EPILEPSY GRAND MAL

Summary

The veteran served from July 1987 to July 1991, including service in the Persian Gulf. The veteran appeals the denial of service connection for several conditions: tonic-clonic seizures, GERD with hiatal hernia, alcohol use disorder, depressive disorder, anxiety disorder, spigelian hernia, and deep vein thrombosis pulmonary embolism. The Board conceded current diagnoses for seizures, GERD, alcohol use disorder, anxiety, and depressive disorder, finding the first element of service connection met. Service treatment records documented gastroenteritis for the GERD claim and a mental health evaluation for the psychological claims, satisfying the second element for those. However, for all these conditions, the Board found the nexus element lacking. VA examiners opined that the seizures were less likely than not related to service, attributing them to alcohol withdrawal. The GERD was deemed not chronic, and the psychological conditions were found less likely than not related to service, with the examiner noting pre-service alcohol issues and no specific stressor. For spigelian hernia and deep vein thrombosis, the Board found no evidence of in-service event, injury, or incurrence. Consequently, all these claims were denied. The claim for Gulf War syndrome was remanded due to a duty to assist error, as a general Gulf War examination was requested but not conducted.

Rationale

Current diagnosis conceded; Persian Gulf service satisfies second element; VA examiner opined less likely than not related to service

Full Decision Text

Citation Nr: A26038465
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 210616-166462
DATE: April 24, 2026

ORDER

Entitlement to service connection for tonic-clonic, or grand mal, seizures is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD) with hiatal hernia is denied.

Entitlement to service connection for alcohol use disorder, depressive disorder, and anxiety disorder is denied.

Entitlement to service connection for spigelian hernia is denied.

Entitlement to service connection for deep vein thrombosis pulmonary embolism is denied.

REMANDED

Entitlement to service connection for gulf war syndrome is remanded.

FINDINGS OF FACT

1. The Veteran's tonic-clonic or grand mal seizures are less likely than not related to his active service.

2. The Veteran's GERD with hiatal hernia is less likely than not related to his active service.

3. The Veteran's alcohol use disorder, depressive disorder, and anxiety disorder are less likely than not related to his active service.

4. The evidence of record does not identify an in-service event, injury, or incurrence related to the Veteran's spigelian hernia.

5. The evidence of record does not identify an in-service event, injury, or incurrence related to the Veteran's thrombophlebitis of the right leg.

CONCLUSIONS OF LAW

1. The criteria for service connection for tonic-clonic, or grand mal, seizures 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 GERD 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 alcohol use disorder, depressive disorder, and anxiety disorder 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 spigelian hernia 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 deep vein thrombosis pulmonary embolism have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from July 1987 to July 1991.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2020 rating decision by a Department of Veterans Affairs (VA) regional office (RO). The Veteran timely appealed by submitting a June 2021 VA Form 10182 and requested the Hearing docket. A January 2025 notification advised the Veteran that a hearing was scheduled for March 18, 2025. The Veteran did not appear for the scheduled Board hearing.

Therefore, the Board may only consider the evidence of record at the time of the September 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the scheduled hearing. 38 C.F.R. § 20.302(c). If evidence was submitted either: (1) during the period after the AOJ issued the decision and prior to the scheduled Board hearing, or; (2) more than 90 days following the scheduled hearing, then 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 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.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of
 consider any evidence 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.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) an 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).

1. Entitlement to service connection for seizures, GERD, and a psychiatric disability. 

The Veteran asserts he is entitled to service connection for a seizure disorder, GERD, and psychiatric disabilities including anxiety, depression, and alcohol use disorder. See March 2020 VA 21-526EZ. 

VA has conceded the Veteran has the following current diagnoses: tonic-clonic, or grand mal, seizures; GERD with hiatal hernia; alcohol use disorder; anxiety disorder; and depressive disorder. Under the Appeals Modernization Act (AMA), the Board is bound by favorable findings unless they are rebutted by clear and unmistakable evidence. 38?C.F.R. §§?3.104(c); 20.801(a). After a thorough review of the Veteran's electronic claim file, the Board concludes that such clear and unmistakable evidence does not exist. Therefore, the first element of service connection is met for these claims. 

Regarding an in-service event or incurrence, the Veteran has documented service in the Persian Gulf. This is sufficient to satisfy this element for the seizures claim. For the GERD claim, the Veteran's service treatment records document treatment for gastroenteritis. For the psychological disabilities, the Veteran's service treatment records document a mental health evaluation. Therefore, the second element of service connection is met for these claims.

Turning to the final element, a nexus between the Veteran's service and his current disabilities, the evidence of record does not support nexus findings for these claims. In June 2020, a VA examiner opined that the Veteran's diagnosed seizure disorder was less likely than not related to his service because evidence of record is consistent with seizure disorder caused by alcohol withdrawal. See June 2020 C&P Exam. Also in June 2020, a VA examiner opined that the Veteran's in-service gastroenteritis was acute only, with no evidence of chronicity of care until the Veteran's GERD began in 2004 fourteen years after separation from service. See June 2020 C&P Exam. Lastly, regarding the psychological disabilities, a VA examiner opined in September 2020 that the Veteran's diagnosed psychological disabilities were less likely than not due to his service. See September 2020 C&P Exam. The examiner reasoned that the Veteran had problems with alcohol prior to joining the military, and that there is no evidence that his alcohol use is related to an underlying mental condition or any particular stressor event. The examiner opined that the Veteran's anxiety and depressive disorders are related to and secondary to the Veteran's alcohol use disorder. 

There is no alternative positive nexus evidence of record. Therefore, there is no reasonable doubt to be resolved. In summation, the evidence of record supports that the Veteran's tonic-clonic or grand mal seizures, GERD with hiatal hernia, and psychological disorders are less likely than not related to his active service. Therefore, the criteria for service connection for these disabilities have not been met and service connection must be denied.

2. Entitlement to service connection for spigelian hernia and deep vein thrombosis pulmonary embolism.

The Veteran asserts he is entitled to service connection for spigelian hernia and deep vein thrombosis pulmonary embolism. See March 2020 VA 21-526EZ.

VA has conceded the Veteran has current diagnoses of spigelian hernia and thrombophlebitis of the right leg. The evidence of record does not contain clear and unmistakable evidence to rebut these favorable findings. Therefore, the first element of service connection is met. 

There is no evidence of record of a relevant in-service event, injury, or incurrence. The Veteran's service records do not contain relevant complaints or treatment. The Veteran has not otherwise provided an explanation or contention as to how these disabilities relate to his
osis pulmonary embolism.

The Veteran asserts he is entitled to service connection for spigelian hernia and deep vein thrombosis pulmonary embolism. See March 2020 VA 21-526EZ.

VA has conceded the Veteran has current diagnoses of spigelian hernia and thrombophlebitis of the right leg. The evidence of record does not contain clear and unmistakable evidence to rebut these favorable findings. Therefore, the first element of service connection is met. 

There is no evidence of record of a relevant in-service event, injury, or incurrence. The Veteran's service records do not contain relevant complaints or treatment. The Veteran has not otherwise provided an explanation or contention as to how these disabilities relate to his service. Even the March 2020 VA 21-526 EZ only lists current disabilities. Therefore, there is insufficient evidence to meet the second element of service connection.

In summation, the evidence of record does not identify an in-service event, injury, or incurrence related to the Veteran's spigelian hernia or thrombophlebitis. Therefore, the criteria for service connection for these disabilities have not been met and service connection must be denied.

REASONS FOR REMAND

1. Entitlement to service connection for gulf war syndrome is remanded.

The Veteran asserts he is entitled to service connection for gulf war syndrome. 

A general medical gulf war opinion was requested prior to the September 2020 rating decision on appeal. See June 2020 Exam Request. However, a general gulf war examination does not appear to have been conducted based on the evidence of record. There is no explanation in the record as to why this examination was not conducted. The failure to provide a requested examination that is relevant to the Veteran's gulf war syndrome claim constitutes a pre-decisional duty to assist error. As there is insufficient evidence to otherwise grant the benefit on appeal, remand is required to correct the duty to assist error. See 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Schedule the Veteran for a new gulf war examination and obtain a new medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's claimed gulf war syndrome.

After a review of the record, the examiner is asked to answer the following:

(a.) Identify any current diagnosis that reasonably relates to the Veteran's claimed gulf war syndrome condition.

(b.) For any disability diagnosed, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's disability had its onset in or was incurred in service?

The examiner is advised that the lack of treatment records, either in-service or after, with reports of relevant symptoms alone is insufficient rationale for a negative medical nexus opinion.

The examiner is further advised that the Veteran is competent to report observable symptoms. Any such reports as to the onset and nature of symptoms must be taken into account, along with the other evidence of record, in formulating the requested opinion. 

A complete rationale must be provided for any opinion(s) expressed. If any requested opinion cannot be provided without resorting to speculation, then the clinician must explain why this is so.

 

 

CHRISTOPHER A. WENDELL

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. J.

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.