APLASTIC ANEMIA ACQUIRED

EMILY TAMLYN · 2026 · Case ID: A26038061

MIXED

Summary

The veteran, who served in the U.S. Army from June 1970 to June 1973 and later in the Florida Army National Guard, appeals the denial of service connection for several conditions. The veteran sought service connection for anemia, chronic bronchitis, chronic kidney disease (CKD), GERD, and a bilateral ankle disorder, all claimed to be due to toxic exposure during service. Additionally, the veteran claimed erectile dysfunction as secondary to service-connected disabilities and sought service connection for a left knee disorder. The Board found the January 2024 VA medical opinions to be less persuasive due to their lack of consideration for toxic exposure and reliance on insufficient evidence. In contrast, a December 2025 private clinician's opinion was afforded significant weight, thoroughly addressing the nexus between toxic exposures and the development of anemia, chronic bronchitis, CKD, and GERD, supported by medical literature and the veteran's service records. The private opinion also linked the bilateral ankle disorder to the nature and circumstances of the veteran's service. The Board found the evidence in approximate balance for these conditions and resolved doubt in the veteran's favor, granting service connection. For erectile dysfunction, the Board found the private opinion adequate, linking it to the Veteran's GERD, and granted service connection based on approximate balance and the benefit of the doubt. The claim for a left knee disorder was remanded due to a pre-decisional duty to assist error, as the veteran had documented in-service injury and current diagnosis of knee arthritis, but no VA examination was provided to assess the nexus.

Rationale

Private clinician opinion found anemia related to service and toxic exposures.; VA examiner found no current diagnosis and no relationship to TERA.; Board found private opinion more persuasive due to detailed rationale and medical citations.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

240206-416742

Full Decision Text

Citation Nr: A26038061
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 240206-416742
DATE: April 23, 2026

ORDER

Entitlement to service connection for anemia, to include as due to exposure to toxins, is granted.

Entitlement to service connection for chronic bronchitis, to include as due to exposure to toxins. is granted.

Entitlement to service connection for chronic kidney disease (CKD), to include as due to exposure to toxins, is granted.

Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as due to exposure to toxins, is granted.

Entitlement to service connection for a bilateral ankle disorder, claimed as loss of motion, is granted.

Entitlement to service connection for erectile dysfunction, to include as due to service-connected disabilities, is granted.

REMANDED

Entitlement to service connection for a left knee disorder is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, anemia is related to service.

2. Resolving reasonable doubt in the Veteran's favor, chronic bronchitis is related to service.

3. Resolving reasonable doubt in the Veteran's favor, CKD is related to service.

4. Resolving reasonable doubt in the Veteran's favor, GERD is related to service.

5. Resolving reasonable doubt in the Veteran's favor, a bilateral ankle disorder, claimed as loss of motion, is related to service

6. Resolving reasonable doubt in the Veteran's favor, erectile dysfunction is due to the Veteran's service-connected disabilities.

CONCLUSIONS OF LAW

1. The criteria for service connection for anemia, to include as due to exposure to toxins, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for chronic bronchitis, to include as due to exposure to toxins, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for CKD, to include as due to exposure to toxins, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for GERD, to include as due to exposure to toxins, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for a bilateral ankle disorder, claimed as loss of motion, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for erectile dysfunction as secondary to service-connected disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from June 1970 to June 1973. The Veteran also had service in the Florida Army National Guard.

The rating decision on appeal was issued in January 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the February 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 12, 2025.

Therefore, the Board may only consider the evidence of record at the time of the January 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted
only consider the evidence of record at the time of the January 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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

However, because the Board is remanding the claim of entitlement to service connection for a left knee disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103 (c)(2)(ii).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Establishing service connection generally requires competent evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after separation when 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, including arthritis, may be service connected on a presumptive basis if manifested to a compensable degree in a specified period of time post-service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. That period of time is usually one year. 38 C.F.R. § 3.307 (a)(3). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303 (b).

Under 38 C.F.R. § 3.303 (b), an alternative method of establishing an in-service disease or injury and a nexus for chronic diseases is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; 38 C.F.R. § 3.303 (b).

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 subject to lay observation. 38 U.S.C. § 1154 (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). Lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson
§ 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). Lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Under 38 U.S.C. § 101 (24) "active military, naval, or air service" includes active duty; any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in the line of duty; and any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred in or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident that occurred during such training.

For the purposes of determining service connection based on Reserve service, ACDUTRA means full-time training duty, where the service member is available for duty around-the-clock performed by the Reserve components. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). Annual two-week training is an example of ACDUTRA. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA. 38 U.S.C. §§ 101 (24), 106, 1110, 1131.

Generally, when a claim for service connection is based only on a period of ACDUTRA or INACDUTRA, there must be evidence the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during that period of ACDUTRA or INACDUTRA for service connection to be granted. 38 U.S.C. §§ 101 (2), (22), (24); 38 C.F.R. § 3.6 (a); Donnellan v. Shinseki, 24 Vet. App. 167 (2010); Acciola v. Peake, 22 Vet. App. 320, 324 (2008). In the absence of such evidence, the period of ACDUTRA or INACDUTRA would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" for that period of ACDUTRA or INACDUTRA service alone. 38 U.S.C. § 101 (2), (24); Acciola, 22 Vet. App. at 324.

Specifically, service connection may also be granted for disability resulting from disease or injury incurred during ACDUTRA or injuries incurred during INACDUTRA, or from an acute myocardial infarction (heart attack), a cardiac arrest or a cerebrovascular accident (stroke), which occurred during such training. 38 U.S.C. §§ 101 (24), 106; 38 C.F.R. § 3.6 (a). 38 C.F.R. § 3.6 (a) permits service connection for acute myocardial infraction, a cardiac arrest, or a cerebrovascular accident which occurred during INACDUTRA training.

Generally, no presumptions (including the presumptions of soundness, aggravation, or for presumptive diseases) apply to periods of ACDUTRA and INACDUTRA unless "veteran" status is attained during those periods. Paulson v. Brown, 7 Vet. App. 466, 470 (1995). As to the presumption of soundness, it does not apply to an appellant who had only ACDUTRA service and who is not otherwise a veteran. Id. Even for veterans who have achieved "veteran" status through a prior period of active service and now claim a disability incurred only during a later period of ACDUTRA, the presumption of soundness applies only when the veteran has been "examined, accepted, and enrolled for service" and where that examination revealed no "defects, infirmities, or disorders." Valerie Y. Smith v. Shinseki, 24 Vet. App. 40
Paulson v. Brown, 7 Vet. App. 466, 470 (1995). As to the presumption of soundness, it does not apply to an appellant who had only ACDUTRA service and who is not otherwise a veteran. Id. Even for veterans who have achieved "veteran" status through a prior period of active service and now claim a disability incurred only during a later period of ACDUTRA, the presumption of soundness applies only when the veteran has been "examined, accepted, and enrolled for service" and where that examination revealed no "defects, infirmities, or disorders." Valerie Y. Smith v. Shinseki, 24 Vet. App. 40, 45-46 (2010). In essence, there must be an entrance examination prior to the period of ACDUTRA (or INACDUTRA) in which the appellant claims the disease or injury occurred; otherwise, the presumption of soundness does not attach. Id. at 45-46. Moreover, if the appellant has not achieved "veteran" status through a prior period of service, then the presumption of soundness does not attach to a period of ACDUTRA (or INACDUTRA), no matter if an examination occurred prior to the period of ACDUTRA (or INACDUTRA). Id.

With respect to a claim for aggravation of a preexisting condition during a period of ACDUTRA or INACDUTRA, in order for a claimant to establish "veteran" status, the claimant must demonstrate both elements of aggravation (1) that the preexisting disability permanently worsened in service, and (2) that such worsening was beyond the natural progression of the disease (i.e., such worsening was caused by service). See Donnellan, 24 Vet. App. 167. In such instances, the claimant is not entitled to the easier presumption of aggravation standard. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a). The standard of proof for the claimant is the "benefit of the doubt" standard; thus, the claimant must only show that there is an approximate balance of positive and negative evidence to prevail on this matter. See Donnellan, 24 Vet. App. 167. There is no shifting burden to VA as there is when the presumptions of soundness and aggravation apply. Id. Accordingly, the burden to establish incurrence or aggravation in service remains with the Veteran.

1. Entitlement to service connection for anemia

2. Entitlement to service connection for chronic bronchitis

3. Entitlement to service connection for chronic kidney disease

4. Entitlement to service connection for GERD

5. Entitlement to service connection for a bilateral ankle disorder, claimed as loss of motion

The Veteran contends that his anemia, chronic bronchitis, chronic kidney disease, GERD, and a bilateral ankle disorder are attributable to his active military service, and he seeks service connection.

To afford the Veteran the broadest possible scope for his claim, the issue of service connection for loss of motion has been recharacterized accordingly to that of entitlement to service connection for a bilateral ankle disorder. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009).

Turning to the record, the Veteran's service treatment records (STRs) reveal an April 1970 Report of Medical Examination (RME) that shows normal clinical evaluations for the lungs and chest, abdomen, genitourinary system, and endocrine system. In April 1971, the Veteran complained of a productive cough. In December 1971, the Veteran complained of chest pains and was assessed with pleurisy. A March 1973 Report of Medical History (RMH) from the time of separation reveals that the Veteran denied a frequent cough, frequent indigestion, "trick" or locked knee, kidney stones, and chronic or frequent colds.

Additionally, STRs from the Veteran's time in the Florida Army National Guard reveal an October 1974 RME, not during a period of active duty, that shows normal clinical evaluations for the lungs and chest, abdomen, genitourinary system, and endocrine system. In an accompanying RMH from October 1974, the Veteran continued to deny a frequent cough, frequent indigestion, "trick" or locked knee, kidney stones, and chronic or frequent colds. Likewise in a periodic RME from a non-active duty period from October 1978 clinical evaluations of the lungs and chest, abdomen, genitourinary system, and endocrine system were noted to be normal and the Veteran continued to deny
Additionally, STRs from the Veteran's time in the Florida Army National Guard reveal an October 1974 RME, not during a period of active duty, that shows normal clinical evaluations for the lungs and chest, abdomen, genitourinary system, and endocrine system. In an accompanying RMH from October 1974, the Veteran continued to deny a frequent cough, frequent indigestion, "trick" or locked knee, kidney stones, and chronic or frequent colds. Likewise in a periodic RME from a non-active duty period from October 1978 clinical evaluations of the lungs and chest, abdomen, genitourinary system, and endocrine system were noted to be normal and the Veteran continued to deny a frequent cough, frequent indigestion, "trick" or locked knee, kidney stones, and chronic or frequent colds in an October 1978 RMH.

The Veteran was afforded a series of VA examinations in January 2024 in connection with these claims. With respect to the Veteran's claim for anemia, the examiner found that the Veteran did not have a current diagnosis. The examiner explained that there was no relationship between anemia and a toxic exposure risk activity (TERA).

With respect to the Veteran's claimed chronic bronchitis, the examiner found that the Veteran has current diagnoses of chronic bronchitis and chronic airway obstruction. The examiner opined that the Veteran's chronic bronchitis was not due to a TERA because the examiner found that there was no relationship between chronic bronchitis and a TERA.

Likewise, the examiner found that the Veteran has a current diagnosis of chronic kidney disease, stage 3, in regards to the claimed kidney disorder. The examiner opined that the Veteran's chronic kidney disease was not due to a TERA because the examiner found that there was no relationship between chronic kidney disease and a TERA.

In the January 2024 VA examination for esophageal disorder, the examiner found that the Veteran does not have a current diagnosis of GERD or any other disorder pertaining to esophageal conditions. The examiner explained that there was no relationship between GERD and a toxic exposure risk activity (TERA).

VA treatment records from November 2023 reveal that the Veteran has a current diagnosis of anemia listed in the active problem list. Likewise, in September 2019, it was reported that the Veteran had GERD, noted as a small sliding hiatal hernia on barium swallow testing. VA treatment records from October 2023 reveal that the Veteran has a diagnosis of ankle arthritis.

In December 2025, the Veteran testified at a Board hearing. The Veteran testified that he was in the military when he was diagnosed with anemia. Further, the Veteran explained that he reported feeling dizzy to his supply sergeant, but that he did not seek medical treatment in-service. The Veteran described that during service he developed a cough. The Veteran also explained that during service he experienced urinary dysfunction. The Veteran testified that he experienced symptoms of GERD during training and that his bronchitis began during service. The Veteran further testified that during service he fell down a stairway and that he now has constant pain in his ankles.

In March 2026, the Veteran submitted a December 2025 opinion of a private clinician in support of his claims. The clinician found that the Veteran's anemia is attributable to his military service and associated environmental exposures. In support of this conclusion, the clinician referenced medical literature in explaining that toxic exposures can contribute to inflammation, bone marrow suppression, renal dysfunction, and impaired erythropoiesis, which are all recognized mechanism in the development of anemia.

Likewise, the private clinician found that the Veteran's chronic bronchitis is related to his military service. In particular, the clinician explained that the Veteran reported persistent cough, wheezing, and shortness of breath, during or shortly after active service, with symptoms that have continued and progressively worsened over time. Referencing medical literature, the clinician further noted that the Veteran's exposure to toxins during service is medically consistent with the development of chronic bronchitis.

Further, the private clinician determined that the Veteran's chronic kidney disease (CKD), is related to his military service. The clinician explained that CKD is recognized to evolve silently following cumulative toxic and environmental exposures, and that the Veteran's medical records support a chronic and progressive pattern of renal impairment, which is medically consistent with sustained kidney damage rather than transient dysfunction.

Equally, the private clinician found that the Veteran's GERD is attributable to his active military service. The clinician noted that the Veteran's exposure to fuels, solvents, and other chemical agents known to irritate the gastrointestinal tract and contribute to chronic reflux pathology. As such, the clinician explained that the Veteran's continuous post-service symptomatology, objective diagnostic findings, and exposure to toxins during service, the Veteran's GERD represents a progression of gastrointestinal symptoms that first manifested during active military service.

Additionally, the private clinician found that the Veteran's bilateral ankle disorder was caused by his military service. The clinician explained that nature and circumstances of the Veteran's service is medically consistent with a chronic musculoskeletal condition resulting from cumulative mechanical stress.

Where conflicting medical opinions are given, there must be an assessment of the opinions. When assessing the probative value of a medical opinion, the access to claims files and the thoroughness and detail of the opinion must be considered. The opinion is considered probative if it is definitive and supported by detailed rationale. See Prejean v. West, 1 Vet. App. 444, 448-9 (2000). The Court has held that claims file review, as it pertains to obtaining an overview of a claimant's medical history, is not a requirement for private medical opinions. A medical opinion that contains only data and conclusions is not entitled to any weight. Further, a review of the claims file cannot compensate for lack of the reasoned analysis required in a medical opinion, which is where most of the probative value of a medical opinion comes from. "It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2009).

The Board finds the January 2024 VA medical opinions are of less persuasive value. In this regard, the January 2024 VA examiners provided opinions without considering the extent of the Veteran's exposure to toxins during service in rendering negative etiological opinions. Moreover, the VA medical opinions specifically pointed to a lack of evidence as the foundation for the negative opinions, which is not allowed. As such, these opinions are not afforded significant weight.

In comparison, the December 2025 private clinician provided extensive consideration of the Veteran's service treatment records as well as the nature and circumstances of the Veteran's military occupation while on active service. Moreover, the December 2025 opinion provided thorough discussion on the impact of exposure to toxins and the development of each of the Veteran's relevant claimed disabilities discussed above in rendering positive opinions. Further, the December 2025 opinions contained complete citations to medical journals in support of the opinions. Therefore, the Board affords significant probative weight to these opinions.

In light of the evidence as discussed above, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's claimed anemia, chronic bronchitis, chronic kidney disease, GERD, and bilateral ankle disorder began in service and the symptoms of these disabilities have continued since service to the present. The evidence documents that the Veteran exposure to toxins was presumed by VA and the December 2025 private medical opinion determined that such exposure resulted in the Veteran's claimed anemia, chronic bronchitis, CKD, and GERD. Additionally, the evidence shows that the Veteran has a current diagnosis of bilateral ankle arthritis and the December 2025 private medical opinion found that this was caused by service. Significantly, the Board has found the December 2025 private opinion adequate.

In conclusion, with resolution of reasonable doubt in the Veteran's favor, the claims for service connection for anemia, chronic bronchitis, chronic kidney disease, GERD, and a bilateral ankle disorder are granted.

6. Entitlement to service connection for erectile dysfunction, to include as due to service-connected disabilities

The Veteran contends that his erectile dysfunction is due to his exposure to toxins during service. Alternatively, the Veteran contends that his erectile dysfunction is due to his service-connected disabilities.

6. Entitlement to service connection for erectile dysfunction, to include as due to service-connected disabilities

Secondary service connection will be granted if the evidence demonstrates that a current disability is proximately due to or the result of, or is aggravated beyond its natural progression, by a service-connected disability. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. The United States Court of Appeals for the Federal Circuit recently clarified that, as contemplated by 38 U.S.C. § 1110, secondary aggravation will be shown where a non-service-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two conditions, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).

Turning to the record, the Veteran's STRs reveal that in September 1971, the Veteran was diagnosed with a venereal disease.

VA treatment records show that since at least December 2016, the Veteran has an active prescription for medication based on a diagnosis of erectile dysfunction.

In December 2025, the Veteran testified at a Board hearing. The Veteran also explained that during service he contracted a venereal disease, which then caused his erectile dysfunction. Furthermore, the Veteran described experiencing urinary dysfunction during his active service.

In March 2026, the Veteran submitted a December 2025 opinion from a private clinician. The clinician opined that the Veteran's current erectile dysfunction was caused by the medications used to treat his psychiatric disorder and GERD. In this regard, the clinician noted that the chronicity of the Veteran's erectile dysfunction symptoms, lack of sustained response to standard therapies, and need for escalating interventions indicates a persistent disorder rather than a transient side effect due to longterm use of medications for psychiatric disorders and GERD.

The Board finds this medical opinion is fully adequate. Here, the opinion writer fully addressed the nexus question. The opinion reflects that the writer reviewed the file, provided full citation to medical literature, and provided an informed opinion fully responsive to the question at issue. See Nieves-Rodriguez, 22 Vet. App. at 295. This opinion is valuable and is afforded great weight.

In light of the grant of service connection for GERD discussed above, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's erectile dysfunction was caused by his now service-connected GERD. The evidence shows that the Veteran is service-connected for GERD and the December 2025 private medical opinion found that but for the Veteran's GERD, the Veteran would not have erectile dysfunction. Moreover, there are no contrary opinions in the record. Therefore, resolving reasonable doubt in the Veteran's favor, entitlement to service connection for erectile dysfunction is warranted.

REASONS FOR REMAND

Entitlement to service connection for a left knee disorder is remanded.

The Veteran seeks service connection for a left knee disorder, which he asserts is due to his active military service.

VA treatment records reveal that the Veteran has been seen and treated for a left knee disability, to include having a left knee replacement. Moreover, VA treatment records reveal that the Veteran has a current diagnosis of osteoarthritis of the knee.

The Veteran's STRs reveal that the Veteran was seen and treated for a left foot injury in December 1971.

To date the Veteran has not been afforded a VA examination to determine the nature and etiology of his claimed left knee disorder.

VA must provide an examination where the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but contains: (1) competent evidence of diagnosed disability or symptoms of disability, (2) establishes an event, injury or disease in-service, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease. 38 C.F.R. § 3.159 (c)(4) (2019); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the evidence need only "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible
evidence of record does not contain sufficient competent medical evidence to decide the claim, but contains: (1) competent evidence of diagnosed disability or symptoms of disability, (2) establishes an event, injury or disease in-service, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease. 38 C.F.R. § 3.159 (c)(4) (2019); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the evidence need only "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology).

Here the Veteran's STRs show that he injured his left lower extremity during service and VA treatment records reveal that he has a diagnosis of left knee arthritis.

Therefore, the Board finds that pre-decisional duty to assist error was committed because the AOJ failed to schedule the Veteran for the appropriate VA examination. When the Board identifies a pre-decisional duty to assist error, under 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c), 20.802(a), the Board must remand the appeal back to the AOJ with instructions to correct the error.

The matters are REMANDED for the following action:

1. Schedule the Veteran with the appropriate VA examiner to determine the nature and etiology of the Veteran's left knee disorder. The entire electronic claims file must be reviewed, and such review must be documented in the report. The report should include discussion of the Veteran's documented medical history and assertions. All indicated tests should be accomplished and all clinical findings should be reported in detail and any earlier reports should be reconciled, if necessary.

The examiner should opine as to whether the Veteran's left knee disorder is related to service. In rendering this opinion, the examiner must consider the Veteran's statements regarding the onset of his condition and continuity of symptomatology.

In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements of continuity of symptoms since service and may not disregard those statements merely because there was no treatment.

The rationale for all opinions expressed must be provided and the examiner must clearly articulate the reasons for his or her conclusions. If an opinion cannot be provided without resort to speculation, it must be noted in the opinion report, and a rationale should be provided for that conclusion.

2. Readjudicate the claim.

Emily Tamlyn

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Scanlan, Counsel

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

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