HYPERTENSION

J. PARKER · 2026 · Case ID: A26035635

DENIED

Summary

The veteran served from March 1954 to November 1957 and appeals the denial of service connection for hypertension, GERD, aortic valve regurgitation, and hypothyroidism. The Board found current diagnoses for all conditions but denied service connection for each. For hypertension, the Board noted a current diagnosis but found no evidence of in-service injury, chronic symptoms, or continuity of symptoms post-service, and rejected the claim for secondary service connection to PTSD due to lack of established primary service connection. The Board also found the VA examiner's initial opinion regarding hypertension and toxic exposure to be without probative value due to an inaccurate factual premise about PFAS exposure. A subsequent VA opinion found hypertension less likely than not caused by toxic exposure, citing other risk factors. For GERD, the Board found no in-service injury or chronic/continuous symptoms, and denied secondary service connection to non-Hodgkin's lymphoma based on a VA opinion finding no nexus. For aortic valve regurgitation, the Board found no in-service injury, chronic, or continuous symptoms, and denied secondary service connection to hypertension due to lack of established primary service connection. The Board also found the VA opinion attributing regurgitation to hypertension to be probative. For hypothyroidism, the Board found no in-service injury, chronic, or continuous symptoms, and denied direct service connection to toxic exposure or secondary connection to non-Hodgkin's lymphoma, citing a VA opinion finding it less likely than not related to service and more likely due to primary thyroid disease. All claims were denied.

Rationale

No in-service injury, disease, or event; No chronic symptoms in service; No continuity of symptoms post-service; Secondary to PTSD denied due to lack of primary SC; VA opinion found less likely than not related to toxic exposure

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260316-637391

Full Decision Text

Citation Nr: A26035635
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 260316-637391
DATE: April 16, 2026

ORDER

Service connection for high blood pressure is denied.

Service connection for gastroesophageal reflux disease (GERD) is denied.

Service connection for aortic valve regurgitation is denied.

Service connection for hypothyroidism is denied.

FINDINGS OF FACT

1. The evidence shows toxic exposure during service to asbestos.

2. The evidence shows current diagnoses of hypertension, GERD, aortic valve regurgitation, and hypothyroidism.

3. There was no hypertension or cardiovascular system injury, disease, event, or "chronic" symptoms of hypertension during service; symptoms of hypertension were not continuous since service separation and did not manifest to a compensable degree within one year of service separation.

4. There is no service-connected primary disability of posttraumatic stress disorder (PTSD) upon which secondary service connection for hypertension and GERD may be granted.

5. The GERD is not related to the service-connected non-Hodgkin's lymphoma.

6. There was no GERD or gastroesophageal injury, disease, or event in service.

7. There is no service-connected primary disability of hypertension upon which secondary service connection for aortic valve regurgitation may be granted.

8. The aortic valve regurgitation is due to the non-service-connected hypertension.

9. There were no "chronic" symptoms of aortic valve regurgitation during service; symptoms of aortic valve regurgitation were not continuous since service separation and did not manifest to a compensable degree within one year of service separation.

10. There was no hypothyroidism or thyroid injury, disease, event, or "chronic" symptoms of hypothyroidism during service; symptoms of hypothyroidism were not continuous since service separation and did not manifest to a compensable degree within one year of service separation.

11. The currently diagnosed hypothyroidism was not incurred in or causally related to service.

12. The hypothyroidism is not caused or worsened by the service-connected non-Hodgkin's lymphoma.

CONCLUSIONS OF LAW

1. The criteria for service connection for high blood pressure have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for GERD have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for aortic valve regurgitation have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for hypothyroidism have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran, who is the appellant, served on active duty from March 1954 to November 1957.

This appeal comes to the Board of Veterans' Appeals (Board) from a February 2026 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

By way of procedural history, in November 2025 the Veteran filed a claim for service connection for high blood pressure, GERD, aortic valve regurgitation, and hypothyroidism. A February 2026 rating decision denied service connection. The Veteran filed a substantive appeal in March 2026.

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket; therefore, the Board may only consider the evidence of record at the time of the February 2026 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran
A February 2026 rating decision denied service connection. The Veteran filed a substantive appeal in March 2026.

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

This appeal has been advanced on the Board's docket. 38 U.S.C. § 7107(b).

Service Connection Legal Authority

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. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service.

In this case, the evidence shows current diagnoses of hypertension, aortic valve regurgitation (valvular heart disease), and hypothyroidism, which are considered chronic diseases under 38 C.F.R. § 3.309(a). As such, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable to this matter. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases 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. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit grant of service connection not only for disability caused
2, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995).

To prevail under a theory of secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). Any increase in the severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disability, will be itself service connected. 38 C.F.R. § 3.310(b).

On August 10, 2022, the PACT Act became law. See P.L. 117-168. The PACT Act provides that VA has an obligation to provide a VA examination for any service connection claim when there is evidence of a disability, evidence of participation in toxic exposure risk activity (TERA), and such evidence is not sufficient to establish service connection for the disability. Section 303 implemented 38 U.S.C. § 1168 which requires a disability examination and medical opinion be requested for certain non-presumptive conditions involving TERAs. In this case, the RO has recognized TERA exposure.

1. Service connection for high blood pressure is denied.

The Veteran appeals for service connection for high blood pressure, contending that high blood pressure is related to the (non-service-connected) PTSD. See November 2025 VA Form 21-526EZ.

The February 2026 rating decision made favorable findings that 1) there is a current diagnosed disability of hypertension (January 2026 VA examination), and 2) the Veteran participated in TERA as the military occupation specialty (MOS) of firefighter exposed the Veteran to asbestos, PFAS, and aqueous film forming foam (AFFF). Under the AMA, the Board is bound by favorable findings made by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c).

Initially, the record shows a current hypertension disability, as indicated in the January 2026 VA examination. The record shows a current diagnosis of hypertension, and a December 2025 TERA Memorandum indicated exposure to asbestos during service. While the RO purported to find in the February 2026 rating decision that the Veteran was exposed to PFAS in firefighting foam in service in a December 2025 TERA Memorandum, a February 2026 TERA Memorandum determined that the December 2025 TERA Memorandum was incorrect in conceding exposure because the Department of Defense did not begin using AFFF, containing PFAS, to fight fuel fires until the 1970s according to VA Public Health. See VA Public Health, PFAS-Perfluoroalkyl and polyfluoroalkyl substances (April 14, 2026), https://www.publichealth.va.gov/exposures/pfas.asp. Further, AFFF was created in the 1960s and the Veteran served from 1954 to 1957. Therefore, the the February 2026 rating decision finding exposure in service to AFFF containing PFAS was clearly in error.

With regard to the contention that service connection is warranted for hypertension due to PTSD, service connection for PTSD has not been established; therefore, the claim for service connection for hypertension as secondary to PTSD (38 C.F.R. § 3.310) must be denied as a matter of law because there is no primary service-connected disability upon which secondary service connection may be granted. See 38 C.F.R. § 3.310(a); Reiber v. Brown,
Further, AFFF was created in the 1960s and the Veteran served from 1954 to 1957. Therefore, the the February 2026 rating decision finding exposure in service to AFFF containing PFAS was clearly in error.

With regard to the contention that service connection is warranted for hypertension due to PTSD, service connection for PTSD has not been established; therefore, the claim for service connection for hypertension as secondary to PTSD (38 C.F.R. § 3.310) must be denied as a matter of law because there is no primary service-connected disability upon which secondary service connection may be granted. See 38 C.F.R. § 3.310(a); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

After review of all the evidence, lay and medical, the Board finds the persuasive weight of the evidence is against a finding that a cardiovascular injury, disease, or event occurred during active service or that the symptoms of hypertension were "chronic" in service. The Veteran does not contend that hypertension was directly caused by service or even that there were relevant symptoms during service. The complete service treatment records do not show treatment of cardiovascular injury, disease, or even symptoms. See, e.g., October 1957 service treatment records (indicating normal blood pressure of 120/70 on the service separation examination).

For these reasons, the lay and medical evidence generated contemporaneous to service, which shows no in-service cardiovascular injury or disease and no chronic symptoms of hypertension, is likely to accurately reflect the Veteran's physical condition, so is of probative value and provides evidence against a finding of cardiovascular symptoms during service. Accordingly, the criteria for presumptive service connection under 38 C.F.R. § 3.303(b) based on "chronic" symptoms in service are not met.

The Board next finds that the persuasive weight of the lay and medical evidence shows that symptoms of hypertension were not continuous since active service, including not to a degree of 10 percent within one year of separation from active service. Private treatment records indicated onset of hypertension in September 2012, approximately 55 years after service separation. See April 2021 private treatment records. The Veteran did not indicate that the diagnosis or any symptoms were within one year of service separation.

As the persuasive weight of the evidence demonstrates no "continuous" hypertension symptoms since active service, including to a compensable degree within the first post-service year, the criteria under 38 C.F.R. § 3.303(b) for presumptive service connection based on "continuous" symptoms or symptoms manifested to a degree of 10 percent within one year of service separation are not met. 38 C.F.R. §§ 3.307, 3.309.

The Board finds that the persuasive weight of the competent and probative evidence is against a finding that the current hypertension is etiologically related to service, including as a result of toxic exposures.

VA provided a VA examination in January 2026 regarding the hypertension and toxic exposures wherein the examiner opined that the hypertension was at least as likely as not related to toxic exposure risk activities. The examiner reasoned that there was medical literature indicating an association between PFOS exposure and hypertension, explaining that there was a correlation between higher levels of PFOS, PFOA, and PFHxS and increased risk of hypertension. The examiner further explained that AFFF caused hypertension through its PFAS content, which was an endocrine disruptor and could cause systemic inflammation, disrupted lipid metabolism, damage blood vessels (atherosclerosis), increase oxidative stress, and potentially alter hormone levels, all leading to elevated blood pressure.

An addendum opinion was requested in February 2026 as the RO determined that the January 2026 VA opinion did not discuss the Veteran's medical history and how this led the examiner to determine the hypertension was caused by the in-service TERA. The February 2026 VA examiner opined that hypertension was less likely than not caused by the indicated toxic exposure risk activities. The examiner reasoned that the Veteran had other risk factors for hypertension, namely PTSD, that were the more likely cause of the hypertension in the Veteran's case.

The January 2026 VA opinion is afforded no probative weight as it was based upon an inaccurate factual premise of exposure to PFAS in firefighting foam - a factual assumption that is contrary to the weight of the evidence in this case and the Board's findings of fact made after a weighing of all the evidence. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value).

The February
than not caused by the indicated toxic exposure risk activities. The examiner reasoned that the Veteran had other risk factors for hypertension, namely PTSD, that were the more likely cause of the hypertension in the Veteran's case.

The February 2026 VA examiner had medical expertise and adequate information on which to base the medical opinion, relied on factually accurate assumptions that are consistent with the Board's findings of fact in this case, and provided adequate rationale based on an accurate medical history and known medical principles. For these reasons, the Board assigns the February 2026 VA medical opinion probative value, weighing against a direct nexus between hypertension and TERA exposure in service.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for the hypertension is warranted. Rather, the evidence persuasively weighs against service connection for the hypertension as directly incurred in service or otherwise caused by or etiologically related to service, to include as directly related to asbestos exposure, or on a "chronic disease" presumptive basis; therefore, the appeal must be denied.

2. Service connection for GERD is denied.

The Veteran appeals for service connection for GERD, contending the GERD is related to the (non-service-connected) PTSD. See November 2025 VA Form 21-526EZ.

The February 2026 rating decision made favorable findings that 1) the evidence showed a current diagnosed disability of GERD (January 2026 VA examination), and 2) the Veteran participated in TERA as the MOS exposed the Veteran to asbestos, PFAS, and AFFF. Under the AMA, the Board is bound by favorable findings made by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c). As discussed previously herein, the RO's favorable finding of exposure to PFAS in AFFF in service in the February 2026 rating decision was clearly in error.

Initially, the record shows that a current GERD disability, as indicated by the January 2026 VA examination report.

With regard to the contention that service connection is warranted for GERD due to PTSD, service connection for PTSD has not been established; therefore, the claim for service connection for GERD as secondary to PTSD (38 C.F.R. § 3.310) must be denied as a matter of law because there is no primary service-connected disability upon which secondary service connection may be granted. See 38 C.F.R. § 3.310(a); Reiber, 7 Vet. App. at 516-17; Sabonis, 6 Vet. App. at 430.

The persuasive weight of the lay and medical evidence demonstrates that there was no relation (or nexus) between the GERD and service-connected non-Hodgkin's lymphoma.

VA provided a VA examination in February 2026 wherein the examiner opined that the GERD was less likely than not proximately due to or caused by the service-connected non-Hodgkin's lymphoma. The examiner explained that GERD was primarily related to lower esophageal sphincter dysfunction, hiatal hernia, obesity, dietary and lifestyle factors (e.g., alcohol, caffeine, smoking), and certain medications. The examiner further explained that, while non-Hodgkin's lymphoma may involve abdominal organs in some cases, in this case there was no evidence that the non-Hodgkin's lymphoma involved the esophagus, stomach, or lower esophageal sphincter. In addition, while the Veteran reported some difficulty swallowing and eating (dysphagia), there was no documentation linking these symptoms to structural or functional changes that would cause GERD and there was no temporal or pathophysiologic mechanism connecting the non-Hodgkin's lymphoma or dysphagia to the onset of GERD.

The January 2026 VA examiner had medical expertise and adequate information on which to base the medical opinion, relied on factually accurate assumptions that are consistent with the Board's findings of fact in this case, and provided adequate rationale based on an accurate medical history and known medical principles. For these reasons, the Board assigns the January 2026 VA medical opinion probative value, weighing against a nexus between GERD and the service-connected non-Hodg
and eating (dysphagia), there was no documentation linking these symptoms to structural or functional changes that would cause GERD and there was no temporal or pathophysiologic mechanism connecting the non-Hodgkin's lymphoma or dysphagia to the onset of GERD.

After review of all the evidence, lay and medical, the Board finds the persuasive weight of the evidence is against a finding of a gastroesophageal injury, disease, or event in service. The Veteran does not contend that the GERD was directly caused by service or even that there were relevant symptoms during service. The complete service treatment records do not show gastroesophageal injury, symptoms, findings, or diagnoses. The Veteran contends that the GERD began after service, and the evidence shows that GERD was diagnosed in 2010, over 50 years after separation from service. See January 2026 VA examination.

After a review of the evidence, both lay and medical, the Board finds that the persuasive weight of the evidence is against finding that the GERD was otherwise causally or etiologically related to active service toxic exposures. VA provided an examination in January 2026, wherein the examiner opined that the GERD was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner reasoned that no medical or scientific evidence available indicated a relationship between the development of GERD and asbestos or PFAS exposure. The examiner indicated that there were risk factors outside of military service, including diagnosed generalized anxiety disorder and age, that outweighed the factors identified in the TERA.

For the foregoing reasons, the Board finds that the criteria are not met for service connection for GERD on direct or secondary service connection bases; therefore, the appeal must be denied.

3. Service connection for aortic valve regurgitation is denied.

The Veteran appeals for service connection for aortic valve regurgitation, contending that this is related to (non-service-connected) high blood pressure. See November 2025 Statement in Support of Claim.

The February 2026 rating decision made favorable findings that 1) there was a current diagnosed disability of valvular heart disease (January 2026 VA examination), 2) the claimed issue of aortic valve regurgitation is secondary to the primary nonservice-connected disability of hypertension, and 3) the Veteran participated in TERA as the MOS, namely, exposure to asbestos, PFAS, and AFFF. Under the AMA, the Board is bound by favorable findings made by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c). As discussed previously herein, the RO finding of exposure to PFAS in AFFF in service in the February 2026 rating decision was clear error.

Initially, the record shows that the Veteran had a valvular heart disease disability, specifically aortic valve regurgitation, as indicated in the January 2026 VA examination. The record shows that a January 2026 VA examiner opined that hypertension was the known etiology of the valvular heart disease disability. The January 2026 examiner opined that the aortic valve regurgitation was at least as likely as not proximately due to or the result of high blood pressure. The examiner provided the rationale that hypertension caused aortic regurgitation by chronically increasing stress on the aorta, leading to its dilation and the stretching of the aortic root, which prevented the valve leaflets from closing properly, causing leakage back into the left ventricle. The examiner further explained that increased pressure damaged the valve's structure or the annulus where it sits, creating a poor seal, especially as the condition became chronic.

The January 2026 VA examiner had medical expertise and adequate
etiology of the valvular heart disease disability. The January 2026 examiner opined that the aortic valve regurgitation was at least as likely as not proximately due to or the result of high blood pressure. The examiner provided the rationale that hypertension caused aortic regurgitation by chronically increasing stress on the aorta, leading to its dilation and the stretching of the aortic root, which prevented the valve leaflets from closing properly, causing leakage back into the left ventricle. The examiner further explained that increased pressure damaged the valve's structure or the annulus where it sits, creating a poor seal, especially as the condition became chronic.

With regard to the contention that service connection is warranted for aortic valve regurgitation due to hypertension, service connection for hypertension has not been established; therefore, the claim for service connection for aortic valve regurgitation as secondary to hypertension (38 C.F.R. § 3.310) must be denied as a matter of law because there is no primary service-connected disability upon which secondary service connection may be granted. See 38 C.F.R. § 3.310(a).

The Secretary of VA has determined that conditions with an etiology not associated with toxic exposure do not require a TERA examination and medical opinion. In this case, the examiner has attributed the aortic valve regurgitation to post-service hypertension, which was not associated with toxic exposure and the Veteran has not submitted evidence to the contrary; thus, a TERA examination and medical opinion are not required in connection with the service connection claim for aortic valve regurgitation.

After review of all the evidence, lay and medical, the Board finds the persuasive weight of the evidence is against a finding of a cardiovascular injury, disease, or event occurred during active service, that the symptoms of aortic valve regurgitation were "chronic" in service, and symptoms of aortic valve regurgitation were not continuous since active service, including not to a degree of 10 percent within one year of separation from active service. As discussed previously herein, there was no cardiovascular injury, disease, or event during active service. The Veteran does not contend that the aortic valve regurgitation was directly caused by service or even that there were relevant symptoms during service. The complete service treatment records do not show complaints, symptoms, findings, or diagnosis of a heart injury during service. The Veteran contends that the aortic valve regurgitation began after service. The evidence shows that aortic valve regurgitation was diagnosed in 2023, over 60 years after separation from service.

For these reasons, the lay and medical evidence generated contemporaneous to service, which shows no in-service cardiovascular injury or disease and no chronic symptoms of aortic valve regurgitation, is likely to accurately reflect the Veteran's physical condition, so is of probative value and provides evidence against a finding of aortic valve regurgitation symptoms during service. Accordingly, the criteria for presumptive service connection under 38 C.F.R. § 3.303(b) based on "chronic" symptoms in service are not met. Further, as the persuasive weight of the evidence demonstrates no "continuous" aortic valve regurgitation symptoms since active service, including to a compensable degree within the first post-service year, the criteria under 38 C.F.R. § 3.303(b) for presumptive service connection based on "continuous" symptoms or symptoms manifested to a degree of 10 percent within one year of service separation are not met. 38 C.F.R. §§ 3.307, 3.309.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for the aortic valve regurgitation is warranted. Rather, the evidence persuasively weighs against service connection for the aortic valve regurgitation, to include as directly incurred in service or otherwise caused by or etiologically related to service, or on a "chronic disease" presumptive basis; therefore, the appeal must be denied.

4. Service connection for hypothyroidism is denied.

The Veteran appeals for service connection for hypothyroidism, contending the current hypothyroidism is from exposure to fighting fires with aqueous film forming foam and alternatively from radiation treatment for the service-connected non-Hodgkin's lymphoma. See November 2025 VA Form 21-526EZ, November 2025 Statement in Support of
urgitation is warranted. Rather, the evidence persuasively weighs against service connection for the aortic valve regurgitation, to include as directly incurred in service or otherwise caused by or etiologically related to service, or on a "chronic disease" presumptive basis; therefore, the appeal must be denied.

4. Service connection for hypothyroidism is denied.

The February 2026 rating decision made favorable findings that 1) there was a current diagnosed disability of hypothyroidism (January 2026 VA examination), 2) there was a primary (service-connected) disability of non-Hodgkin's lymphoma, and 3) the Veteran participated in TERA, as the MOS caused exposure to asbestos, PFAS, and AFFF. Under the AMA, the Board is bound by favorable findings made by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c). As discussed previously herein, the RO was in clear error when it made a favorable finding of exposure to PFAS in AFFF in service in the February 2026 rating decision. The record shows that the Veteran had a hypothyroidism disability, as indicated in the January 2026 VA examination.

The Board finds that the persuasive weight of the lay and medical evidence of record demonstrates that the hypothyroidism (endocrine system) symptoms were not "chronic" in service, and were not "continuous" after service, did not manifest to a compensable degree within one year of service, and were not incurred in or causally related to service, to include exposure to asbestos. The complete service treatment records do not show treatment of thyroid injury, symptoms, or diagnosis. See, e.g., October 1957 service treatment records (indicating normal endocrine system on separation examination). The Veteran contends that the hypothyroidism began after service in 2015 when he had radiation for the service-connected non-Hodgkin's lymphoma. See January 2026 Thyroid and Parathyroid DBQ.

For these reasons, the lay and medical evidence generated contemporaneous to service, which shows no in-service endocrine injury or disease and no chronic symptoms of hypothyroidism, is likely to accurately reflect the Veteran's physical condition, so is of probative value and provides evidence against a finding of hypothyroidism symptoms during service. Accordingly, the criteria for presumptive service connection under 38 C.F.R. § 3.303(b) based on "chronic" symptoms in service are not met.

The Board next finds that the persuasive weight of the evidence shows that symptoms of hypothyroidism were not continuous since active service, including not to a degree of 10 percent within one year of separation from active service. The Veteran indicated onset of hypothyroidism in 2015, approximately 58 years after service separation. See January 2026 Thyroid and Parathyroid DBQ. The Veteran did not indicate that the diagnosis or any symptoms were within one year of service separation.

As the persuasive weight of the evidence demonstrates no "continuous" hypothyroidism since active service, including to a compensable degree within the first post-service year, the criteria under 38 C.F.R. § 3.303(b) for presumptive service connection based on "continuous" symptoms or symptoms manifested to a degree of 10 percent within one year of service separation are not met. 38 C.F.R. §§ 3.307, 3.309.

The Board finds that the persuasive weight of the competent and probative evidence is against a finding that the current hypothyroidism is etiologically related to service, including as a result of toxic exposures. VA provided an examination in January 2026 wherein the examiner opined that the hypothyroidism was less likely than not caused by or otherwise related to service, to include exposure to toxic risk activities during service. The examiner explained that there was no medical or scientific evidence available that provided any indication of a relationship between the development of hypothyroidism and the TERA. Further, there were risk factors outside of military service (radiation treatments) that far outweighed the factors identified in the TERA.

The January 2026 VA examiner had medical expertise and adequate information on which to
evidence is against a finding that the current hypothyroidism is etiologically related to service, including as a result of toxic exposures. VA provided an examination in January 2026 wherein the examiner opined that the hypothyroidism was less likely than not caused by or otherwise related to service, to include exposure to toxic risk activities during service. The examiner explained that there was no medical or scientific evidence available that provided any indication of a relationship between the development of hypothyroidism and the TERA. Further, there were risk factors outside of military service (radiation treatments) that far outweighed the factors identified in the TERA.

The persuasive weight of the lay and medical evidence demonstrates that there was no relation (or nexus) between the hypothyroidism and service-connected non-Hodgkin's lymphoma.

The Veteran was afforded a VA examination in February 2026 wherein the examiner opined that the hypothyroidism was less likely than not proximately due to or the result of the service-connected non-Hodgkin's lymphoma or any radiation treatment for the non-Hodgkin's lymphoma. The examiner explained that hypothyroidism was an endocrine disorder characterized by insufficient thyroid hormone production, most commonly caused by autoimmune disease, iodine deficiency, certain medications, or prior thyroid surgery or radiation exposure. While radiation therapy could cause hypothyroidism, the Veteran's medical records indicated that the radiation fields and doses used for treatment of the non-Hodgkin's lymphoma did not involve the thyroid gland. In addition, there was no documentation of thyroid involvement by non-Hodgkin's lymphoma or functional impairment of the thyroid prior to or after therapy. Finally, there was no temporal or pathophysiologic evidence linking the non-Hodgkin's lymphoma radiation treatment to the development of hypothyroidism in the Veteran. The examiner concluded that, based on review of current medical literature and available clinical records, the Veteran's hypothyroidism was more likely related to primary thyroid disease rather than secondary to non-Hodgkin's lymphoma or its radiation treatment.

The February 2026 VA examiner had medical expertise and adequate information on which to base the medical opinion, relied on factually accurate assumptions that are consistent with the Board's findings of fact in this case, and provided adequate rationale based on an accurate medical history and known medical principles. For these reasons, the Board assigns the February 2026 VA medical opinion probative value, weighing against a nexus between hypothyroidism and non-Hodgkin's lymphoma or its radiation treatment.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for hypothyroidism is warranted. Rather, the evidence persuasively weighs against service connection for the hypothyroidism as directly incurred in service or otherwise caused by or etiologically related to service, to include as directly related to asbestos exposure, as secondary to the service-connected non-Hodgkin's lymphoma, or on a "chronic disease" presumptive basis; therefore, the appeal must be denied.

J. PARKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Beilsmith, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

Analyze in VA Law Explorer