ANEURYSM ANY LARGE ARTERY

D. JOHNSON · 2026 · Case ID: A26035789

MIXED

Summary

The veteran, who served from October 1968 to May 1970, including service in Vietnam, appeals the denial of service connection for right carotid artery occlusion and stenosis, amaurosis fugax (claimed as temporary right eye blindness), and bilateral cataract surgeries, all claimed secondary to presumed herbicide exposure. The Board denied all three claims. For the carotid artery and amaurosis fugax, the Board found the VA examiner's opinion more probative than the veteran's private physician's conclusory statement, as the VA opinion addressed the lack of nexus between the conditions and herbicide exposure, attributing the carotid artery issue to atherosclerosis. For the cataracts, the Board noted the veteran failed to attend a rescheduled VA examination, leaving no probative evidence linking the condition to service or herbicide exposure. The Board found the veteran was not competent to provide a medical opinion on etiology for any of the conditions. The Board also remanded the claim for headaches/migraines secondary to hypertension, finding the VA examiner inadequately addressed aggravation. Service connection for all three appealed conditions was denied.

Rationale

VA examiner found condition less likely than not caused by toxic exposure.; VA examiner attributed condition to hyperlipidemia, not herbicide exposure.; Private physician's nexus opinion lacked rationale.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251001-585715

Full Decision Text

Citation Nr: A26035789
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 251001-585715
DATE: April 16, 2026

ORDER

1. Entitlement to service connection for occlusion and stenosis of the right carotid artery, to include as due to herbicide exposure, is denied.

2. Entitlement to service connection for amaurosis fugax (claimed as temporary right eye blindness), to include as due to herbicide exposure, is denied.

3. Entitlement to service connection for bilateral cataract eye surgeries, to include as due to herbicide exposure, is denied.

REMANDED

Entitlement to service connection for headaches/migraines, to include as secondary to hypertension, is remanded.

FINDINGS OF FACT

1. The approximate balance of the evidence is against finding that the Veteran's occlusion and stenosis of the right carotid artery is related to an in-service injury or disease, to include presumed exposure to herbicide agents.

2. The approximate balance of the evidence is against finding that the Veteran's amaurosis fugax (claimed as temporary right eye blindness) is related to an in-service injury or disease, to include presumed exposure to herbicide agents.

3. The approximate balance of the evidence is against finding that the Veteran's bilateral cataract surgeries are related to an in-service injury or disease, to include presumed exposure to herbicide agents.

CONCLUSIONS OF LAW

1. The criteria for service connection for occlusion and stenosis of the right carotid artery, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§1110, 1116, 5107; 38C.F.R. §§3.102, 3.303, 3.307, 3.309(e).

2. The criteria for service connection for amaurosis fugax (claimed as temporary right eye blindness), to include as due to herbicide exposure, have not been met. 38 U.S.C. §§1110, 1116, 5107; 38C.F.R. §§3.102, 3.303, 3.307, 3.309(e).

3. The criteria for service connection for bilateral cataract surgeries, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§1110, 1116, 5107; 38C.F.R. §§3.102, 3.303, 3.307, 3.309(e), 3.655(b).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active naval services from September 1966 to May 1970. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal, and the Republic of Vietnam Campaign Medal.

The Appeals Modernization Act (AMA) automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). Here, the November 2024 rating decision issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ), denied the entitlement to service connection for migraine headaches. In the January 2025 rating decision, the AOJ denied entitlement to service connection for bilateral cataract eye surgeries. Further, in the September 2025 rating decision, the AOJ denied entitlement to service connection for the right carotid artery and amaurosis fugax (temporary right eye blindness). The November 2024, January 2025 and the September 2025 rating decisions constitute initial decisions; therefore, the AMA applies.

In June 2025, the Veteran sought the Higher-Level Review (HLR) of the November 2024 and January 2025 compensation rating decision by submitting a VA Form 20-0996, Decision Review Request: HLR. In the September 2025 HLR rating decision, the AOJ confirmed and continued the November 2024 and January 2025 rating decisions as reflected above. The Veteran appealed the September 2025 rating decisions (all four issues) by submitting an October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)). The Veteran elected the Hearing Review docket. The Veteran appeared at a hearing before the undersigned in December 2025. The transcript of the hearing is of record. The Board acknowledges the one-year period to change review options under the Appeals Modernization Act (AMA) has not yet expired for the September 2025 rating decisions; however, the Veteran's appearance at
the September 2025 HLR rating decision, the AOJ confirmed and continued the November 2024 and January 2025 rating decisions as reflected above. The Veteran appealed the September 2025 rating decisions (all four issues) by submitting an October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)). The Veteran elected the Hearing Review docket. The Veteran appeared at a hearing before the undersigned in December 2025. The transcript of the hearing is of record. The Board acknowledges the one-year period to change review options under the Appeals Modernization Act (AMA) has not yet expired for the September 2025 rating decisions; however, the Veteran's appearance at the December 2025 Board hearing precludes a change in dockets. See 38 C.F.R. § 20.202(c)(2); see also Williams v. McDonough, 37 Vet. App. 305 (2024).

In accordance with the provisions of the AMA, the Board's review in this case is limited to record considered by the Agency of Original Jurisdiction (AOJ) in the November 2024 (under HLR), January 2025 (under HLR), and September 2025 rating decisions on appeal, as well as evidence submitted by the Veteran, or his representative, within ninety days of his December 2025 Board hearing. See 38 C.F.R. § 20.302(a). The Board cannot consider evidence associated with the claims file between the issuance of the rating decisions and the Veteran's December 2025 Board hearing or any evidence associated with the claims file after the end of ninety-day evidence submission window following the December 2025 Board hearing. If evidence was associated with the claims file during a period when additional evidence was not allowed, the Board has not considered it in its decision. See 38 C.F.R. § 20.300; see also Cook v. McDonough, 36 Vet. App. 175 (2023).

However, because the Board is remanding the claim of entitlement to service connection for headaches/migraines, to include as secondary to hypertension, any evidence the Board could not consider with respect to that claim will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

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[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to service connection for occlusion and stenosis of the right carotid artery, to include ase due to herbicide exposure, is denied.

The Veteran asserts his presumed exposure to herbicide agents in the Republic of Vietnam caused his occlusion and stenosis in the right artery. See December 2025 Hearing Transcript.

VA laws and regulations provide that, if a Veteran was exposed to certain herbicide agents during service, certain listed diseases are presumptively service connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e).

A Veteran who "served in the Republic of Vietnam" between January 9, 1962, and May 7, 1975, is presumed to have been exposed to herbicide agents during such service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii).

Even if service connection is not warranted under one of the presumptive regulations, this does not preclude a claimant from establishing service connection with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The rationale employed in Combee also applies to claims based on exposure to herbicide agents. Brock v. Brown, 10 Vet. App. 155 (1997).

The Veteran served in the Republic of Vietnam (Saigon) during the period of October 10, 1968, to April 27, 1970, as is thus presumed to have been exposed to herbicide agents during such service. See STR-Medical.

The Veteran is diagnosed with occlusion and stenosis of the right carotid artery. See June 2025 private treatment record, July 2025 C&P Exam. Right carotid artery stenosis is not a disease which may
3 (Fed. Cir. 1994). The rationale employed in Combee also applies to claims based on exposure to herbicide agents. Brock v. Brown, 10 Vet. App. 155 (1997).

The Veteran is diagnosed with occlusion and stenosis of the right carotid artery. See June 2025 private treatment record, July 2025 C&P Exam. Right carotid artery stenosis is not a disease which may be presumptively service connected where herbicide agent exposure is presumed. Thus, service connection cannot be established on a presumptive basis under 38 C.F.R. § 3.309. However, service connection is warranted if competent evidence links a non-presumptive disease to the presumed herbicide agent exposure. See 38 U.S.C. § 1110; Combee, 34 F.3d at 1042.

Thus, the question for the Board is whether the Veteran's diagnosed right carotid artery stenosis is related to exposure to herbicide agents or were otherwise directly related to his active-duty military service.

The January 2025 VA examiner opined that occlusion and stenosis of the right carotid artery is less likely than not caused by the indicated toxic exposure risk activities after considering the potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities. The examiner noted that a TERA memorandum reflects toxic exposure to herbicide agent orange and asbestos. The examiner stated that service treatment records and post service records are silent for diagnosis of ischemic heart disease or coronary artery disease. The CTA angio neck report revealed that the Veteran had severe proximal right ICA stenosis due to extensive atherosclerotic plaque and minimal proximal left ICA stenosis. The examiner found that medical literature does not support the relationship between the TERA exposure and occlusion and stenosis of the right carotid artery. The literature supports a diagnosis of ischemic heart disease/ coronary artery disease, which the Veteran does not have a diagnosis of. Rather, the Veteran is diagnosed with atherosclerosis in the right carotid artery causing occlusion and stenosis which is not related to herbicide exposure. The more likely causes of the Veteran's right carotid artery causing occlusion and stenosis is due to hyperlipidemia and not TERA. Based on the evidence provided, the examiner opined that a nexus cannot be established.

The Veteran submitted a positive nexus statement that his "cardiac conditions" including "occlusion and stenosis" of the right carotid artery is "most likely caused by or a result of exposure to Agent Orange." See December 2025 Email Correspondence. Notably, however, the private physician only provided a conclusory statement and did not include a rationale for the opinion of how the conditions affect each other. As such, the Board finds the positive nexus to lack probative value, as it presents a conclusion without the appropriate rationale.

The Board finds the January 2025 VA medical opinion to be more probative than the December 2025 private nexus opinion because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. The examiner reviewed the record, private and VA treatment records. The examiner's opinions were based on the specific facts of this case as presented in the record and by the Veteran at prior in-person examinations. The examiner reviewed the record and provided appropriate rationales that are factually accurate, fully articulated, and soundly reasoned. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000).

While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current diagnosis of right artery stenosis to an in-service injury or occurrence as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case.

Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as whether it is less likely than not that the Veteran's right artery st
report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current diagnosis of right artery stenosis to an in-service injury or occurrence as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case.

Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as whether it is less likely than not that the Veteran's right artery stenosis is related to active service, to include presumed exposure to herbicide agents. As the approximate balance of evidence of record weighs against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for amaurosis fugax (claimed as temporary right eye blindness), to include as due to herbicide exposure, is denied.

The Veteran asserts his exposure to herbicide agents in the Republic of Vietnam caused his amaurosis fugax. See December 2025 Hearing Transcript.

Even if service connection is not warranted under one of the presumptive regulations, this does not preclude a claimant from establishing service connection with proof of direct causation. See Combee, supra. The rationale employed in Combee also applies to claims based on exposure to herbicide agents. Brock, 10 Vet. App. 155.

The Veteran is diagnosed with amaurosis fugax. See September 2025 C&P Exam. Amaurosis fugax is not a disease which may be presumptively service connected where herbicide agent exposure is presumed. Thus, service connection cannot be established on a presumptive basis under 38 C.F.R. § 3.309. However, service connection is warranted if competent evidence links a non-presumptive disease to the presumed herbicide agent exposure. See 38 U.S.C. § 1110; Combee, supra.

Thus, the question for the Board is whether the Veteran's diagnosed amaurosis fugax is related to exposure to herbicide agents or were otherwise directly related to his active-duty military service.

The September 2025 VA examiner opined that the Veteran's amaurosis fugax is less likely than not caused by exposure to herbicides and asbestos after considering the potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities. The examiner indicated that amaurosis fugax is not an eye condition, but rather a description of a visual symptom. Further, the examiner stated with confidence that the Veteran's amaurosis fugax is related to his carotid occlusion, but the examiner could not say that his carotid occlusion is related to active service. This would be best determined by a cardiologist or vascular surgeon. The Board acknowledges that there is a strong inference that the herbicide agents did not cause the Veteran's amaurosis fugax.

The Veteran submitted a positive nexus statement that his amaurosis fugax is "most likely caused by or a result of exposure to Agent Orange." See December 2025 Email Correspondence. Notably, however, the private physician only provided a conclusory statement and did not include a rationale for the opinion of how the conditions affect each other. As such, the Board finds the positive nexus to lack probative value, as it presents a conclusion without the appropriate rationale.

The Board finds the September 2025 VA medical
related to active service. This would be best determined by a cardiologist or vascular surgeon. The Board acknowledges that there is a strong inference that the herbicide agents did not cause the Veteran's amaurosis fugax.

The Board finds the September 2025 VA medical opinion to be more probative than the December 2025 private nexus opinion because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. The examiner's opinions were based on the specific facts of this case as presented in the record and by the Veteran at prior in-person examinations. The examiner reviewed the record and provided appropriate rationales that are factually accurate, fully articulated, and soundly reasoned. See Nieves-Rodriguez, 22 Vet. App. 295; see also Prejean, 13 Vet. App. at 448-9.

While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current diagnosis of amaurosis fugax to an in-service injury or occurrence as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Therefore, the Veteran is not competent to provide an etiology opinion in this case.

Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as whether it is less likely than not that the Veteran's amaurosis fugax is related to exposure to herbicide agents. As the approximate balance of evidence of record weighs against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th 776.

3. Entitlement to service connection for bilateral cataract eye surgeries, to include as due to herbicide exposure, is denied.

The Veteran asserts his exposure to herbicide agents in the Republic of Vietnam caused his bilateral cataract eye surgeries. See December 2025 Hearing Transcript.

Even if service connection is not warranted under one of the presumptive regulations, this does not preclude a claimant from establishing service connection with proof of direct causation. See Combee, supra. The rationale employed in Combee also applies to claims based on exposure to herbicide agents. Brock, supra.

The Veteran is diagnosed with bilateral cataracts. See September 2025 Rating Decision-Narrative. Bilateral cataracts is not a disease which may be presumptively service connected where herbicide agent exposure is presumed. Thus, service connection cannot be established on a presumptive basis under 38 C.F.R. § 3.309. However, service connection is warranted if competent evidence links a non-presumptive disease to the presumed herbicide agent exposure. See 38 U.S.C. § 1110; Combee, supra.

Thus, the question for the Board is whether the Veteran's diagnosed bilateral cataracts is related to exposure to herbicide agents or were otherwise directly related to his active-duty military service.

As noted above, the Veteran appealed the September 2025 HLR decision that denied the Veteran's claim to service connection for bilateral cataracts. The Veteran elected the Hearing Review docket. In
exposure is presumed. Thus, service connection cannot be established on a presumptive basis under 38 C.F.R. § 3.309. However, service connection is warranted if competent evidence links a non-presumptive disease to the presumed herbicide agent exposure. See 38 U.S.C. § 1110; Combee, supra.

As noted above, the Veteran appealed the September 2025 HLR decision that denied the Veteran's claim to service connection for bilateral cataracts. The Veteran elected the Hearing Review docket. In accordance with the provisions of the AMA, the Board's review in this case is limited to record considered by the Agency of Original Jurisdiction (AOJ) as of the January 16, 2025 (under HLR) rating decision, as well as evidence submitted by the Veteran, or his representative, within ninety days of his December 2025 Board hearing. See 38 C.F.R. § 20.302(a). Thus, the Board in addressing this issue was limited to the record prior to January 16, 2025. Further, there was not any relevant evidence pertaining to this issue in the ninety-day window including the December 2025 Board hearing.

Upon the Board's review, the Veteran's claim file reflected that an Exam Scheduling Request was forwarded to the VA clinical staff for a TERA examination on November 12, 2024. On November 15, 2024, an exam scheduling request contention cancellation noted that the Veteran's examination was canceled at the Veteran's request. Further, on November 29, 2024, the VA notified the Veteran that they were attempting to reschedule exams for his service connection claim. The Veteran did not respond to the notification. The January 2025 rating decision notified the Veteran and his representative that he failed to attend the VA examination scheduled in support of his claim. The AOJ indicated that there is no information presently indicating good cause for the absence on the scheduled appointment date.

Pursuant to 38 C.F.R. § 3.655(b), when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(b).

Given the Veteran's request to cancel the scheduled VA examination regarding his claim, the record does not have probative evidence of a nexus between the Veteran's bilateral cataracts and his active service, to include presumed exposure to herbicide agents. The Veteran has not submitted a positive nexus statement that his bilateral cataracts are related to active service, including herbicide agent exposure.

While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current bilateral cataracts to an in-service injury or occurrence as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Therefore, the Veteran is not competent to provide an etiology opinion in this case.

Accordingly, the Board finds that most probative evidence weighs against a finding that the Veteran's bilateral cataracts are related to active service, to include exposure to herbicide agents. As the approximate balance of evidence of record weighs against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, supra.

REASONS FOR REMAND

Entitlement to service connection for headaches/migraines, to include as secondary to hypertension, is remanded.

The Veteran asserts that his migraine headaches are caused and/or aggravated by his service-connected hypertension.

The Veteran was afforded a VA examination in November 2024. The VA examiner provided a negative nexus opinion regarding secondary service connection as to whether the Veteran's service-connected hypertension caused the Veteran's migraine headaches.

The Board finds the November 2024 medical opinion regarding the causal connection between Veteran's migraine headaches and his service-connected hypertension to be adequate. However, the November 2024 VA examiner failed to address secondary service connection as it relates to whether the Veteran's service-connected hypertension aggravated the Veteran's migraine headaches. The AOJ's failure to address aggravation as it relates to secondary service connection constitutes a pre-decisional duty to assist error. Therefore, the Board finds further development is warranted to obtain an adequate medical opinion regarding secondary service connection. Barr v. Nicholson, 21 Vet. App. 303 (
The VA examiner provided a negative nexus opinion regarding secondary service connection as to whether the Veteran's service-connected hypertension caused the Veteran's migraine headaches.

The matter is REMANDED for the following action:

Forward the Veteran's claims file for addendum medical opinion by a qualified VA examiner to determine the nature and etiology of the Veteran's migraine headaches. The claims file must be made available to and reviewed by the examiner.

The examiner must provide an opinion as to whether the Veteran's claimed migraine headaches were aggravated by his service-connected hypertension.

In providing the above opinion on aggravation, the examiner must opine whether the Veteran's migraine headaches would be less severe and result in less functional impairment but for the appellant's service-connected hypertension.

The examiner is advised that any incremental increase in nonservice-connected disability by a service-connected condition warrants secondary service connection regardless of permanence. See Ward v. Wilkie, 31 Vet. App. 233 (2019). Additionally, the but-for causation standard is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. See Spicer v. McDonough, 61 F.4th 1360, 1366 (Fed. Cir. 2023). In other words, the requested opinion above concerning secondary service connection should consider any causal link, or any incremental increase.

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A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she shall explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limit of current medical knowledge in providing an answer to that particular question(s).

D. C. JOHNSON

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Ivan Franklin

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

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