DIVERTICULOSIS

B. D. WATSON · 2026 · Case ID: A26037332

MIXED

Summary

The Veteran served from February 1970 to January 1972, receiving an honorable discharge. This case involves appeals of multiple rating decisions denying service connection for various conditions, including diverticulitis, erectile dysfunction, an acquired psychiatric disorder, cirrhosis of the liver, anemia, chronic kidney disease, polyneuropathy, acute gastritis, hypertension, diabetes mellitus type II, asthma, gout, and an increased rating for coronary artery disease. The Veteran elected the hearing docket, and a Board hearing was held. The Board reviewed the evidence of record at the time of the prior decisions, noting that any new evidence submitted would require a Supplemental Claim. The Board applied the three-element test for service connection, requiring evidence of a current disability, in-service incurrence or aggravation, and a causal relationship. For the acquired psychiatric disorder, the Board found the evidence persuasive and resolved reasonable doubt in the Veteran's favor, granting service connection. For all other claimed conditions, the Board found the persuasive weight of the evidence weighed against a causal connection to service, citing either lack of current disability, non-service connection of the condition, or that the condition was secondary to a non-service-connected disability. For coronary artery disease, the Board found the criteria for an increased rating were not met. Service connection for the acquired psychiatric disorder is granted, while all other claims are denied.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250902-580347

Full Decision Text

Citation Nr: A26037332
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 250902-580347
DATE: April 21, 2026

ORDER

Entitlement to service connection for diverticulosis is denied.

Entitlement to service connection for erectile dysfunction (ED) is denied.

Entitlement to service connection for an acquired psychiatric disorder is granted.

Entitlement to service connection for cirrhosis of the liver is denied.

Entitlement to service connection for anemia is denied.

Entitlement to service connection for chronic kidney disease is denied.

Entitlement to service connection for polyneuropathy is denied.

Entitlement to service connection for acute gastritis, with hemorrhage is denied.

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for diabetes mellitus, type II (DMII) is denied.

Entitlement to service connection for asthma is denied.

Entitlement to service connection for gout is denied.

Entitlement to an evaluation in excess of 10 percent for coronary artery disease CAD) is denied.

FINDINGS OF FACT

1. The persuasive weight of the evidence weighs against a finding that the Veteran's diverticulitis was causally connected to his active-duty service.

2. The persuasive weight of the evidence weighs against a finding that the Veteran's ED was causally connected to his active-duty service.

3. Giving the Veteran the benefit of all reasonable doubt, the persuasive weight of the evidence weighs in favor of finding that the Veteran's mental health condition was causally related to service.

4. The Veteran has DMII which is not service connected, was obese, and previously diagnosed with alcohol dependence and the persuasive weight of the evidence weighs against a finding that his cirrhosis of the liver was causally related to service, to include as a result of any TERA.

5. The persuasive weight of the evidence weighs against a finding that the Veteran currently has anemia, and his prior iron deficiency anemia was not causally related to service, to include as a result of any TERA.

6. The Veteran's in-service kidney infections were treated and resolved, and the persuasive weight of the evidence weighs against a finding that the Veteran's current chronic kidney infection diagnosis was causally related to service, to include a TERA.

7. The Veteran's polyneuropathy is a result of the Veteran's non-service connected DMII.

8. The persuasive weight of the evidence weighs against a finding that the Veteran's gastritis was causally related to service to include from a TERA.

9. The persuasive weight of the evidence weighs against a finding that the Veteran's hypertension was causally related to service to include from a TERA.

10. The persuasive weight of the evidence weighs against a finding that the Veteran's DMII was causally related to service to include from a TERA.

11. The persuasive weight of the evidence weighs against a finding that the Veteran's mild asthma was causally related to service, to include from a TERA.

12. The persuasive weight of the evidence weighs against a finding that the Veteran's gout was causally related to service to include from a TERA.

13. The Veteran's CAD did not require treatment with continuous medication and there was no evidence of metabolic equivalents (MET) less than seven METs.

CONCLUSIONS OF LAW

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

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

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

4. The criteria for service connection for cirrhosis of the liver have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

6. The criteria for service connection for chronic kidney disease have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.
.102, 3.303.

4. The criteria for service connection for cirrhosis of the liver have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

6. The criteria for service connection for chronic kidney disease have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

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

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

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

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

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

13. The criteria for an evaluation in excess of 10 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7005.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1970 to January 1972. He was honorably discharged.

This matter comes before the Board of Veterans' Appeals (Board) from six rating decisions issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). A July 2025 rating decision denied service connection for diverticulitis and ED. A May 2025 rating decision denied service connection for an acquired psychiatric disorder to include depression. An April 2025 decision denied an evaluation in excess of 10 percent for CAD. A December 18, 2024 rating decision denied service connection for cirrhosis of the liver, polyneuropathy, acute gastritis, anemia, and chronic kidney disease. A December 9, 2024, rating decision denied service connection for gout and asthma. A November 2024 decision denied service connection for hypertension and DMII.

In September 2025, the Veteran filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD) appealing the rating decisions listed above and elected the hearing docket. A Board hearing was held in January 2026, and a transcript of the hearing is associated with the claims file.

The Board may only consider the evidence of record at the time of the respective decisions on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). 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 docket pursuant to 38 C.F.R. § 20.902(c).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by
). 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 docket pursuant to 38 C.F.R. § 20.902(c).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases may be service-connected on a presumptive basis if manifested to a compensable degree within a specified period following separation from service (generally one year). 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. For chronic diseases listed in 38 C.F.R. § 3.309(a), nexus to service may be established by showing continuity of symptomatology since service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Arthritis, cirrhosis of the liver, DM II, and organic diseases of the nervous system, are considered "chronic diseases" under 38 C.F.R. § 3.309 (a). Therefore, the presumptive provisions of 38 C.F.R. § 3.303 (b) for "chronic" in-service symptoms and "continuous" post-service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

For a showing of a chronic disease in service, the mere use of the word "chronic" will not suffice; rather, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. 38 C.F.R. § 3.303(b). Continuity of symptomatology after service is required where a condition noted during service is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. Id. The presumptive service connection provisions based on "chronic" in-service symptoms and "continuity of symptomatology" after service under 38 C.F.R. § 3.303(b) have been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013) (holding that the "chronic" in service and "continuous" post-service symptom presumptive provisions of 38 C.F.R. § 3.303 (b) only apply to "chronic" diseases at 3.309(a)).

Secondary service connection may be granted for a disability which is proximately due to or the result of an established service-connected disease. 38 C.F.R. §§ 3.310 (a)-(b); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a); Allen v, Brown, 7 Vet. App. 439 (1995). When service connection is established for a secondary condition, the secondary condition shall be considered part of the original condition. Id. A medical nexus opinion must state whether the claimed condition was caused by or aggravated by the service-connected condition. El-Amin v. Shinseki, 26 Vet. App. 136 (2013); 38 U.S.C. § 1110.

Secondary aggravation exists when the non-service-connected disability was not caused by a service-connected disability but would be less severe were it not for a service-connected disability. Spicer v.
, 1131; 38 C.F.R. § 3.303 (a); Allen v, Brown, 7 Vet. App. 439 (1995). When service connection is established for a secondary condition, the secondary condition shall be considered part of the original condition. Id. A medical nexus opinion must state whether the claimed condition was caused by or aggravated by the service-connected condition. El-Amin v. Shinseki, 26 Vet. App. 136 (2013); 38 U.S.C. § 1110.

Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence).

Depending on the evidence and the contentions of record in a particular case, lay evidence can be competent and sufficient to establish a diagnosis and medical etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377.

Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Lay testimony is not competent to determine the extent or etiology of matters which require medical testing and expertise to determine. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).

The claimant has the responsibility to present and support a claim for benefits. 38 U.S.C. § 5107(a). The VA shall consider all information, including lay and medical evidence of record. VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

At the outset, the Board notes that the second element of service connection may be satisfied by an inservice injury or an inservice illness. The relevant service connection rating decisions have all conceded an in-service injury of a TERA.

The Board notes that an October 2024 TERA opinion conceded a high probability of asbestos exposure. A July 2024 TERA opinion conceded TERA from the Veteran's in-service duties as a machine mechanic and firefighter. Potential exposure to asbestos, petroleum products, benzene, diesel fuel, exhaust fumes, fine particulate matter, fuels, oils, solvents, lubricants, and degreasers were conceded. The Veteran was not exposed to any herbicide agents, which the Veteran also acknowledged during an October 2024
the Board notes that the second element of service connection may be satisfied by an inservice injury or an inservice illness. The relevant service connection rating decisions have all conceded an in-service injury of a TERA.

During the January 2026 Board hearing, the Veteran asserted that the Navy food and drinking water could have caused many of his current illnesses. Neither TERA opinion supported a TERA based on food or water. Accordingly, the record did not support the Veteran's assertion that the food or water was toxic and caused any of the conditions addressed in this claim.

None of the rating decisions have conceded an in-service illness for any of the service connection claims. For each of the service connection claims below, the Board will address whether the Veteran had an in-service illness and whether there was a nexus between the TERA and the respective illness.

1. Entitlement to service connection for diverticulosis is denied.

The July 2025 rating decision conceded the first two elements of service connection. The decision conceded that the Veteran had a current disability of diverticulitis and conceded an in-service injury of a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds that the first and second elements of service connection are satisfied.

During the January 2025 hearing, the Veteran testified that he had in-service symptoms of gastritis and or diverticulitis, to include bloating, abdominal pain, and nausea, but did not go to sick call while on active duty because the military discouraged going to sick call during boot camp. He also stated he only went to sick bay on one occasion and "that was something to do with the weather. I fell sick with either a cold or the flu but that was all I went to sick bay for." He additionally stated that he sought care for abdominal pain, bloating, and nausea, immediately after service, "say within a few weeks." Hearing Transcript, pp. 4. 5, 6, 11.

First, the Veteran had numerous visits for medical treatment during service. For example, in 1970, there were service treatment records (STR) for March, May, June, and November. In 1971, there were STRs for January 14 and 25, February, April 6 and 19, May, June, September, October 5 and 27. In 1972, there was an STR for January and a separation examination in the same month. The Veteran did not report any stomach issues at any of these medical visits or on his January 1972 separation examination. Second, the record did not contain any treatment records for any period shortly after service. The earliest treatment summary in the record was in 1992, approximately 20 years after the Veteran separated from service.

An October 2008 VA mental health and general examination record noted that the Veteran stated that he was having a problem with alternating diarrhea and constipation. He stated that he had a colonoscopy which was negative and a barium enema which revealed diverticula. The record noted that the condition was stable since onset. The Veteran did not state or otherwise indicate that this had been an ongoing condition since he was in the military. He also did not mention bloating, abdominal pain, or nausea.

Additionally, the July 2025 VA intestinal conditions DBQ noted a November 2007 diagnosis of diverticulosis. Gastritis was not diagnosed in this examination and was the subject of a December 2024 rating decision, which will be discussed separately. The Veteran advised the examiner that since the onset date he began experiencing constipation and nausea which worsened over the years. The Veteran did not state that he had similar symptoms in service or shortly after service. He separated from the military in 1972, and the onset date was approximately 35 years after service.

The Board finds that the Veteran's testimony during the January 2026 hearing was inconsistent with the record and the Board finds that the Veteran is not a reliable historian in this regard.

Furthermore, his in-service history of symptoms at the time-of-service separation is more contemporaneous to service so it is of more probative value than the more recent assertions made over three decades
2024 rating decision, which will be discussed separately. The Veteran advised the examiner that since the onset date he began experiencing constipation and nausea which worsened over the years. The Veteran did not state that he had similar symptoms in service or shortly after service. He separated from the military in 1972, and the onset date was approximately 35 years after service.

The Board finds that the Veteran's testimony during the January 2026 hearing was inconsistent with the record and the Board finds that the Veteran is not a reliable historian in this regard.

Furthermore, his in-service history of symptoms at the time-of-service separation is more contemporaneous to service so it is of more probative value than the more recent assertions made over three decades after service. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding Board decision giving higher probative value to a contemporaneous letter the Veteran wrote during treatment than subsequent assertions years later).

The lack of contemporaneous medical records is a fact that the Board of Veterans' Appeals may also consider and weigh against a veteran's lay evidence. Courts applying common law evidentiary principles have generally held that the absence of a record of an event which would ordinarily be recorded gives rise to a legitimate negative inference that the event did not occur. Given that the Veteran had numerous medical clinic visits while on active duty, it would be reasonable to expect that the Veteran would have mentioned any stomach or related issues. The fact that there was no mention in the STRs or 1972 separation examination gives rise to a legitimate negative inference that he did not have such issues in service.

Courts have refused to admit evidence of the absence of a record to show that an event did not occur, where it was not reasonable to expect the event to have been recorded. The absence of certain evidence may be pertinent if it tends to disprove, or prove, a material fact. The definition of evidence encompasses negative evidence, which tends to disprove the existence of an alleged fact. The lack of records does not, in itself, render lay evidence not credible. However, as a general matter, the lack of contemporaneous medical records may be a fact that the Board of Veterans' Appeals can consider and weigh against a veteran's lay evidence. See AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013).

For these reasons, the Board finds that the second element of service connection based on an in-service illness, is not satisfied.

The third element of service connection is a nexus between the current disability and the in-service TERA injury. During the January 2026 Board hearing, the Veteran asserted that the Navy food and drinking water could have caused his diverticulitis. Hearing Transcript, pp. 8. As noted above, neither TERA opinion supported a TERA based on food or water. Accordingly, the record does not support the Veteran's assertion that the food or water was toxic and caused his diverticulosis.

The July 2025 VA nexus opinion noted that the medical literature did not support a finding that there was any association between asbestos exposure and diverticulosis. The examiner further opined that the claimed condition of diverticulosis was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Accordingly, the Board finds that the nexus element has not been satisfied for service connection for diverticulosis.

As the three elements of service connection for diverticulitis have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred diverticulitis in service or that his diverticulitis was causally related to service.

2. Entitlement to service connection for ED is denied.

The July 2025 rating decision conceded the first two elements of service connection. The decision conceded that the Veteran had a current disability of ED and conceded an in-service injury of a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection for ED are satisfied.

The Veteran had no inservice complaints of ED
is denied. See, 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for ED is denied.

The Veteran had no inservice complaints of ED despite multiple medical treatment visits while on active duty and ED was not noted on the Veteran's separation physical. The evidence reflected that he was diagnosed with ED in 1997, over two decades after the Veteran separated from service. See, October 2008, VA mental health and general examination. During the January 2026 Board hearing, the Veteran testified that he did not have ED related complaints from his wife while he was in service but also testified that he was only home twice during his two years of service. He further testified that he did not seek treatment for ED until sometime after service and was treated by the VA with Viagra. Hearing Transcript, pp. 9, 10.

The October 2008 VA examiner noted that the Veteran stated his ED began in 1997 and that he had six children. The Veteran advised the October 2008 examiner that he would have problems during sexual activity. The July 2025 VA male reproductive examination noted that ED was diagnosed in November 2001 but also noted that the Veteran advised that his ED began in 1971 when he began having difficulty achieving and maintaining an erection suitable for intercourse. The Veteran advised the July 2025 examiner that the same ED problems currently exist.

The Veteran's testimony regarding ED onset in 1971 was inconsistent with the information he gave to the July 2025 ED examiner, the 2008 VA examiner, his STRs, and his 1972 separation from service examination which did not list any medical conditions. For these reasons, the Board does not find the Veteran to be a reliable historian.

Additionally, his in-service records and the information he provided to the 2008 VA examiner were more contemporaneous with his service than the January 2026 hearing testimony where the Veteran was seeking compensation. Given that the Veteran had numerous medical clinic visits while on active duty, it would be reasonable to expect that the Veteran would have mentioned any ED issues. The fact that there was no mention in the STRs or 1972 separation examination gives rise to a legitimate negative inference that he did not have such issues on active duty. AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997).

For the reasons stated above, the Board finds that the second element of service connection for ED based on an inservice illness is not satisfied.

The third element of service connection is a nexus between the first two elements of service-connection. The Veteran testified during the January 2026 hearing that the drinking water and food at sea caused his ED. Hearing Transcript, pp. 8. Neither the July 2024 or October 2024 TERA opinions supported a TERA based on food or water. Accordingly, the record does not support the Veteran's assertion that the food or water was toxic and caused his ED. Additionally, the July 2025 VA ED nexus examiner opined that the Veteran's ED was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The examiner further opined that there was no association between asbestos exposure and ED. Therefore, it was less likely than not that the Veteran's condition of erectile dysfunction was caused by the indicated toxic exposure risk activity of asbestos, after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Accordingly, the Board finds that the nexus element has not been satisfied for service connection for ED based on TERA.

As the three elements of service connection for ED have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred ED in service or that his ED is causally related to service.

As the evidence is persuasively against the Veteran's claim, it
between asbestos exposure and ED. Therefore, it was less likely than not that the Veteran's condition of erectile dysfunction was caused by the indicated toxic exposure risk activity of asbestos, after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Accordingly, the Board finds that the nexus element has not been satisfied for service connection for ED based on TERA.

3. Entitlement to service connection for an acquired psychiatric disorder is granted.

Diagnosis of mental disorders is required to conform to the Diagnostic Statistical Manual, fifth edition (DSM-V) criteria. 38 C.F.R. §4.125. The scope of a claim for a mental health disability includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant. The Board of Veterans' Appeals should not limit its consideration of a claim based on an appellant's belief that he suffered from post-traumatic stress disorder (PTSD), a diagnosis he generally is not competent to render in the first place. The scope of a claim for a mental health disability includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). When other mental disorders are within the scope of the claim, a direct service connection analysis for the conditions that are not PTSD are required.

With specific regard to PTSD, three elements must be present: (1) a current medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125 (a); (2) medical evidence of a causal nexus between current symptomatology and a claimed in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997).

The May 2025 rating decision conceded that the Veteran had a current disability of depression and PTSD. The April 2025 VA mental disorder examiner opined that the Veteran's symptoms did not meet the DSM V criteria for PTSD while the Veteran's January 2025 private psychologist's opinion, in pertinent part, stated he had PTSD, and major depressive disorder with anxious distress and psychotic features. The November 2020 VA mental disorder examiner opined that the Veteran had generalized anxiety disorder but did not meet the DSM V criteria for PTSD. The examiner also noted symptoms of depression, anxiety, and sleep impairment. Accordingly, the Board finds that while the examiners may not agree on the Veteran's specific diagnosis, they all agreed that the Veteran had a psychiatric disorder. Thus, the first element of service connection is satisfied.

The second element of service connection is an in-service injury or illness. The Veteran did not seek any mental health treatment while on active duty. The Veteran claimed that while in service he served on a naval ship which carried ammunition and that the stress and anxiety while serving on a ship carrying ammunition caused his mental disorder. As the Veteran served on a ship carrying ammunition, the Board finds the second element of service connection, an in-service injury is satisfied.

The third element of service connection is a link between the first two elements, i.e. whether serving on a ship carrying ammunition caused the Veteran's mental health issues or made them worse. The February 2025 Board decision remanded the claim deciding that the Veteran's January 2025 private examiner opinion which reflected a diagnosis of PTSD and depression, did not provide a cogent nexus opinion.

An April 2025 VA mental disorder nexus examiner referenced the Veteran's statements regarding his stressor. The Veteran stated his stressor was that he was on a ship that he felt was a "powder keg" and was told that if it blew, there was nothing he could do. The examiner noted that the Veteran did not remember any single stressful event but did recall
of service connection is a link between the first two elements, i.e. whether serving on a ship carrying ammunition caused the Veteran's mental health issues or made them worse. The February 2025 Board decision remanded the claim deciding that the Veteran's January 2025 private examiner opinion which reflected a diagnosis of PTSD and depression, did not provide a cogent nexus opinion.

An April 2025 VA mental disorder nexus examiner referenced the Veteran's statements regarding his stressor. The Veteran stated his stressor was that he was on a ship that he felt was a "powder keg" and was told that if it blew, there was nothing he could do. The examiner noted that the Veteran did not remember any single stressful event but did recall that he found the whole experience to be stressful. The nexus examiner opined that this description did not meet DSM V criteria A for PTSD. The examiner noted a November 2020 VA mental disorder examination which reflected a diagnosis of generalized anxiety disorder (GAD) and that the Veteran had not been treated for this condition. The April 2025 examiner opined that many factors cause anxiety, which were not mentioned in the November 2020 examination. Considering all the facts, the April 2025 examiner opined that the claimed condition was less likely than not caused by the claimed in-service injury, event or illness.

Another April 2025 VA nexus examiner opined that a GAD was at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) incurred in or caused by the claimed in-service injury, event or illness. The rationale was that the private examination submitted by the Veteran reflected diagnoses of anxiety disorder, PTSD, depressive disorder, and insomnia disorder and "some secondary conditions that have developed in progression since his military service which have further aggravated his mental health including but not limited to bereavement disorder, panic attacks, somatoform features, hallucinations, alcohol dependency, and many other psychological medical conditions."

The April 2025 VA examiner noted that the Veteran's stress began while he was on the Naval Munitions Ship that was carrying ammunition and his anxiety continued post military service. The records reflected that he was prescribed medication for mental health issues. The examiner concluded that therefore, it was at least as likely as not that the claimant's GAD was incurred in or caused by the in-service injury, event, or disease, to include the Veteran's reports that he had anxiety and stress while serving aboard a ship carrying ammunition.

During the January 2026 Bord hearing, the Veteran testified that he was on an ammunition oiler and was told that if "the ammunition would blow, that anything within a 25-mile radius would capsize and you wouldn't have any chance of getting saved or alive." He also testified that he was fearful of storms while at sea. Hearing Transcript, pp. 7, 10. The Veteran further testified that he was prescribed Xanax by his local doctor about a month or two after he was discharged from service. He stated he then went to a VA psychologist and a psychiatric doctor in Shreveport. Hearing Transcript, pp.12, 13. The Board notes that there were no treatment summaries in the record covering any illness, including mental illness, until decades after the Veteran separated from service.

There were several mental disorder examinations and each examiner's opinion differed regarding diagnoses and causation. The benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). Thus, the Board gives the Veteran the benefit of every doubt and finds that the nexus element is satisfied.

As the three elements of service connection are satisfied, the persuasive weight of the evidence weighs in favor of a finding that the Veteran's psychiatric disorder is causally related to service.

In reaching such a determination, the Board considered the applicability of the benefit of the doubt doctrine. That doctrine is applicable in the instant appeal, and his claim for service-connection for an acquired psychiatric disorder must be granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, (Fed. Cir. 2021).

4. Entitlement to service connection for cirrhosis of the liver is denied.

The December 2024 rating decision conceded a current disability of cirrhosis of the liver and an in-service TERA exposure. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection for cirrhosis are satisfied.

There was no evidence that the Veteran had any symptoms of liver cirrhosis on active duty, nor did the Veteran contend he had such symptoms while on active duty. The
§ 3.102; Lynch v. McDonough, 21 F.4th 776, (Fed. Cir. 2021).

4. Entitlement to service connection for cirrhosis of the liver is denied.

There was no evidence that the Veteran had any symptoms of liver cirrhosis on active duty, nor did the Veteran contend he had such symptoms while on active duty. The Veteran instead contended that the liver cirrhosis was caused by the water and food on the naval ship. Hearing Transcript, pp. 14. The December 2024 VA cirrhosis examiner noted that the Veteran's cirrhosis was diagnosed in 2015. The Veteran testified that since he was discharged, all his medical care and prescriptions have been from the VA. Hearing Transcript, pp. 15. Accordingly, the Veteran did not have an inservice illness of cirrhosis of the liver while on active duty.

The third element of service connection is a nexus between the first two elements. The Board will next consider whether the Veteran had cirrhosis due to a TERA. As noted above, the evidence does not support a finding that the food and water on board the ship constituted a TERA. See, July and October 2024 TERA memorandum.

The December 2024 VA nexus opinion conceded that the Veteran was exposed to asbestos, chemical hazards from petroleum product derivatives likely containing benzene as a contaminant, diesel fuel and exhaust fumes, fine particulate matter, fuels, oils, solvents, lubricants and degreasers during military service. Th examiner opined that common causes of liver cirrhosis include excessive drinking of alcohol, hepatitis B and C virus infections, and fatty liver that is caused by obesity and diabetes. The Board notes that the Veteran has diabetes and is obese with a body mass index (BMI) of 33.1. See, February 1996 VA treatment record noting the Veteran was diagnosed with DMII six months prior and an August 1996 VA treatment record noting the Veteran's BMI of 33.1 and encouraging him to lose weight. Additionally, an August 2015 VA treatment record noted a diagnosis of alcohol dependence in partial remission.

The nexus examiner opined that upon review of the medical literature, there was no evidence that supported that liver cirrhosis was caused by toxic exposure to asbestos, chemical hazards from petroleum product derivatives likely containing benzene as a contaminant, diesel fuel and exhaust fumes, fine particulate matter, fuels, oils, solvents, lubricants or degreasers. The claimed condition of liver cirrhosis was less likely than not caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Accordingly, the Board finds the nexus element is not satisfied.

As the three elements of service connection for cirrhosis of the liver have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred cirrhosis of the liver in service or as a result of service.

5. Entitlement to service connection for anemia is denied.

The December 2024 rating decision conceded a current disability of anemia and an in-service TERA exposure. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection for anemia are satisfied.

The Veteran's STR did not reflect any anemia or other hematologic inservice illness. The Veteran has also not contended that he had anemia while on active duty. The December 2024 VA hematologic condition examiner noted the Veteran stated he was compliant with his medications for his iron deficiency anemia. He stated that he was prescribed iron tablets and multivitamins and his symptom was fatigue. The examiner noted that the Veteran's condition was active and required continuous treatment with oral supplementation.

During the January 2026 Board hearing, the Veteran testified that he had no idea what caused his iron deficiency anemia. He
.104. Thus, the Board finds the first and second elements of service connection for anemia are satisfied.

During the January 2026 Board hearing, the Veteran testified that he had no idea what caused his iron deficiency anemia. He stated that while he was taking the medicine, his doctors told him to discontinue the medicine and that he no longer needed the medicine. The Veteran testified that he no longer takes iron pills or any medicine for anemia. He further testified that while he currently took a multi-vitamin, he did not take any vitamins for anemia. Accordingly, the Veteran's testimony indicated the anemia condition resolved.

In any event, the VA hematologic nexus examiner opined that upon review of medical literature, there was no evidence that iron deficiency anemia is caused by exposure to asbestos or other toxic exposure. Therefore, it was less likely than not that the Veteran's condition of iron deficiency anemia was caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The Veteran did not have anemia on active duty. An August 2008 VA treatment record noted a diagnosis of anemia. He was diagnosed with anemia decades after he separated from service and the Veteran's testimony reflected the condition resolved. Additionally, the nexus examiner opined that a TERA did not cause the anemia.

As the three elements of service connection for anemia have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred anemia as a result of his active-duty service. As the evidence is persuasively against the Veteran's claim, it is not in approximate balance; the benefit-of-the-doubt rule does not apply, and the claim is denied. See, 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

6. Service connection for chronic kidney disease is denied.

The first element of service connection is a current disability. The December 2024 rating decision conceded a current disability of chronic kidney disease. The Board is bound by this favorable finding. 38 C.F.R. § 3.104. Thus, the Board finds the first element of service connection for chronic kidney disease is satisfied.

The second element of service connection is an inservice illness or injury. The Veteran had several kidney infections while on active duty which were all treated and resolved. See, STRs for January, March 1970, and January, April, May, June, October 1971. The December 2024 rating decision conceded the Veteran was exposed to a TERA as a result of his firefighting duties. Thus, the second element of service connection based on an inservice illness and an injury is satisfied.

The third element of service connection is a nexus between the first two elements of service connection. The December 2024 VA kidney nexus examiner noted that the Veteran had DMII and hypertension and that these were the most common causes of kidney disease. The examiner further opined that there was no medical literature that found that chronic kidney disease resulted from asbestos exposure. The examiner then opined that it was less likely than not that the Veteran's chronic kidney disease was caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

Of note is the fact that the Veteran worked in a paper mill plant for approximately 40 years as a forklift driver and foreman. See, May 2003 Veteran statement, and October 2008 VA mental disorder examinations noting he went to work at a paper mill after separation from service; August 2010 VA treatment record; and June 2012 VA treatment record noting he retired from the paper mill in October 2007. It is unknown what TERA the Veteran may have been exposed to during those 30 plus years.

The examiner also addressed whether the Veteran claimed kidney disease was directly related to military service. Based on review of the available evidence, it was less likely than not that the claimed condition was due to service as there was a lack of substantiating evidence
in a paper mill plant for approximately 40 years as a forklift driver and foreman. See, May 2003 Veteran statement, and October 2008 VA mental disorder examinations noting he went to work at a paper mill after separation from service; August 2010 VA treatment record; and June 2012 VA treatment record noting he retired from the paper mill in October 2007. It is unknown what TERA the Veteran may have been exposed to during those 30 plus years.

The examiner also addressed whether the Veteran claimed kidney disease was directly related to military service. Based on review of the available evidence, it was less likely than not that the claimed condition was due to service as there was a lack of substantiating evidence supporting a nexus between the current diagnosis of chronic kidney disease and military service. The examiner opined that although an untreated kidney infection could cause chronic kidney disease, the record indicated that the Veteran's kidney infection was treated with tetracycline and there was no evidence of recurrent kidney infections. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. Based on these opinions, the Board finds that the nexus element has not been satisfied.

As the three elements of service connection have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred chronic kidney disease inservice or as a result of service.

7. Entitlement to service connection for polyneuropathy is denied.

The December 2024 rating decision conceded the current disability of polyneuropathy, and TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first element of service connection for polyneuropathy and the second element, an in-service injury due to TERA are both satisfied.

The third element of service connection is a nexus between the first two elements. The December 2024 VA polyneuropathy examiner opined that the Veteran's polyneuropathy was due to DMII. The Veteran is not service connected for DMII. Accordingly, the Veteran cannot be service connected for polyneuropathy secondary to DMII. Secondary service connection may be granted for a disability which is proximately due to or the result of an established service-connected disease. 38 C.F.R. §§ 3.310 (a)-(b); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a); Allen v, Brown, 7 Vet. App. 439 (1995).

The December 2024 VA polyneuropathy nexus opinion also noted that the Veteran was exposed to asbestos, chemical hazards from petroleum product derivatives, diesel fuel, exhaust fumes, fine particulate matter, fuels, oils, solvents, lubricants, and degreasers. The examiner opined that there was no medical literature that referenced evidence of an association between polyneuropathy and these exposures. Therefore, it was less likely than not that the Veteran's condition of polyneuropathy was caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

As the three elements of service connection are not satisfied, the persuasive weight of the evidence weighs against a finding that the Veteran's polyneuropathy was causally connected to his active-duty service.

8. Entitlement to service connection for gastritis is denied.

The December 2024 rating decision conceded the first element of service connection, a current disability of acute gastritis with hemorrhage and the second element of service connection, an inservice injury, a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection for gastritis, and the
apply, and the claim is denied. See, 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

8. Entitlement to service connection for gastritis is denied.

The December 2024 rating decision conceded the first element of service connection, a current disability of acute gastritis with hemorrhage and the second element of service connection, an inservice injury, a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection for gastritis, and the second element of service connection based on an in-service injury due to TERA are satisfied.

The Veteran testified during the January 2026 Board hearing that he had abdominal pain, bloating and cramping in service. Hearing Transcript, pp. 7, 8. As noted above, the Veteran had numerous STRs, none of which complained about bloating, cramping or abdominal pain.

The Veteran also testified that he sought medical care shortly after service with a Dr. F who diagnosed acute gastritis. Hearing Transcript, pp. 5, 8. The Board notes that the Veteran advised the October 2008 VA examiner that his diverticulitis was diagnosed in 2007 and did not mention any inservice gastritis symptoms or treatments immediately following service. An October 2008 VA mental health and general examination record noted that the Veteran stated that he was having a problem with alternating diarrhea and constipation. He stated that he had a colonoscopy which was negative and a barium enema which revealed diverticula. The record noted that the condition was stable since onset. The Veteran did not state or otherwise indicate that this had been an ongoing condition since he was in the military. He also did not mention bloating, abdominal pain, or nausea.

Of note, gastritis was first noted in the VA treatment records in 2013, over three decades after he separated from service. An August 2013 VA gastroenterology endoscopy record, by the Chief, gastroenterology, noted the Veteran had a gastric ulcer recently treated and there was patchy gastritis of uncertain significance, likely nonsteroidal anti-inflammatory drug (NSAID) induced. The Veteran's duodenum was normal. An August 2013, endoscopy pathology report noted that organisms consistent with H. pylori were not identified. The diagnosis was moderate chronic inactive gastritis with benign lymphoid nodule. A July 2013 gastroenterology treatment record noted that the Veteran was advised to avoid NSAIDs. Although gastritis was in the Veteran's records on lists including his on-going conditions, the record did not reflect gastritis complaints after 2013, which may reflect the condition resolved.

The Board finds that the Veteran's testimony during the January 2026 hearing was inconsistent with the record and the Board finds that the Veteran is not a reliable historian in this regard.

Furthermore, his in-service history of symptoms at the time-of-service separation is more contemporaneous to service so it is of more probative value than the more recent assertions made over three decades after service. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding Board decision giving higher probative value to a contemporaneous letter the Veteran wrote during treatment than subsequent assertions years later).

For these reasons, the Board finds that the second element of service connection, an in-service illness, is not satisfied. The Board additionally notes that the December 2024 VA intestinal examiner noted that the Veteran's gastritis was not chronic.

The December 2024 rating decision conceded the second element of service connection based on an in-service injury, a TERA. The December 2024 VA gastritis examiner opined it was less likely than not that the Veteran's condition of gastritis was caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. As noted above, the clinician opined that the gastritis was likely due to the use of NSAIDs. The Board finds that the nexus element is not satisfied.

As the three elements of service connection have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred gastritis in service or as a result of service.

9. Entitlement to service connection for hypertension is denied.

The November 2024 rating decision conceded the first element of service connection, a current hypertension disability. The decision also conceded an in-service injury of a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection for hypertension and the second element of service connection, an in-service injury due to TERA, are satisfied.

The Veteran's STRs did not reflect he had hypertension on active duty. The October 2024 VA hypertension examiner noted the onset of the Veteran's hypertension was 1994. The Veteran testified that he was diagnosed with hypertensin a few months after he separated from service. Hearing Transcript, pp. 23. The Veteran, however, submitted a July 2003 statement that he was first treated for hypertension in 1992 by a local doctor and the VA, which was approximately 20 years after he separated from service. The evidence in the record did not support the Veteran's hearing testimony that he had hypertension shortly after he separated from service. Thus, the Board finds that the Veteran did not have an inservice illness of hypertension nor was there evidence of chronicity of symptomatology within a year of separation from service.

The third element of service connection is a nexus between the first two elements. In a September 2003 statement, the Veteran asserted that his hypertension was the result of his exposure to asbestos while on active duty. The October 2024 VA hypertension nexus examiner opined that there was no evidence that asbestos exposure caused hypertension. Therefore, it was less likely than not that the Veteran's condition of hypertension was caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Thus, the Board finds the nexus element is not satisfied.

As the three elements of service connection have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred hypertension inservice or as a result of service.

As the evidence is persuasively against the Veteran's claim, it is not in approximate balance; the benefit-of-the-doubt rule does not apply, and the claim is denied. See, 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.4th 776
deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Thus, the Board finds the nexus element is not satisfied.

10. Entitlement to service connection for DMII is denied.

The November 2024 rating decision conceded the first element of service connection, a current DMII disability. The decision also conceded an in-service injury of a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection, a current DMII disability, and an in-service injury due to TERA are satisfied.

The Veteran testified during his Board hearing that he had DMII symptoms of frequent urination, extreme thirst and blurred vision, and tingling in his hands while on active duty. Hearing Transcript, pp. 24. None of the numerous STRs reflected any evidence that the Veteran complained of any of these symptoms while on active duty.

The Veteran also testified that he was diagnosed with DMII a few months after separation from service. Hearing Transcript, pp. 24. The Board notes that the Veteran submitted a July 2003 statement asserting that he was treated for DMII by a private physician in 1992. Other than the Veteran's assertion that he was diagnosed with DMII shortly after separation from service, the record reflected that the Veteran was first diagnosed with DMII in 1996, approximately 24 years after he separated from active duty. See, September 1997 and September 2003 VA treatment records. A September 1997 VA treatment record noted that the Veteran was diagnosed approximately one year prior with DMII. A February 1996 VA treatment record noted that the Veteran's appointment was to address DMII which was newly diagnosed six months prior. The Board finds that the Veteran is not a reliable historian with regards to the onset of DMII symptoms or the general date DMII was diagnosed. Thus, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred a DMII illness in service.

Additionally, as there were no medical summaries in the record noting DMII type symptoms within a year of his separation from active and his DMII diagnosis was approximately 24 years after he separated from active duty, there was no evidence of chronicity of symptomatology.

The third element of service connection is a nexus between the first two elements. The Veteran asserted in his May 2003 statement that asbestos exposure caused his hypertension, DMII and gout. The Veteran also submitted a May 2003 statement that the VA diagnosed his hypertension, DMII and gout and that he had never worked around or had exposure to any known cancer-causing agents or chemicals. As noted above, the Veteran has advised VA treatment providers that he worked for a paper mill shortly after separation from service and retired over thirty years later as a shipping foreman from the paper mill in 2007.

The October 2024 VA DMII nexus examiner noted that the record reflected evidence of non-deployment related TERA consistent with the Veteran's service. The Veteran's military occupational specialty included probable exposure to asbestos. The examiner opined that DMII was less likely than not caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities. Thus, the Board finds the nexus element has not been satisfied.

As the three elements of service connection have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred DMII in-service or as a result of a TERA in-service injury.

11. Entitlement to service connection for asthma is denied.

The December 2024 rating decision conceded a current disability of asthma and an inservice injury
the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred DMII in-service or as a result of a TERA in-service injury.

11. Entitlement to service connection for asthma is denied.

The December 2024 rating decision conceded a current disability of asthma and an inservice injury of a TERA. The decision also conceded an in-service injury of a TERA. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first and second elements of service connection, current asthma disability and an in-service injury due to TERA are satisfied.

During the Board hearing, the Veteran testified that while on active duty, he had shortness of breath, coughing and wheezing which continued to get worse after he left active duty. Hearing Transcript, pp. 25. The Veteran's STRs did not have any records noting shortness of breath or wheezing. He did have a cold in January 1970, an upper respiratory infection in March 1970, a sore throat in January 1971, nasal congestion in September 1971 and a "sinus drip" in October 1971. He testified that he went to a local doctor shortly after service for his respiratory condition. The Veteran also attributed his asthma as a result of asbestos exposure. Hearing Transcript, pp. 25, 26.

The December 2024 VA respiratory examination noted the Veteran was diagnosed with asthma in 2014. The Veteran advised the examiner that the onset was in 1994 and not shortly after service as he testified during the Board hearing. The Veteran advised the examiner that in 1994 he was experiencing shortness of breath upon exertion. The Veteran also advised the examiner that his condition has worsened over the years. The examiner noted the asthma diagnosis was mild and that the Veteran had not had an asthma attack in the last 12 months.

A June 2019 VA treatment record noted the Veteran had childhood asthma. The Board, however, notes that asthma was not listed on the Veteran's November 1969 enlistment examination. The October 2014 VA treatment record reflected the Veteran had a spirometry test which reflected the Veteran did not have COPD as there was no airway obstruction, but, instead had mild asthma with an intermittent wheeze. The Veteran checked that he did not have asthma on a February 2014 dental health history form. A February 2007 VA treatment record noted the Veteran had stopped smoking 15 years prior. There was a May 2003 VA treatment record noting that the Veteran had submitted a statement that he was exposed to asbestos and now had a breathing problem.

The Veteran's testimony regarding the onset of asthma symptoms while on active duty is inconsistent with the record and his previous statements to medical care providers. The Veteran was diagnosed with mild asthma in 2014 and there was no evidence in the record that he was diagnosed with asthma in 1994 or prior to 1994. The Veteran's testimony that he had shortness of breath and wheezing while on active duty is likewise not supported by the record. The Board finds that the persuasive weight of the evidence weighs against a finding that the Veteran had asthma while on active duty or shortly after separation from active duty. Additionally, the record has no evidence of continuity of symptomatology since separation from service. Accordingly, the second element of service connection based on an inservice illness is not satisfied.

The third element of service connection is the nexus between the Veteran's asthma and TERA during active duty. In this case, the December 2024 VA asthma nexus examiner opined that while asbestos exposure can trigger asthma symptoms in some individuals, current medical research does not definitively conclude that asbestos exposure directly causes asthma; there is no strong link between the two, and most studies show no significant association between asbestos exposure and the development of asthma. Therefore, the claimed condition was less likely than not caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Accordingly, the Board finds that the nexus element is not satisfied.

As the three elements of service connection have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred asthma in-service or as a result of a TERA in-service injury.

As the evidence
does not definitively conclude that asbestos exposure directly causes asthma; there is no strong link between the two, and most studies show no significant association between asbestos exposure and the development of asthma. Therefore, the claimed condition was less likely than not caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Accordingly, the Board finds that the nexus element is not satisfied.

12. Entitlement to service connection for gout is denied.

The December 2024 rating decision conceded a current disability of gout and asbestos exposure. The Board is bound by these favorable findings. 38 C.F.R. § 3.104. Thus, the Board finds the first element of service connection, a current gout disability, and the second element of service connection, an in-service injury due to asbestos exposure, are satisfied.

The Board notes that in a September 2003 statement, the Veteran asserted that his gout was caused by asbestos exposure. Decades later, the Veteran testified during the January 2026 Board hearing that he believed that his gout was caused by the water and food in the military. Hearing Transcript, pp. 26. As mentioned above, the TERA memorandum did not recognize the food and water served aboard the naval ship to which the Veteran was assigned as a TERA.

The second element of service connection may also be satisfied by an in-service illness. The Veteran testified that doctors told him that gout was caused by uric acid accumulating around the joints, and he was advised to limit the amount of red met that he ate. He also testified that his gout had a way of flaring up from time to time and that he thought it began during a time when he was in service after he started eating and drinking the water. Hearing transcript, pp. 26, 27.

The Veteran asserted in a May 2003 statement that he was diagnosed with gout by the VA. The Veteran also asserted in a July 2003 statement that he was first diagnosed with gout in 1992 by a local doctor. A November 2001 VA treatment record reflected a gout prescription. There is no evidence in the record to support the assertion that he was diagnosed with gout in 1992 and the Board notes, that 1992 was two decades after the Veteran separated from service.

There is no evidence that the Veteran complained of gout symptoms while on active duty and he sought medical care on numerous occasions. As noted in the sections above, the Veteran is not a reliable historian regarding the onset of his symptoms and illnesses. The Board finds that the second element of service connection, an in-service illness has not been satisfied. As noted above, the December 2024 rating decision conceded the alternative second element of service connection, an in-service injury, a TERA.

The third element of service connection is a nexus between the first two elements. The December 2024 VA gout nexus examiner opined that it was well established that hyperuricemia is a prerequisite of gout and that the risk of clinical gout increases in the presence of factors that increase serum urate levels. The examiner then referenced a study which demonstrated for the first time an association between occupational exposure to inorganic dust and incident gout. Based on this dust study, the examiner opined that it was at least as likely as not that the Veteran's gout was caused by the indicated toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The examiner, however, did not explain anything about the study to include how many participants nor did the examiner address the fact that an association is different from causation. The examiner did not explain the relevance of dust exposure to the presence of hyperuricemia or whether the study indicated that dust exposure without hypouricemia was associated with gout. Additionally, the TERA memorandum did not state that the Veteran was exposed to dust which was also not addressed by the VA gout nexus examiner. For these reasons, the Board finds the gout nexus opinion was inadequate
toxic exposure risk activity, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The Board is aware that there was a gout nexus opinion, albeit inadequate, but not a gout examination. The VA is not obligated to provide an examination for a medical nexus opinion where there is no supporting nexus evidence in the record. 38 U.S.C. § 38 C.F.R. § 5103A(d)(2)A and B; McLendon v. Nicholson, 20 Vet. App. 79 (2006); Duenas v. Principi, 18 Vet. App. 512, 519 (2004). The claimant's own conclusory lay assertion alone is not sufficient to render a VA examination or opinion necessary and does not trigger VA's duty to obtain a medical opinion to decide the claims. Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010).

As the three elements of service connection have not been satisfied, the Board finds that the persuasive weight of the evidence is against a finding that the Veteran incurred gout in-service or as a result of a TERA in-service injury.

13. Entitlement to an evaluation in excess of 10 percent for CAD is denied.

The Veteran's CAD is rated under Diagnostic Code 7005. 38 C.F.R. § 4.104, DC 7005.

Effective November 14, 2021, VA amended the rating criteria for arteriosclerotic heart disease (coronary artery disease) under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. 86 Fed. Reg. 54089 (Sep. 30, 2021). This amended regulation applies to all applications for benefits received by VA or that are pending before the AOJ on or after November 14, 2021. Claims pending prior to the effective date will be considered under both the pre- and post-amendment rating criteria, and whichever is more favorable to the Veteran will be applied. However, the Board may not apply the post-amendment rating criteria to a period prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Conversely, the Board is not precluded from applying the pre-amendment rating criteria to a period on or after the effective date of the post-amendment rating criteria so long as it was in effect during the pendency of the appeal.

The CAD pre-amendment rating criteria (prior to November 14, 2021) under 38 C.F.R. § 4.104, DC 7005, assigned a 10 percent rating is warranted where a workload of greater than 7.0 metabolic equivalents (METs) but not greater than 10.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication is required. A 30 percent rating is warranted where a workload of greater than 5.0 METs but not greater than 7.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or there is cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted where there is more than one episode of acute congestive heart failure in the past year, or a workload of greater than 3.0 METs but not greater than 5.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection
medication is required. A 30 percent rating is warranted where a workload of greater than 5.0 METs but not greater than 7.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or there is cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted where there is more than one episode of acute congestive heart failure in the past year, or a workload of greater than 3.0 METs but not greater than 5.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted where there is chronic congestive heart failure, or a workload of 3.0 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 30 percent.

Under the pre-amendment rating criteria, one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104, Note (2). When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. Id.

The amended rating criteria provides:

Effective November 14, 2021, under 38 C.F.R. § 4.104, DC 7005, CAD is rated in accordance with the General Rating Formula for Diseases of the Heart. A 10 percent rating is warranted where a workload of 7.1-10.0 METs results in heart failure symptoms, or continuous medication is required for control. A 30 percent rating is warranted where a workload of 5.1-7.0 METs results in heart failure symptoms, or where there is cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multi gated acquisition scan or magnetic resonance imaging). A 60 percent rating is warranted where a workload of 3.1-5.0 METs results in heart failure symptoms. A 100 percent rating is warranted where a workload of 3.0 METs or less results in heart failure symptoms.

Under the post-amendment rating criteria, one MET is the energy cost of standing body weight per minute. 38 C.F.R. § 4.104, Note (2). When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms may be used. Id.

For purposes of the General Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).

As an initial matter, an April 2024 rating decision implemented an April 2024 Board decision, which granted service connection for his CAD. The CAD disability was assigned a 10 percent rating effective December 1, 2017, the date VA received an Intent to File a claim that was followed within one year by the Veteran's claim for service connection for CAD in January 2018. Accordingly, the Board will evaluate the Veteran's disability under both versions of DC 7005 and apply the version most beneficial to the Veteran.

By way of background, in September 2008, the Veteran's private practice physician, Dr. J.O., submitted a letter stating that Dr. J.O. and the Veteran's private cardiologist, Dr. A.M. had the Veteran hospitalized because of an uncontrollable history of tachycardia. The letter further stated that the Veteran was unable to work because of his rapid pulse. The letter also noted the Veteran had hypertension, hyperlipidemia and diabetes. In June 2008, Dr. A.M noted on insurance forms that the Veteran had a
in January 2018. Accordingly, the Board will evaluate the Veteran's disability under both versions of DC 7005 and apply the version most beneficial to the Veteran.

By way of background, in September 2008, the Veteran's private practice physician, Dr. J.O., submitted a letter stating that Dr. J.O. and the Veteran's private cardiologist, Dr. A.M. had the Veteran hospitalized because of an uncontrollable history of tachycardia. The letter further stated that the Veteran was unable to work because of his rapid pulse. The letter also noted the Veteran had hypertension, hyperlipidemia and diabetes. In June 2008, Dr. A.M noted on insurance forms that the Veteran had a syncope episode in October 2007. Dr. A.M's first diagnosis was CAD, the second diagnosis hypertension, and the third diagnosis syncope. On an August 2008 insurance form, Dr. A.M. noted that the Veteran's diagnosis/disability was diabetes, hypertension, increased lipids, dizziness, and increased heart rate. The October 2008 echocardiogram report noted that the findings were consistent with systemic hypertension.

The Veteran filed for a non-service-connected pension in October 2008. The VA October 2008 examination report noted CAD with complications of tachycardia, dizziness, syncope, dyslipidemia, and hypertension. The Veteran advised the VA examiner that he had a syncope episode with dizziness in 2008 and the onset was in 2006.

The March 2025 VA heart condition examiner noted the Veteran had hypertension, CAD, and a mitral valve insufficiency. The Veteran advised the examiner that his symptoms began in 1970 when he began experiencing shortness of breath and was referred to a cardiologist who diagnosed CAD. As noted above, CAD was diagnosed in 2008, over three decades after the Veteran separated from service. The Veteran advised the examiner that his current symptoms were shortness of breath, chest pain at times, and dizziness.

The March 2025 examiner opined that the Veteran's MET level of greater than seven, but not greater than ten based solely on the Veteran's current cardiac functional level. The examiner noted there were no arrythmias, no cardiac dilation. and no cardiac hypertrophy. The Veteran's 2008 echocardiogram reflected a left ventricular ejection fraction (LVEF) of 55 percent which is a more accurate finding regarding cardiovascular manifestations alone. A normal left ventricular wall with mild concentric left ventricular hypertrophy was also noted. The Board notes that the October 2008 electrocardiogram report noted a LVEF rate of 55 to 60 percent, noting mild concentric left ventricular hypertrophy. Another echocardiogram was done in June 2009 which reflected a LVEF rate of 50 to 55 percent and no hypertrophy was noted. An October 2012 echocardiogram reflected an LVEF rate of 60 to 65 percent and moderate left ventricular hypertrophy.

The VA Manual for rating disabilities, V.iii5.3.f. addresses the long-term effects of hypertension and notes that hypertension can increase the cardiac load as to result in hypertrophy of the cardiac muscle or cardiac dilation. The Manual notes that if sufficiently severe, it can cause arteriosclerosis of uneven distribution. The Veteran is not service connected for hypertension and the record reflected that his hypertension began in approximately 1994. Accordingly, the hypertension existed for approximately a decade before CAD was diagnosed in 2007.

The Veteran testified during the January 2026 Board hearing that a doctor has not restricted his activity. He testified that he restricted his own activity. He additionally testified that he needed help with everyday tasks such as cooking, cleaning, taking a shower, and getting clothes ready. Hearing Transcript, pp. 31. A September 2018 Veteran statement noted that he had someone to assist him with daily tasks after he broke his right leg. The caretaker submitted a June 2017 statement that she assisted the Veteran with meal preparation, showering, food shopping and dressing as a result of his right leg which he broke in two places in April 2013. The caretaker also stated that she drove the Veteran to doctor appointments.

The March 2025 examiner noted that the Veteran takes medication for hypertension but no medication for a heart condition. The Veteran advised the examiner that he occasionally had chest pain. A few months later, during the January 2026 Board hearing, the Veteran testified that he was having intense chest pain weekly, sometimes twice a week, for which he used nitroglycerin pills daily. He also testified that he had shortness of breath and could only walk 20 to 25 feet before he had to stop and could only talk for a short length of time before he had shortness of breath. He further testified that he had heart flutters and palpitations on a weekly basis, along with dizziness and falling. He took meclizine daily for the dizziness but testified that it never helped much. Hearing Transcript, pp. 28, 29, 30. The Board notes that during the October 2024 Board hearing, the Veteran testified that his heart medicine was nitroglycerin and he "sometimes took nitroglycerin." Hearing Transcript, pp. 6. There were no medical summaries in the record to reflect that the Veteran's symptoms had significantly deteriorated or changed as he described during the January 2026 hearing.

A June 2024 VA treatment record noted that the Veteran had intermittent dizziness for the last several months. The Veteran described an intermittent feeling of unsteadiness when standing or with prolonged ambulation. He noted the symptoms improved with sitting and completely resolved after five to ten minutes. The Veteran reported that he has been taking meclizine for management, which he stated improved his symptoms but did not completely resolve the symptoms. Contrary to his Board testimony, the Veteran denied nausea, vision changes, shortness of breath, palpitations, numbness/tingling, trauma, or falls.

The medical treatment notes in the record did not reflect that the Veteran had shortness of breath with talking or very limited movement. The medical records that did contain a reference to a breathing issue were in the context of asthma and the Veteran's assertion that he had chronic obstructive pulmonary disease. A September 2016 VA treatment record noted that the provider requested the Veteran discontinue trazadone, oxybutynin, and decrease gabapentin for trial periods to see if his dizziness improved. The record did not reflect whether the Veteran complied.

An October 2012 letter advised the Veteran that his echocardiogram reflected he had a strong heart, and leaky/malfunctioning heart valves which required no treatment at that time and an enlarged heart likely due to high blood pressure. A May 2012 VA treatment record noted the Veteran had seen ENT and neurology about his dizziness and hypoglycemia and hypotension were the suspected causes of the dizziness. A Holter monitor did not reflect any obvious causes of the Veteran's symptoms. A July 2010 VA treatment record noted that the Veteran's syncope was probably due to hypo/hyperglycemic episodes. A 2007 cardiologist record did not reflect that the syncope was a symptom of the Veteran's CAD as it listed three separate diagnoses, CAD, hypertension and syncope.

A June 2022 VA treatment record noted that the Veteran stated that his dizziness began several years prior and had not improved nor worsened since onset. The provider noted that the Veteran did not check his blood pressure when the dizziness occurred and noted that the Veteran stated that meclizine improved his symptoms. The Veteran denied a positional nature of the dizziness, and denied nausea, vomiting, chest pains, palpitations, shortness of breath, abdominal pain, or incontinence of bowel or bladder.

During the January 2026 Board hearing, the Veteran testified that he saw a doctor for his mental health one to two months after separation from service because he was having flashbacks, hallucinations, dizziness and had poor balance causing him to fall down. Hearing Transcript, pp. 13. He also testified that he had dizziness and nausea in service which he associated with his hypertension. Hearing Transcript, pp. 22. The Board notes that in March 2009, the Veteran advised a VA provider that he had a syncopal episode two weeks prior and had to retire in 2007 due to a syncopal episode and dizziness. The Veteran's testimony reflected that he also recognized that his dizziness and syncope may not be attributable to his CAD.

The extent of the inconsistencies in the Veteran's hearing testimony and the record render him an unreliable historian of the onset, description and frequency of his symptoms.

The record did not reflect that the Veteran was on any continuous medication
. Hearing Transcript, pp. 13. He also testified that he had dizziness and nausea in service which he associated with his hypertension. Hearing Transcript, pp. 22. The Board notes that in March 2009, the Veteran advised a VA provider that he had a syncopal episode two weeks prior and had to retire in 2007 due to a syncopal episode and dizziness. The Veteran's testimony reflected that he also recognized that his dizziness and syncope may not be attributable to his CAD.

The extent of the inconsistencies in the Veteran's hearing testimony and the record render him an unreliable historian of the onset, description and frequency of his symptoms.

The record did not reflect that the Veteran was on any continuous medication for CAD. The VA heart examiner noted medication for hypertension, for which the Veteran is not service connected. The record reflected that to the extent the Veteran had shortness of breath, it was the result of his asthma or other respiratory condition for which he is also not service connected. Moreover, the Veteran testified during the October 2024 Board hearing, that he had experienced dizziness with active-duty training activities. Hearing Transcript, pp. 6. If correct, this reflected the Veteran's dizziness was not the result of CAD which was diagnosed many years later. Additionally, as noted above, several medical records suggested that the Veteran's dizziness was the result of his hypertension, medications or hypo/hyperglycemic events.

Prior to November 14, 2021, under 38 C.F.R. § 4.104, DC 7005, a 10 percent rating is warranted where a workload of greater than 7.0 metabolic equivalents (METs) but not greater than 10.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication is required. The evidence of record did not reflect that the Veteran was on continuous medication for CAD. The record also did not reflect that the Veteran had fatigue, angina, dizziness, or syncope as a result of METs greater than 7 but not greater than 10. To the extent the Veteran had any of these symptoms, the record reflected they were likely due to other conditions for which he was not service connected, to include DMII and hypertension.

Accordingly, the record does not support the Veteran's CAD meets the criteria for a 10 percent evaluation under the prior or current heart rating criteria. As he does not meet the criteria for a 10 percent evaluation, an evaluation in excess of 10 percent for CAD is not warranted.

The persuasive weight of the evidence weighs against a finding that the Veteran's CAD caused an impairment in excess of a 10 percent evaluation. The Board has considered the benefit of the doubt doctrine and determined it is not applicable.

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As the evidence is persuasively against the Veteran's claim for an evaluation in excess of 10 for CAD, the evidence is not in approximate balance, and the benefit of the doubt rule does not apply. Therefore, the claim must be denied. See 38 U.S.C. § 5107(b); 38 CFR § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board W. Polk

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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