Case A26037126

Summary

The veteran, a veteran who served from November 1986 to November 1990, appeals several claims for service connection. The veteran sought service connection for chronic fatigue syndrome (CFS), hypertension (HTN), obstructive sleep apnea (OSA), a cardiovascular (CV) disorder, bullous emphysema, and chronic obstructive pulmonary disease (COPD). The appeal for CFS was dismissed as the veteran withdrew it. Service connection for HTN, OSA, and the CV disorder was denied. The Board found no evidence of in-service incurrence for these conditions, and while a private consultant opined HTN and OSA were secondary to PTSD, the Board found this opinion lacked probative value due to reliance on associations rather than causation and speculative reasoning. The Board also found the veteran's weight gain, cited as a link to OSA and cardiomyopathy, was not shown to be caused or aggravated by service-connected disabilities. Service connection for bullous emphysema and COPD was granted on a presumptive basis under the PACT Act due to the veteran's qualifying service in Southwest Asia during the Persian Gulf War. The Board noted that while the veteran's service treatment records were unavailable, the evidence did not suggest these conditions began in service or were continuously symptomatic since service, precluding direct service connection. The Board afforded greater weight to clinical findings over lay statements regarding etiology.

Rationale

Veteran expressed intent to withdraw claim for CFS; Withdrawal was explicit and unambiguous; Board lacks jurisdiction to review withdrawn appeal

Full Decision Text

Citation Nr: A26037126
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 210302-143204
DATE: April 21, 2026

ORDER

The appeal for service connection for chronic fatigue syndrome (CFS) is dismissed.

Service connection for hypertension (HTN) is denied.

Service connection for obstructive sleep apnea (OSA) is denied.

Service connection for a cardiovascular (CV) disorder is denied.

Service connection for bullous emphysema is granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act).

Service connection for chronic obstructive pulmonary disease (COPD) is granted pursuant to the PACT Act. 

FINDINGS OF FACT

1. The Veteran served on active duty from November 1986 to November 1990; he has been 100 percent disabled based on unemployability since September 2021 and on a schedular basis since December 2021, plus in receipt of special monthly compensation (SMC).

2. In January 2025, prior to the promulgation of a decision on the appeal, the Veteran expressed an intent to withdraw the pending claim for service connection for CFS. 

3. HTN was not shown in service, was not shown to a compensable degree within one year of service, and symptoms were not continuous since service; HTN is not causally or etiologically related to service and was not caused by or permanently worsened in severity by a service-connected disability. 

4. OSA was not shown in service, is not causally or etiologically related to service, and was not caused by or permanently worsened in severity by a service-connected disability. 

5. A CV disorder, diagnosed as cardiomyopathy, was not shown in service, is not causally or etiologically related to service, and was not caused by or permanently worsened in severity by a service-connected disability. 

6. The Veteran has been diagnosed with emphysema and COPD, which are on the list of diseases presumptively associated with service in the Persian Gulf War (PGW).

CONCLUSIONS OF LAW

1. The criteria for withdrawal of the appeal for service connection for CFS have been met. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.205 (2025).

2. HTN was not incurred in service, is not presumed to have been incurred in service, and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 3.310 (2025). 

3. OSA was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2025).

4. A CV disorder was not incurred in service and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2025). 

5. Bullous emphysema is presumed to have been incurred in service. 38 U.S.C. §§ 1110, 1117, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.317, 3.320 (2025). 

6. COPD is presumed to have been incurred in service. 38 U.S.C. §§ 1110, 1117, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.317, 3.320 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (
38 C.F.R. §§ 3.159, 3.303, 3.317, 3.320 (2025). 

6. COPD is presumed to have been incurred in service. 38 U.S.C. §§ 1110, 1117, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.317, 3.320 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In November 2019, the agency of original jurisdiction (AOJ) denied the claims for service connection for HTN and OSA. In March 2020, the AOJ denied the claims for service connection for CFS, a CV disorder, emphysema, and COPD. 

Subsequently, the Veteran filed for a Higher-Level Review (HLR) and the AOJ continued the denials in October 2020. In March 2021, the Veteran appealed to the Board via a Form 10182 and elected the Hearing docket. In January 2025, he withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the decisions on appeal, as well as any evidence submitted by the Veteran within 90 days following receipt of the withdrawal of the hearing request in January 2025. 38 C.F.R. § 20.302(b). 

Moreover, the Board notes that the AOJ found that new and relevant evidence was received and reopened the claims for service connection for HTN and OSA in the November 2019 rating decision; however, the AOJ continued denial of the claims in the October 2020 HLR rating decision and found that the claims were not reopened because the evidence was not new and relevant. The Board finds that the AOJ's November 2019 decision to reopen the claims was a favorable decision which is binding. As such, the claim for service connection for HTN and OSA will be decided on the merits. 

Withdrawal of Appeal for CFS

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.205.

In January 2025 correspondence, prior to promulgation of a decision on the appeal, the Veteran expressed an intent to withdraw the pending claims for service connection for CFS. Specifically, the representative wrote: "the [Veteran] wishes to withdraw the following issue(s): 1. Chronic fatigue syndrome." Hence, there remain no allegations of errors of fact or law for appellate consideration.

The withdrawal of the appeal was explicit, unambiguous, and made with a full understanding of the consequences of such action on the Veteran's part. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018). Accordingly, the Board does not have jurisdiction to review the appeal for service connection for CFS, and it is dismissed. 

Service Connection Claims

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). 

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310.  Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence
 See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). 

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310.  Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Service connection may be granted on a secondary basis with an intercurrent cause of obesity if a service-connected disability caused or aggravated a veteran's obesity, and the aggravation of obesity was then a substantial factor in causing or aggravating the claimed disorder, and whether the claimed disorder would have occurred but for obesity aggravated by the service-connected disability. See Walsh v. Wilkie, 32 Vet. App, 300, 307 (2020). 

Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

Hypertension

Turning to the medical evidence, the clinical treatment records reflect that the Veteran has a diagnosis of HTN. As such, a disorder has been shown, and the first element of service connection is met. 

As to in-service incurrence, the service treatment records (STRs) are unavailable. In March 2020 correspondence, VA indicated that all efforts to obtain the STRs had been exhausted and that any future attempts to obtain the records would be futile. Under 38 U.S.C. § 1154(b), the Board has an obligation to resolve reasonable doubt in favor of the Veteran and accept lay evidence as sufficient proof of service connection where records are otherwise unavailable. As the STRs are unavailable, the Board will proceed accordingly. 

Nonetheless, the medical and lay evidence of record does not suggest that HTN began during active duty. Rather, VA medical records note that HTN began in approximately August 2009, nearly 20 years after separation. Importantly, the Veteran does not contend that symptoms of HTN began during service. Therefore, HTN was not shown in service. As such, the medical evidence does not support service connection on a direct basis. 

The Veteran's main contention is that HTN is secondary to service-connected posttraumatic stress disorder (PTSD). In support of the claim, a March 2025 private consultant stated that it was highly likely that HTN was secondary to PTSD. The consultant explained that the psychosocial stressor of PTSD caused anxiety and triggered the sympathetic nervous system to enter "fight or flee mode," which increased heart rate, blood pressure, and breathing. 

Moreover, the March 2025 consultant cited to medical studies to support this conclusion. Specifically, they noted a study which "suggested a variety of factors might contribute to this comorbidity between PTSD and [CV disease]". Further, they noted a meta-analysis which positively associated PTSD with the development of CV disease, including HTN. Finally, they noted a study which showed a significant association between depression, panic disorder, social phobia, and other psychological disorders with a subsequent diagnosis of HTN. In sum, the consultant concluded that it was at least as likely as not that HTN was secondary to PTSD. 

After review, the Board affords the March 2025 private opinion lesser probative value. In formulating the opinion, the private consultant relied upon medical studies which found an "association" between PTSD and HTN; however, these studies did not find a "causative" relationship between the disorders. Specifically, the finding that PTSD was positively associated with the development of HTN does not show causation. In sum, the consultant based this opinion on a correlation between PTSD and HTN and not a cause-and-effect relationship. 

Next, the consultant's rationale is speculative throughout the opinion. For example, they stated that "[c]hronic activation of the sympathetic nervous system such as in PTSD,
 HTN was secondary to PTSD. 

After review, the Board affords the March 2025 private opinion lesser probative value. In formulating the opinion, the private consultant relied upon medical studies which found an "association" between PTSD and HTN; however, these studies did not find a "causative" relationship between the disorders. Specifically, the finding that PTSD was positively associated with the development of HTN does not show causation. In sum, the consultant based this opinion on a correlation between PTSD and HTN and not a cause-and-effect relationship. 

Next, the consultant's rationale is speculative throughout the opinion. For example, they stated that "[c]hronic activation of the sympathetic nervous system such as in PTSD, can cause chronic HTN." This is speculative as the consultant finds only that PTSD "can" cause HTN. Furthermore, the consultant relied on a medical study which stated that "[s]everal past reviews have suggested a variety of factors might contribute to this comorbidity between PTSD and CVD." This statement is also speculative as the study suggests that factors "might" contribute to a comorbidity between PTSD and HTN. Thus, the Board finds this medical opinion of lesser probative value. As such, the medical evidence does not support service connection for HTN as secondary to PTSD. 

As to presumptive service connection based on chronicity/continuity of symptomatology, HTN was not shown in service and did not manifest to a compensable degree within a year of separation from service. Rather, the March 2025 private consultant indicated that HTN was first noted in approximately August 2009.

Further, the evidence does not establish continuity of symptomatology as the first mention of elevated blood pressure was in August 2009, when a physician assessed uncontrolled HTN. This came nearly 20 years after the Veteran separated from service. As HTN was not shown in service and not shown for nearly two decades after discharge, service connection is not warranted on a presumptive basis under 38 C.F.R. §§ 3.307, 3.309. In sum, the medical evidence does not support service connection for HTN.

Sleep Apnea

Turning to the medical evidence, VA clinical treatment records reflect a diagnosis of OSA. Specifically, the VA records show complaints of OSA beginning in approximately 2010, with a diagnosis in approximately 2011. As such, a diagnosis of OSA has been shown, and the first element of service connection is met. 

Next, as to in-service incurrence, the medical and lay evidence of record does not suggest that OSA began during active duty. Rather, VA medical records note that OSA began in approximately 2010, 20 years after separation. Importantly, the Veteran does not contend that symptoms of OSA began during service. Therefore, OSA was not shown in service. As such, the medical evidence does not support service connection on a direct basis. 

Rather, the Veteran's main contention is that OSA is secondary to weight gain and obesity caused by service-connected PTSD. In support of the claim, a March 2025 private consultant opined that it was at least as likely as not that OSA was secondary to weight gain from PTSD. First, the consultant noted that the Veteran weighed 155 pounds in 1986 when he enlisted in service. Further, they noted that he weighed 245 pounds in 2011, with a body mass index (BMI) of 35.1 (obese) and 226 pounds in 2021 with a BMI of 32.6 (obese). 

Next, the consultant cited to a medical study which showed that obesity was likely the most important risk factor for the development of OSA due to a significant association between the two disorders. Then, they explained that the Veteran had experienced constant and chronic weight gain since leaving service, which was most likely due to constant anxiety and depression related to PTSD. The consultant stated that it was difficult to exercise and keep excess weight off due to these psychiatric symptoms. 

Moreover, the consultant cited to medical studies which showed a link between PTSD and OSA. Specifically, these studies showed that the prevalence of OSA was higher among patients with PTSD than the general population. Further, another study showed that it was "very likely that the stress of PTSD affects OSA severity." In addition, one study showed that PTSD was often accompanied by biological and behavioral factors such as alcohol consumption, physical inactivity, poor diet, and drug abuse that adversely affected weight and health. 

In sum, the consultant concluded that the medical studies showed that PTSD was one of the primary causes of OSA and that increased PTSD symptoms increased the risk of OSA. As such, they concluded that it was highly likely that OSA was secondary to weight gain from PTSD. 

After review, the Board affords the March 2025 private opinion
 these studies showed that the prevalence of OSA was higher among patients with PTSD than the general population. Further, another study showed that it was "very likely that the stress of PTSD affects OSA severity." In addition, one study showed that PTSD was often accompanied by biological and behavioral factors such as alcohol consumption, physical inactivity, poor diet, and drug abuse that adversely affected weight and health. 

In sum, the consultant concluded that the medical studies showed that PTSD was one of the primary causes of OSA and that increased PTSD symptoms increased the risk of OSA. As such, they concluded that it was highly likely that OSA was secondary to weight gain from PTSD. 

After review, the Board affords the March 2025 private opinion lesser probative value. As noted above, in formulating the opinion, the private consultant relied upon medical studies which found an "association" between OSA and PTSD; however, these studies did not find a "causative" relationship between the disorders. Specifically, the finding that individuals with PTSD had a higher prevalence of OSA compared to the general population does not show causation. In sum, the consultant based this opinion on a correlation between OSA and PTSD and not a cause-and-effect relationship. 

Further, the private consultant opined that PTSD made it difficult to exercise and contributed to poor behavioral choices such as physical inactivity and poor diet, which led to weight gain and obesity. Accordingly, they found that weight gain led to the development of OSA; however, the private consultant relied upon a generalized medical study which showed that individuals with PTSD often struggled with these biological and behavioral factors which could adversely affect weight and health. They did not discuss any of the Veteran's specific dietary or eating habits, nor did they discuss the Veteran's exercise routine or ability to perform physical activity. 

Next, the medical evidence weighs against the March 2025 private consultant's opinion that PTSD caused obesity. Specifically, the clinical treatment records reflect that the Veteran has been obese throughout the period on appeal; however, the medical evidence does not suggest that obesity was the result of a service-connected disability. 

Rather, the evidence shows that the Veteran has been encouraged to exercise and diet to maintain a healthy weight. In a May 2019 treatment note, he indicated that he had significantly improved his diet recently. He was counseled on the importance of improved diet, exercise, and maintaining and achieving a healthy body weight. Further, in July 2019, a clinician discussed CV exercise and the Veteran indicated that he previously rode a stationary bicycle at the gym multiple times per week. The clinician advised him to start slowly but encouraged the activity. In September 2019, a clinician counseled the Veteran on the ongoing importance of lifestyle factors such as weight management, diet, and exercise. 

In sum, the clinical treatment records contained no indication that the Veteran was unable to exercise or diet to control weight due to any service-connected disabilities. Rather, multiple clinicians advised the Veteran on the importance of proper diet and exercise and encouraged low impact activity such as the stationary bicycle. 

Further, even considering that the Veteran may experience some degree of limitation in exercise due to service-connected disabilities, the VA clinicians have not found that he was unable to manage his weight due to these symptoms. For example, an August 2019 VA mental health counselor noted that the Veteran was distressed during the session but was fully oriented with relevant thought processes, relevant thought content, normal judgment, and good insight. The clinician made no indication that the Veteran was unable to control what he ate due to his psychiatric symptoms. In addition, the clinician did not find that the Veteran's symptoms made him unable to perform physical activity. 

While the Veteran's psychiatric symptoms may impact certain choices and limit his ability to perform certain forms of exercise, the Board finds that the decision to exercise, diet, and live a healthy lifestyle remains in his control. As such, the medical evidence does not reflect that the Veteran's obesity was caused by or aggravated by service-connected disabilities. There is no competent medical evidence to suggest that he cannot maintain a healthy weight due to his disabilities. 

In all, the Board finds that the March 2025 private consultant's medical conclusions regarding a connection between the Veteran's OSA and PTSD are of lesser probative value because the conclusions are based on an understanding of the Veteran's disability history which is not supported by the record. 

Accordingly, the Board affords the March 2025 private consultant's opinion regarding OSA, PTSD, obesity, and limited physical activity lesser probative value. Therefore, the medical evidence does not support service connection for OSA on a secondary basis, to include through the intermediary step of obesity. 

Cardiovascular Disorder

Turning to the medical evidence, the clinical treatment records reflect a diagnosis of a CV disorder. Specifically, VA treatment records indicate treatment for cardiomyopathy since August 2018. As
 2025 private consultant's medical conclusions regarding a connection between the Veteran's OSA and PTSD are of lesser probative value because the conclusions are based on an understanding of the Veteran's disability history which is not supported by the record. 

Accordingly, the Board affords the March 2025 private consultant's opinion regarding OSA, PTSD, obesity, and limited physical activity lesser probative value. Therefore, the medical evidence does not support service connection for OSA on a secondary basis, to include through the intermediary step of obesity. 

Cardiovascular Disorder

Turning to the medical evidence, the clinical treatment records reflect a diagnosis of a CV disorder. Specifically, VA treatment records indicate treatment for cardiomyopathy since August 2018. As such, a CV disorder has been shown, and the first element of service connection is met. 

Next, as to in-service incurrence, the medical and lay evidence of record does not suggest that cardiomyopathy began during active duty. Rather, VA medical records note that the CV began in approximately 2018, nearly 30 years after separation. Importantly, the Veteran does not contend that symptoms of a CV disorder began during service. Therefore, the medical evidence does not support the in-service incurrence of cardiomyopathy. As such, the medical evidence does not support service connection on a direct basis. 

Rather, the Veteran's main contention is that cardiomyopathy is secondary to weight gain caused by service-connected PTSD. In support of this claim, the March 2025 private consultant opined that it was highly likely (at least as likely as not) that cardiomyopathy was secondary to weight gain from PTSD. Specifically, the consultant cited to medical literature which showed that weight can and obesity could damage the heart muscle. Further, they noted studies which showed that people with obesity were over twice as likely to develop heat failure. 

After review, the Board affords the March 2025 private opinion lesser probative value. As discussed above, the medical evidence does not support the private consultant's claim that service-connected PTSD caused weight gain or obesity. Again, the Board finds that the decision to exercise, diet, and live a healthy lifestyle remained in the Veteran's control. Therefore, the medical evidence does not support service connection for a CV disorder on a secondary basis, to include through the intermediary step of obesity. 

The Board notes that a VA medical opinion was not obtained regarding secondary service connection for HTN, OSA, or cardiomyopathy. Under AMA, appeals can only be remanded for pre-decisional duty to assist errors. To the extent that the Veteran provided a March 2025 private medical opinion regarding secondary service connection, this evidence was submitted during the evidence submission window after the rating decision on appeal. 

While the Board may consider evidence received during an AMA evidentiary window in adjudicating a claim, it may not remand to correct a pre-decisional duty to assist error based solely on evidence or argument received after the AOJ decision on appeal. Therefore, a remand for a VA examination is not required. 

The Board has considered the Veteran's lay statements that the current disorders were caused by service. While he is competent to report symptoms and to describe observations as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an opinion as to the etiology of the current disorder dues to the medical complexity of the matter involved. 

Specifically, the Veteran is not competent to determine the etiology of diagnosed HTN, OSA, and cardiomyopathy. More specifically, he is not competent to attribute the etiology of these disorders to service-connected disabilities or obesity. Rather, the findings in the clinical evidence are given more probative weight than the consultant opinion as statements made to health care providers for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care. Therefore, the Board attaches greater probative weight to the clinical findings than to the lay statements regarding etiology. 

In sum, after a careful review of the record, the evidence weighs persuasively against the claims for service connection and there is no doubt to be resolved. As such, the appeal for service connection for HTN, OSA, and a CV disorder is denied. 

Emphysema and COPD

The PACT Act created a new presumption for service connection for certain conditions based on exposure to burn pits and other toxins (BPOT) and added new examination requirements where toxic exposure risk activities (TERAs) were implicated. 38 U.S.C. § 1119. Among the new benefits, emphysema and COPD were added to the list of disabilities presumed to be related to toxic exposure during the PGW. 

The Veteran received the Sea Service Deployment Ribbon and VA has conceded he had a qualifying deployment in Southwest Asia that satisfies the criteria for designation as
 doubt to be resolved. As such, the appeal for service connection for HTN, OSA, and a CV disorder is denied. 

Emphysema and COPD

The PACT Act created a new presumption for service connection for certain conditions based on exposure to burn pits and other toxins (BPOT) and added new examination requirements where toxic exposure risk activities (TERAs) were implicated. 38 U.S.C. § 1119. Among the new benefits, emphysema and COPD were added to the list of disabilities presumed to be related to toxic exposure during the PGW. 

The Veteran received the Sea Service Deployment Ribbon and VA has conceded he had a qualifying deployment in Southwest Asia that satisfies the criteria for designation as a Persian Gulf Veteran. Further, the medical evidence reflects that he has a respiratory disorder diagnosed as both bullous emphysema and COPD. Accordingly, service connection for bullous emphysema and COPD is granted on a presumptive basis related to PGW service pursuant to the PACT Act. 

Nonetheless, the Board will consider whether service connection is warranted under any other theory of entitlement. The Veteran does not contend that a respiratory disorder is secondary to a service-connected disability. Moreover, emphysema and COPD are not chronic diseases presumptively associated with service connection under 38 C.F.R. § 3.309. As such, only direct service connection is for application. 

Turning to direct service connection, the STRs are unavailable for review; however, the Veteran does not contend that he sought treatment for a respiratory disorder during service. There is no indication in the record that symptoms of COPD or emphysema began during active duty. Therefore, a respiratory disorder was not shown in service and the medical evidence does not support direct service connection. 

In sum, the medical evidence does not support service connection for a respiratory disorder on a direct basis or any basis other than the PACT Act. Nonetheless, as the Veteran had service in Southwest Asia during the PGW, service connection is warranted on a presumptive basis pursuant to the PACT Act and the appeal is granted to this extent.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

 

 

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Kokolas, Thomas

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.