caused by his active duty.

3. Resolving reasonable doubt in the Veteran's favor, his lumbar radiculopathy of the bilateral lower extremities is caused by his active duty.

4. Resolving reasonable doubt in the Veteran's favor, his right-hand disability is caused by his active duty.

5. Resolving reasonable doubt in the Veteran's favor, his heart disability is caused by his active duty.

6. Resolving reasonable doubt in the Veteran's favor, his allergic rhinitis is caused by his active duty.

7. Resolving reasonable doubt in the Veteran's favor, his allergic rhinitis is caused by his active duty.

8. Resolving reasonable doubt in the Veteran's favor, his type II diabetes mellitus is caused by his active duty.

9. Hypercholesterolemia is not a disease or injury for VA disability compensation purposes.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a psychiatric disability have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310.

2. The criteria for entitlement to service connection for a right ankle strain have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for entitlement to service connection for lumbar radiculopathy of the bilateral lower extremities have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3. 307, 3.309.

4. The criteria for entitlement to service connection for a right-hand disability have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for entitlement to service connection for a heart disability have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

6. The criteria for entitlement to service connection for allergic rhinitis have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

7. The criteria for entitlement to service connection for type II diabetes mellitus have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3. 307, 3.309.

8. The criteria for entitlement to service connection for hypercholesterolemia have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304; 61 Fed
304.

8. The criteria for entitlement to service connection for hypercholesterolemia have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304; 61 Fed. Reg. 20,440, 20,445 (May 7, 1996).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty in the U.S. Army from June 1977 to June 1981, which has been determined to be honorable for VA purposes. He also had active duty in the Army from June 1981 to April 1982, which has been determined to be dishonorable for VA purposes.

This appeal comes before the Board from an August 2020 rating decision, in which the Agency of Original Jurisdiction (AOJ) denied the claims of entitlement to service connection for chronic adjustment disorder with anxiety and depressed mood as secondary to tinnitus, right ankle strain, severe lumbar radiculopathy, right hand fracture, congestive heart failure, severe allergic rhinitis, type II diabetes mellitus, hypercholesterolemia, cervical spine strain, right shoulder strain, and anemia. The Veteran appealed the August 2020 rating decision to the Board.

On a January 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket under the Appeals Modernization Act (AMA). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a virtual Board hearing on July 1, 2024. Therefore, the Board will consider the evidence of record at the time of the August 2020 rating decision on appeal and any evidence submitted by the Veteran and the representative as of the day of the hearing and within 90 days following the hearing, which was September 30, 2024. 38 C.F.R. § 20.302(a).

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

Service Connection, Generally

The Veteran is seeking service connection for his current psychiatric disability, right ankle strain, lumbar radiculopathy of the bilateral lower extremities, right hand disability, heart disability, allergic rhinitis, type II diabetes mellitus, and hypercholesterolemia.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

Where a veteran served 90 days or more of active service, and certain chronic diseases, such as diabetes mellitus and radiculopathy, which is an organic disease of the nervous system, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 113
3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

Additionally, pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis if a disability is due to or the result of a service-connected disease or injury or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (secondary service connection requires "but-for causation," which is "broader than proximate causation"). For secondary aggravation, compensation is "due for any incremental increase in disability-any additional impairment of earning capacity-in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase-regardless of its permanence." Ward v. Wilkie, 31 Vet. App. 233, 239 (2019).

The U. S. Court of Appeals for Veterans Claims (Court) has held that Congress specifically limited entitlement to service-connected benefits to cases where there is a current disability. The requirement of a current disability is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). When the record contains a recent diagnosis of disability prior to the filing of a claim for benefits based on that disability, the report of diagnosis is relevant evidence that must be addressed in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). In the absence of proof of a current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Degmetich v. Brown, 104 F.3d 1328, 1333 (1997). However, a formal diagnosis is not required to satisfy the current disability element for all service-connection claims. See Saunders v. Wilkie, 886 F.3d 1356 (holding that pain alone may constitute a current disability if it functionally impairs earning capacity).

The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus
the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

1. Entitlement to service connection for a psychiatric disability is granted.

The Veteran contends that his current psychiatric disability of chronic adjustment disorder with anxiety and depressed mood is caused by his service-connected tinnitus and hearing loss disabilities. For example, he testified during the July 2024 Board hearing that he was unable to understand what people said to him due to these disabilities. He also testified that his tinnitus caused him to be unable to sleep at night, which contributed to his psychiatric disability symptoms.

Regarding the existence of a present disability, the record reflects that the Veteran has a current acquired psychiatric disability. For example, an October 2019 VA examination for mental disorders shows that the Veteran was diagnosed with adjustment disorder with mixed anxiety and depressed mood. Moreover, the August 2020 rating decision on appeal shows that the AOJ has made a favorable finding that the Veteran was diagnosed with this disability. Thus, the record establishes that the Veteran has a current disability.

Regarding the in-service incurrence or aggravation of a disease or injury element of direct service connection, the Board notes that the Veteran does not assert, and the record does not otherwise suggest, that his current psychiatric disability is caused by or related to his active duty. Rather, as asserted throughout the appeal, including in the September 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits and the July 2024 Board hearing testimony, the Veteran contends that his current psychiatric disability is caused by his service-connected tinnitus and hearing loss disabilities. In that regard, the record reflects that the Veteran's tinnitus and bilateral hearing loss are service-connected disabilities. See August 2020 Rating Decision-Code Sheet. Accordingly, this element of secondary service connection is met.

Regarding the nexus element, i.e., a causal relationship between the Veteran's psychiatric disability and his service-connected tinnitus and bilateral hearing loss disabilities, the claims file contains the medical opinions of the October 2019 and August 2020 VA examiners and the medical opinions of Dr. J. C. from July 2024. The October 2019 VA examiner opined that the Veteran's adjustment disorder with mixed anxiety and depressed mood was at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran's service-connected tinnitus. The examiner explained that the psychiatric disability began subsequent to the service-connected diagnosis of tinnitus, and that it was the direct result of efforts to control or cope with, or a direct psychological response to, the service-connected condition. The examiner stated that the Veteran's psychiatric disability was continuously present since it began, and therefore, there was a nexus between the secondary condition and the service-connected condition.

In contrast, an August 2020 VA examiner opined that the Veteran's adjustment disorder with mixed anxiety and depressed mood was less likely as not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected tinnitus. She explained that the claims file showed a history of the Veteran reporting depressed mood, previously diagnosed as dysthymic disorder, due to the pain caused by neuropathy and difficulty getting around due to this pain. She noted that this was well established back in 2007 during an evaluation by a VA examiner and was consistent with the Veteran's current behavior during the October 2019 VA examination, such as that the Veteran cried out in pain due to the neuropathy in his feet and had difficulty ambulating due to this condition. She stated that there was no documentation in the claims file of the Veteran reporting down or depressed mood primarily due to his tinnitus. Rather, she asserted that he primarily related his depressed mood to chronic pain. She noted that the Veteran's service treatment records were silent for depression, and his depression was not chronic and persistent as he was screened negative for depression in 2019 and 2020.

Following a July 202
. She noted that this was well established back in 2007 during an evaluation by a VA examiner and was consistent with the Veteran's current behavior during the October 2019 VA examination, such as that the Veteran cried out in pain due to the neuropathy in his feet and had difficulty ambulating due to this condition. She stated that there was no documentation in the claims file of the Veteran reporting down or depressed mood primarily due to his tinnitus. Rather, she asserted that he primarily related his depressed mood to chronic pain. She noted that the Veteran's service treatment records were silent for depression, and his depression was not chronic and persistent as he was screened negative for depression in 2019 and 2020.

Following a July 2024 private medical evaluation, Dr. J. C., a Doctor of Medicine, opined that the Veteran's service-connected bilateral hearing loss and tinnitus disabilities have substantially aggravated his adjustment disorder beyond its natural progression. She explained that during the evaluation, the Veteran reported that specifically with regard to his tinnitus, he could not escape this ringing noise that no one else was able to hear. He reported that it made him feel particularly anxious, that he could not return to sleep when he awoke nocturnally due to his rumination over the tinnitus. Additionally, he reported that his hearing impairment made him feel particularly socially isolated as it was embarrassing for him to ask individuals to repeat their statements and this made him feel particularly ashamed and fearful, i.e., anxious over meeting new people and being in large crowds. Consequently, the doctor opined that it was without question that the Veteran's adjustment disorder was substantially aggravated by both his tinnitus and hearing loss.

In this case, although the claims file contains the medical opinion of the August 2020 VA examiner that the Veteran's psychiatric disability was less likely than not proximately due to his service-connect tinnitus, the Board finds that the evidence is at least in equipoise as to whether the Veteran's psychiatric disability was caused by his service-connected tinnitus and bilateral hearing loss. In that regard, the law is clear. Pursuant to the "benefit-of-the-doubt rule," where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. 38 U.S.C. § 5107(b). Although there is some evidence against the claim, the Board finds that the October 2019 medical opinion by a VA examiner and the July 2024 private medical opinion by Dr. J. C. places the evidentiary record in relative equipoise. See Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (holding "if the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt"). Furthermore, the Board notes that in the August 2020 medical opinion, the VA examiner attributed the Veteran's current psychiatric disorder to the pain and neurological symptoms located in the Veteran's lower extremities and feet, rather than his service-connected tinnitus. However, as discussed further below, the Board determines that service connection for lumbar radiculopathy of the bilateral lower extremities is warranted. Thus, the rationale of the August 2020 VA examiner's opinion also supports a finding that the Veteran's chronic adjustment disorder with anxiety and depressed mood is due to his service-connected disabilities.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for a psychiatric disability is warranted. See Lynch, 21 F.4th at 781; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990) ("[T]he 'benefit of the doubt' standard is similar to the rule deeply embedded in sandlot baseball folklore that 'the tie goes to the runner'.... [I]f... the play is close, i.e., 'there is an approximate balance of positive and negative evidence,' the veteran prevails by operation of [statute].").

2. Entitlement to service connection for a right ankle strain is granted.

The Veteran contends that his current right ankle strain is caused by an in-service injury to the right ankle. For example, he testified during the July 2024 Board hearing that he twisted his right ankle while playing for the battalion basketball team in service. He reported that after jumping, he came down on his ankle, which went out and pushed out to the side while twisting. He testified that the injury resulted in the ankle bruising and that the bruises were black, blue, yellow, and other colors. He stated that he sought medical care at that time, and that doctors gave him medication for his pain and some days off to heal.
operation of [statute].").

2. Entitlement to service connection for a right ankle strain is granted.

Regarding the existence of a present disability, the record reflects that the Veteran was diagnosed with a right ankle disability during the appeal. Specifically, a December 2019 VA examination for ankle conditions shows that the Veteran was diagnosed with a right ankle strain. Moreover, the AOJ has made a favorable finding in the August 2020 rating decision on appeal that the Veteran was diagnosed with a current disability. The Board is bound by such favorable findings absent clear and unmistakable error, which the Board does not find to be present in this case. See 38 C.F.R. §§ 3.104(c), 20.801(a). Thus, the record establishes that the Veteran has a current disability.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records document that he injured his right ankle in service. Specifically, a December 1980 service treatment record shows that he complained of pain in the right ankle. He was assessed with a sprain of the right ankle. He was treated for this injury, including being issued an ankle brace and crutches. The Board also notes that in the August 2020 rating decision on appeal, the AOJ made a favorable finding that the Veteran was seen in service in 1980 for ankle pain that was diagnosed as a sprain. Thus, the second element of service connection is met.

Regarding the nexus element, i.e., a causal relationship between the Veteran's current right ankle strain and his active duty, the claims file contains the medical opinion of the December 2019 VA examiner and the July 2024 private medical opinion by Dr. J. C. The VA examiner opined that the Veteran's current right ankle strain was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that the Veteran was seen once in service in 1980 for ankle pain diagnosed as sprain with no further complaints. She explained that a review of medical records revealed no chronicity of ankle pain and that the Veteran was seen once recently for ankle pain in 2019. Therefore, she opined that the Veteran's right ankle strain was less likely as not related to a one-time ankle sprain in 1980 and that no nexus can be established.

In the July 2024 private medical opinion, Dr. J.C. explained in detail the circumstances regarding the Veteran's in-service injury to the right ankle based on his self-reported history, his service treatment records, and applicable medical principles. She determined that the Veteran sustained not just a right ankle sprain while in service, but an inversion injury, which results, with certainty, in significant tendon and ligament damage. She noted that the Veteran reported ongoing and frequent further instability injuries following the in-service basketball injury. She explained that the Veteran currently experienced chronic instability of his right ankle with a chronic sprain/strain. Given this, Dr. J. C. opined that it was at least as likely as not that the Veteran's chronic right ankle issues were the direct result of his in-service inversion injury sustained while playing basketball.

In light of this evidence, although the claims file contains the medical opinion of the December 2019 VA examiner that the Veteran's current right ankle strain was less likely than not due to his active duty, the Board finds that the evidence is at least in equipoise as to whether the Veteran's current right ankle strain is caused by his in-service inversion injury to the right ankle. See 38 U.S.C. § 5107(b). Although there is some evidence against the claim, such as the December 2019 VA examiner's opinion, the Board finds that the July 2024 medical opinion by Dr. J. C. places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. Dr. J. C.'s evaluation and opinion evidenced an awareness of the Veteran's medical history, provided a fully articulated opinion, and furnished a reasoned analysis. The Board therefore attaches significant probative value to this opinion, as it was well reasoned,
ise as to whether the Veteran's current right ankle strain is caused by his in-service inversion injury to the right ankle. See 38 U.S.C. § 5107(b). Although there is some evidence against the claim, such as the December 2019 VA examiner's opinion, the Board finds that the July 2024 medical opinion by Dr. J. C. places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. Dr. J. C.'s evaluation and opinion evidenced an awareness of the Veteran's medical history, provided a fully articulated opinion, and furnished a reasoned analysis. The Board therefore attaches significant probative value to this opinion, as it was well reasoned, detailed, consistent with other evidence of record, and considered the history and nature of the Veteran's in-service injury and his current right ankle strain. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion).

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for a right ankle strain is warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

3. Entitlement to service connection for lumbar radiculopathy of the bilateral lower extremities is granted.

4. Entitlement to service connection for a right-hand disability is granted.

The Veteran contends that his current lumbar radiculopathy located in his bilateral lower extremities and right-hand disability should be granted service connection. Specifically, the Veteran asserts that these disabilities stem from a significant in-service injury to his back and right upper extremity. For example, he testified during the July 2024 Board hearing that while attempting to change the oil on a vehicle, he lost his balance and fell from a height of more than five feet while holding a five-gallon canister in his hand. He testified that he severely injured his back, right shoulder, and right hand during this in-service incident. Because the evidence pertaining to the lumbar radiculopathy and right-hand disabilities is located in the same or similar documents, the Board shall analyze them together below.

In regard to the existence of a present disability, the evidence shows that the Veteran has current lumbar radiculopathy and right-hand disabilities. For example, Dr. J. C. diagnosed the Veteran with lumbar radiculopathy and a right-hand strain/sprain in the July 2024 private evaluation. Thus, the record establishes that this element of service connection is met for both claims.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records show that he injured his back while lifting a five gallon can while working on a "548" vehicle. Specifically, a December 1979 service treatment record showed that the Veteran complained of back pain for one day after lifting a five gallon can into a 548 trap. He reported that he had back pain on and off since that injury. Thus, the Board determines that the second element of service connection is met for both claims.

Regarding the nexus element, i.e., a causal relationship between the Veteran's current lumbar radiculopathy of the bilateral lower extremities and right-hand disability and his in-service injury described above, the claims file contains the July 2024 private medical opinions by Dr. J. C. She opined that the Veteran's current lumbar radiculopathy and right-hand strain/sprain are directly related to his in-service acceleration-deceleration injury he sustained while lifting a five gallon can into a 548 trap where he injured his back and right hand.

Given this evidence, the Board finds that after resolving reasonable doubt in the Veteran's favor, his current lumbar radiculopathy of the bilateral lower extremities and his right-hand disability are caused by or otherwise related to his in-service injury described above. In that regard, the law is clear. Pursuant to the "benefit-of-the-doubt rule," where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. 38 U.S.C. § 5107(b). Although there is some evidence against the claim, the Board finds that the Veteran's credible testimony during the July 2024 Board hearing, as well as Dr. J. C.'s July 2024 medical opinions, places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. Dr. J. C.'s medical opinions included reasoned analyses that considered the relevant
, the law is clear. Pursuant to the "benefit-of-the-doubt rule," where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the Veteran shall prevail upon the issue. 38 U.S.C. § 5107(b). Although there is some evidence against the claim, the Board finds that the Veteran's credible testimony during the July 2024 Board hearing, as well as Dr. J. C.'s July 2024 medical opinions, places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. Dr. J. C.'s medical opinions included reasoned analyses that considered the relevant records, the Veteran's self-reported history and symptoms, and applicable medical principles. The Board therefore attaches significant probative value to her opinions, as they were well reasoned, detailed, and consistent with other evidence of record. See Prejean, 13 Vet. App. at 448-49.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, grants of entitlement to service connection for lumbar radiculopathy of the bilateral lower extremities and a right-hand disability are warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

5. Entitlement to service connection for a heart disability is granted.

The Veteran asserts that his current heart disability is caused by his active duty. Specifically, the Veteran and his representative contend, including during the July 2024 Board hearing, that the Veteran's hypertension, which was documented in service, caused him to develop his current congestive heart failure.

In regard to the first element of service connect, i.e., the existence of a present disability, the evidence shows that the Veteran has a current heart disability. For example, a March 2021 letter from Dr. R.R., a private Doctor of Osteopathic Medicine, shows that the Veteran was diagnosed with atrial fibrillation, hypertension, and heart failure. Likewise, Dr. J. C. documented in her July 2024 private medical evaluation that the Veteran was diagnosed with congestive heart failure. Thus, the record establishes that the Veteran has a current heart disability.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records do not document complaints of, or treatment for, a heart disability, including congestive heart failure. However, the Veteran's service treatment records document that he had elevated blood pressure readings in service. For example, a March 1980 service treatment record shows that the Veteran's blood pressure was 136 systolic over 84 diastolic (136/84), 132/80, 134/84, and 134/80 on that date. He was diagnosed with high blood pressure at that time. Thus, the Board determines that the second element of service connection is met.

In regard to the nexus element of service connection, i.e., a causal relationship between the Veteran's current heart disability and his active duty, the claims file contains one medical opinion on the subject. Specifically, in a July 2024 private medical opinion, Dr. J. C. noted that the blood pressure readings noted above showed that the Veteran had hypertension during his active duty. She noted that when compared to the normal male blood pressure for someone who was the Veteran's age at the time the blood pressure readings were taken in March 1980, i.e., 30 years old, his blood pressure readings at that time showed that he had systolic and diastolic hypertension. She explained that high blood pressure was a major risk factor for all clinical manifestations of coronary artery disease, and that both diastolic and systolic hypertensions were strongly causally related to the development of cardiac disease, including congestive heart failure. She further noted that the pulsatile hemodynamics of hypertension predisposed to the development of left ventricular failure, i.e., congestive heart failure. She noted that this was further illustrated by the stress put on the ventricular muscle by the heart's need to pump blood against an abnormally rigid peripheral vascular system. She explained that long-standing high blood pressure led to left ventricular hypertrophy and diastolic dysfunction that caused an increase in myocardial rigidity, which rendered the myocardium less compliant to changes in the preload, afterload, and sympathetic tone. She noted that adequate blood pressure control must be achieved in patients with hypertension to prevent progression to overt heart failure. She stated that controlling blood pressure was also important in patients with established heart failure, especially among those with preserved ejection fractions. She concluded that given the above, it was least as likely as not that the Veteran's congestive heart failure was the direct result of his hypertension, the
on the ventricular muscle by the heart's need to pump blood against an abnormally rigid peripheral vascular system. She explained that long-standing high blood pressure led to left ventricular hypertrophy and diastolic dysfunction that caused an increase in myocardial rigidity, which rendered the myocardium less compliant to changes in the preload, afterload, and sympathetic tone. She noted that adequate blood pressure control must be achieved in patients with hypertension to prevent progression to overt heart failure. She stated that controlling blood pressure was also important in patients with established heart failure, especially among those with preserved ejection fractions. She concluded that given the above, it was least as likely as not that the Veteran's congestive heart failure was the direct result of his hypertension, the onset of which occurred while he was in service.

Given this evidence, the Board finds that after resolving reasonable doubt in the Veteran's favor, his current heart disability is caused by or otherwise related to his active duty. Although there is some evidence against the claim, the Board finds that Dr. J. C.'s medical opinion places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. The Board attaches significant probative value to her opinion, which was fully articulated and furnished a reasoned analysis. See Prejean, 13 Vet. App. at 448-49. The Board finds it significant that the Veteran's claims file does not contain any medical opinions that indicate or show that the current heart disability was not caused by the Veteran's active duty.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for a heart disability is warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

6. Entitlement to service connection for allergic rhinitis is granted.

The Veteran contends that his current allergic rhinitis is due to his active duty. For example, he testified during the July 2024 Board hearing that although he was diagnosed with allergic rhinitis by a doctor after service in the 1980s, he experienced symptoms of allergic rhinitis in service.

Regarding the existence of a present disability, the evidence shows that the Veteran has a current diagnosis of allergic rhinitis. For example, Dr. J. C. diagnosed the Veteran with allergic rhinitis during July 2024 private evaluation. Thus, the record establishes that this element of service connection is met.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records show that he had symptoms indicative of allergic rhinitis, such as a runny nose, during service. For example, a September 1979 service treatment record shows that the Veteran had symptoms of a runny nose, coughing, and being congested. He was noted to have a chest cold for four days. Thus, the Board determines that the second element of service connection is met.

In regard to the nexus element of service connection, i.e., a causal relationship between the Veteran's current allergic rhinitis and his active duty, the claims file contains the July 2024 private medical opinion by Dr. J. C., who opined that the Veteran experienced the onset of rhinitis during service. She explained that rhinitis was defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. Other reported symptoms included throat clearing, headaches, facial pain, ear pain, itchy throat and palate, snoring, and sleep disturbances. She noted that medical literature showed that a system of rating symptom severity was developed using a seven-point visual analog scale that included elements of nasal symptoms, non-nasal symptoms, and the effects of medications. She explained that the two major classifications were allergic and nonallergic rhinitis (NAR). Allergic rhinitis was present when these symptoms were triggered by an allergen. Perennial allergic rhinitis was most often attributed to dust mites, mold spores, and animal dander, whereas seasonal allergic rhinitis was attributed to a large variety of pollens that varied based on a geographical region. She noted that NAR was when obstruction and rhinorrhea occurred in relation to nonallergic, noninfectious triggers, such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. She stated that while in service, the Veteran experienced the onset of rhinitis, which he continued to experience since that time. She opined that it was at least as likely as not that the Veteran's chronic rhinitis began while he was in service.

Resolving reasonable doubt in the Veteran's favor, his allergic rh
spores, and animal dander, whereas seasonal allergic rhinitis was attributed to a large variety of pollens that varied based on a geographical region. She noted that NAR was when obstruction and rhinorrhea occurred in relation to nonallergic, noninfectious triggers, such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. She stated that while in service, the Veteran experienced the onset of rhinitis, which he continued to experience since that time. She opined that it was at least as likely as not that the Veteran's chronic rhinitis began while he was in service.

Resolving reasonable doubt in the Veteran's favor, his allergic rhinitis is caused by his active duty. See 38 U.S.C. § 5107(b). The Board finds that the July 2024 medical opinion by Dr. J. C. places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. Her medical opinion showed a well-reasoned analysis that considered the pertinent records, the Veteran's self-reported history and symptoms, and relevant medical principles related to rhinitis. The Board therefore attaches significant probative value to her medical opinion. See Prejean, 13 Vet. App. at 448-49.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for allergic rhinitis is warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

7. Entitlement to service connection for type II diabetes mellitus is granted.

The Veteran asserts that service connection for type II diabetes mellitus is warranted as due to his service-connected tinnitus and/or as due to his in-service exposure to organic solvents. For example, in an August 2024 written statement, the Veteran's representative noted that Dr. J. C.'s July 2024 private medical opinion showed that the Veteran's diabetes was due to his tinnitus, which caused weight gain. Additionally, the representative noted that Dr. J. C. opined that the Veteran's current diabetes disability was due to his in-service exposure to organic solvents.

In regard to the first element of service connect, i.e., the existence of a present disability, the evidence shows that the Veteran has been diagnosed with type II diabetes mellitus during the appeal. For example, private treatment records from January 2015, March 2021, January 2022, and September 2022 document that the Veteran was diagnosed with and treated for type II diabetes mellitus. Thus, the record establishes that the Veteran has a current disability.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records do not document complaints of, or treatment for, type II diabetes mellitus, or symptoms indicative of such a disability during service. However, as asserted by the Veteran's representative in the August 2024 written statement, as well as Dr. J. C.'s July 2024 private medical opinion, the record indicates that the Veteran was exposed to organic solvents during service. The Board notes that the Veteran's service personnel records show that his military occupational specialty (MOS) was as a cannon crewman while in service, and that Dr. J. C. indicated that the Veteran was exposed to diesel exhaust due to his MOS in service. Thus, to this extent, the Board determines that the second element of service connection is met.

Moreover, as discussed above, the record reflects that the Veteran's tinnitus is a service-connected disability. See August 2020 Rating Decision-Code Sheet. Accordingly, this element of secondary service connection is met.

In regard to the nexus element of service connection, i.e., a causal relationship between the Veteran's current type II diabetes mellitus and his active duty and/or service-connected tinnitus, the claims file contains one medical opinion on the subject. Specifically, following a thorough discussion of the medical principles involved, as well as numerous citations to medical treatise evidence and medical studies, Dr. J. C. opined in the July 2024 private medical opinion that the Veteran's type II diabetes mellitus was due to his weight gain, which was caused by his service-connected tinnitus, as well as due to his exposure to organic solvents while in service. She concluded that given the medical literature that she discussed in the evaluation report, as well as the Veteran's specific medical history, it was at least as likely as not that his type II diabetes mellitus was caused by his active duty and/or caused by his service-connected tinnitus. She also indicated that at the very least, his diabetes mellitus was substantially aggravated beyond its
medical principles involved, as well as numerous citations to medical treatise evidence and medical studies, Dr. J. C. opined in the July 2024 private medical opinion that the Veteran's type II diabetes mellitus was due to his weight gain, which was caused by his service-connected tinnitus, as well as due to his exposure to organic solvents while in service. She concluded that given the medical literature that she discussed in the evaluation report, as well as the Veteran's specific medical history, it was at least as likely as not that his type II diabetes mellitus was caused by his active duty and/or caused by his service-connected tinnitus. She also indicated that at the very least, his diabetes mellitus was substantially aggravated beyond its natural progression by the service-connected disability.

After resolving reasonable doubt in the Veteran's favor, the Board determines that service connection for type II diabetes mellitus is warranted. Specifically, although there is some evidence against the claim, the Board finds that Dr. J. C.'s medical opinion, in which she opined that the Veteran's type II diabetes mellitus was due to his active duty, places the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. The Board affords significant probative value to her opinion, which was fully articulated, included a reasoned analysis, and was supported by the Veteran's records and applicable treatise evidence and medical principles. See Prejean, 13 Vet. App. at 448-49. Notably, the Board finds it significant that the Veteran's claims file does not contain any medical opinions that contradict Dr. J. C.'s July 2024 medical opinion or indicate or show that his type II diabetes mellitus was not caused by his active duty.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for type II diabetes mellitus is warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

8. Entitlement to service connection for hypercholesterolemia is denied.

The Veteran contends that his hypercholesterolemia or high cholesterol is caused by his active duty. For example, he filed an application for service connection for hypercholesterolemia in September 2019 and he disagreed with the denial of this claim in the January 2021 VA Form 10182. During the July 2024 Board hearing, the Veteran reported that he took mediation for his hypercholesterolemia. The undersigned VLJ engaged with the Veteran regarding his hypercholesterolemia and informed him that this was an abnormal laboratory finding. When asked if his hypercholesterolemia impacted him or if he had any symptoms of this laboratory finding, the Veteran testified that he did not know if his hypercholesterolemia impacted him in any way.

High cholesterol is also referred to as hypercholesterolemia or hyperlipidemia and the Veteran's post-service VA treatment records document a diagnosis of hypercholesterolemia. Nonetheless, the Board finds that the Veteran's claim must be denied as a matter of law, as hypercholesterolemia (high cholesterol or hyperlipidemia) is not a disease or injury for VA disability compensation purposes.

A "disability" for the purposes of awarding VA disability benefits is not only a disease or an injury, but also any "other physical or mental defect." 38 U.S.C. § 1701(1).

Hypercholesterolemia is defined as "excessive cholesterol in the blood." DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 891 (32d ed. 2012). In this regard, the Board notes its reliance on a medical dictionary to define a term is not prejudicial to the Veteran. See, e.g., O'Bryan v. McDonald, 771 F.3d 1376, 1380 (Fed. Cir. 2014) (referencing Dorland's for nature of and symptoms associated with a condition); 38 C.F.R. § 20.908(b).

VA's position is that hypercholesterolemia and elevated cholesterol are laboratory findings and are not disabilities in and of themselves for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (explaining that diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory results and are not, in and of themselves, disabilities and are, therefore, not appropriate entities for the rating schedule). There is no case law to the contrary. See Neary v. Shinseki, 2012 U.S. App. Vet. Claims LEXIS 1819 (2012) (declining to address argument that hyperlipidemia is not a disability but a laboratory finding that manifests itself only in laboratory test results and finding Board's reasons and bases adequate); see also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).

The term disability, for VA purposes, refers to impairment in earning capacity. The evidence persuasively weighs against a finding that the Veteran's hypercholesterolemia, in and of itself, causes a functional impairment of earning capacity. The Veteran's hypercholesterolemia is a laboratory finding and has not been shown to be a disability productive of functional impairment in earning capacity. As such, service connection for hypercholesterolemia must be denied as a matter of law. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

REASONS FOR REMAND

9. Entitlement to service connection for a cervical spine disability is remanded.

The Board determines that the claim of entitlement to service connection for a cervical spine disability should be remanded for a VA examination.

One of the effects of the AMA is to narrow the set of circumstances in which the Board must remand appeals to the AOJ for further development instead of immediately deciding them directly. Nevertheless, even under the AMA, the Board still has the duty to remand issues when necessary to correct a pre-decisional duty-to-assist error or to satisfy a regulatory or statutory duty. 38 C.F.R. § 20.802(a).

VA's duty to assist includes providing a medical examination and/or obtaining a medical opinion when necessary to make a decision on the claim, as defined by law. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Additionally, the VA examination and/or opinion must be adequate to decide the claim. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). To be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board determines that the October 2019 VA examination and medical opinion for the neck (cervical spine) are inadequate to adjudicate the Veteran's service connection claim. Accordingly, a pre-decisional duty-to-assist error occurred for this claim.

Specifically, the Veteran underwent a VA examination in October 2019, during which the examiner diagnosed him with degenerative arthritis of the spine. The Veteran reported that he suffered a fall in the back of an M548 cargo carrier. The examiner noted that the date of onset was in 1978 or 1979. The Veteran reported that he was seen by a provider who performed some procedures and that he was placed on bedrest. He stated that he was also given medication at that time.

Following the in-person examination, the examiner opined that the Veteran's current cervical spine disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. She merely stated that during service, the Veteran's condition was acute only. She stated that there was no evidence of chronicity of care and that a nexus had not been established.

The Board determines that this VA examiner's medical opinion is inadequate to adjudicate the Veteran's service connection claim as the examiner did not provide sufficient rationale as to her medical opinion. See Prejean, 13 Vet. App. at 448-49. Specifically, the examiner failed to explain why the Veteran's in-service injury to his back, which was documented in a December 1979 service treatment record, was acute only. She further did not provide an explanation regarding a lack of evidence of chronicity of care. In that regard, the Board notes that the record shows that the Veteran was seen for symptoms related to his cervical and/or lumbar spine on numerous occasions following service, including in February 1984, June 1984, April 1987, July 1990, July 1997, March 2005, and May 2007.

Thus, on remand, the AOJ should schedule the Veteran for a VA examination to determine whether his current cervical spine disability, to include degenerative arthritis, onset in service or within one year of active duty, or is otherwise related to his active duty.

10. Entitlement to service connection for a right shoulder strain is remanded.

11. Entitlement to service connection for anemia is remanded.

The Board finds that a remand of the service connection claims for a right shoulder strain and anemia is necessary to correct a pre-decisional duty to assist error in failing to obtain outstanding Social Security Administration (SSA) records that are relevant to the Veteran's pending claims.

The Board notes that in a September 2007 VA examination for an acquired psychiatric disorder, the Veteran reported that he last worked in March 2005. He stated that he worked for the State Department of Corrections as a guard in the prison system, and that he was employed by this Department of Corrections for ten years. He stated that he had a shoulder injury at work and was not able to work anymore because of said injury. He informed the examiner that he was receiving disability from SSA for the right shoulder injury that he received on that job.

As the Veteran reported in 2007 that he was in receipt of SSA disability benefits due to a post-service injury to his right shoulder, there was a reasonable possibility that relevant outstanding SSA records existed prior to the rating decision on appeal that denied the claims of entitlement to service connection for a right shoulder strain and anemia. However, the record does not contain any of these SSA records, nor an indication of an attempt to obtain them. As these records may be relevant to his pending service connection claims, the AOJ should have obtained the Veteran's outstanding SSA records and the failure to do so constitutes a pre-decisional duty to assist error. See Clarkson v. Brown, 4 Vet. App. 565, 567-68 (1992) (the duty to assist includes "a duty to assist in gathering social security records when put on notice that the veteran is receiving social security benefits").

Thus, on remand, the AOJ should attempt to obtain the outstanding SSA records relevant to the claims of entitlement to service connection for a right shoulder strain and anemia.

The matters are REMANDED for the following actions:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his cervical spine disability, to include degenerative arthritis of the spine. The claims file should be made available to and be reviewed by the examiner in conjunction with the examination.

After a review of the record, including this Remand, the examiner should respond to the following:

Is it at least as likely as not that the Veteran's cervical spine disability, to include degenerative arthritis of the spine, began during service, manifested within one year of service separation in June 1981, or is otherwise related to an in-service injury, event, or disease, to include his December 1979 injury to his back?

The examiner is asked to provide a rationale for each opinion given. If the examiner is unable to provide an opinion without resorting to speculation, he or she should explain why this is so and what if any additional evidence would be necessary before an opinion could be rendered.

2. Obtain any SSA records associated with the Veteran's disability application, to include clinical and medical records supporting that award, and associate them with the claims file. All efforts to obtain said records should be documented in the claims file along with all responses received from attempts to obtain the records.

ANTHONY C

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