Case A26038503

L. STEPANICK · 2026 · Case ID: A26038503

MIXED

Summary

The Veteran, who served from January 1974 to January 1976, appeals decisions regarding TDIU, irritable bowel syndrome (IBS), non-Hodgkin lymphoma, congestive heart failure (CHF) with bradycardia and pacemaker, and tinea cruris rating reduction. The Board granted TDIU, finding the Veteran unable to secure or follow substantially gainful employment due to service-connected tinnitus, anxiety disorder, and obstructive sleep apnea, with the evidence in relative equipoise. Service connection for IBS secondary to anxiety disorder was granted, as the Board found the evidence sufficient to link the conditions, resolving doubt in the Veteran's favor, despite a VA examiner's initial negative nexus opinion. Service connection for non-Hodgkin lymphoma was denied, as the VA examiner's opinion, finding no link between the Veteran's TERA and the condition, was deemed persuasive and the evidence against the claim. Service connection for CHF with bradycardia and pacemaker secondary to hypertension was granted, as the Board found the evidence sufficient to link the conditions, resolving doubt in the Veteran's favor, despite a VA examiner's opinion that TERA risks were outweighed by other causes. Claims regarding tinea cruris rating reduction and effective date were dismissed as moot due to a subsequent AOJ decision correcting clear and unmistakable error. The Board remanded claims for allergic rhinitis, plantar fasciitis, hypothyroidism, diabetes mellitus, deviated septum, and asthma due to inadequate VA medical opinions that failed to address all relevant evidence or mischaracterized the Veteran's TERA.

Rationale

Economic component met: Veteran not working, no evidence to rebut.; Non-economic component met: Evidence in relative equipoise regarding ability to secure/maintain employment.; Limitations in concentration, memory, driving, and social interaction noted.

Special Benefit

TDIU

Docket No.

260108-613179

Full Decision Text

Citation Nr: A26038503
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 260108-613179
DATE: April 24, 2026

ORDER

A total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted.

Service connection for irritable bowel syndrome (IBS) as secondary to anxiety disorder is granted.

Service connection for non-Hodgkin lymphoma is denied.

Service connection for congestive heart failure (CHF), bradycardia with implanted cardiac pacemaker, as secondary to hypertension is granted.

The issue of the propriety of the reduction of the rating for tinea cruris from 60 percent to 10 percent effective September 26, 2025 is dismissed.

The issue of entitlement to an effective date prior to September 26, 2025 for the award of a 60 percent rating for the Veteran's tinea cruris is dismissed.

REMANDED

The issue of entitlement to service connection for allergic rhinitis is remanded.

The issue of entitlement to service connection for plantar fasciitis is remanded.

The issue of entitlement to service connection for hypothyroidism is remanded.

The issue of entitlement to service connection for diabetes mellitus is remanded.

The issue of entitlement to service connection for a deviated septum is remanded.

The issue of entitlement to service connection for asthma is remanded.

FINDINGS OF FACT

1. The Veteran's service-connected disabilities of tinnitus, anxiety disorder, and obstructive sleep apnea have precluded him from securing or following a substantially gainful occupation.

2. The evidence is at least in approximate balance as to whether the Veteran's IBS is aggravated by his service-connected anxiety disorder.

3. The Veteran's non-Hodgkin lymphoma did not have its onset during and is not otherwise attributable to active military service.

4. The evidence is at least in approximate balance as to whether the Veteran's CHF with bradycardia and pacemaker is due to his service-connected hypertension.

5. The AOJ issued a rating decision on April 8, 2026 which found clear and unmistakable error (CUE) as to the December 1, 2025 decision assigning a 60 percent rating for the Veteran's tinea cruris effective September 26, 2025.

CONCLUSIONS OF LAW

1. The criteria for a TDIU due to the Veteran's service-connected disabilities have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.16.

2. The criteria for service connection for IBS as secondary to service-connected anxiety disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for non-Hodgkin lymphoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

4. The criteria for service connection for CHF with bradycardia and pacemaker as secondary to service-connected hypertension are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. There being no justiciable case or controversy, the issue of the propriety of the reduction in the evaluation for tinea cruris from 60 percent to 10 percent is dismissed. 38 U.S.C. § 7105; 38 C.F.R. § 20.104.

6. There being no justiciable case or controversy, the issue of entitlement to an earlier effective date prior to September 26, 2025 for the award of a 60 percent rating for tinea cruris is dismissed. 38 U.S.C. § 7105; 38 C.F.R. § 20.104.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1974 to January 1976.

This matter comes to the Board of Veterans' Appeals (Board) from December 2025, June 2025, and March 2025 rating decisions of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected
5 for the award of a 60 percent rating for tinea cruris is dismissed. 38 U.S.C. § 7105; 38 C.F.R. § 20.104.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1974 to January 1976.

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket and waived his right to change dockets. Therefore, the Board may only consider the evidence of record at the time of a March 2024 rating decision that was subsequently subject to a higher-level review for the claims for service connection for diabetes mellitus, plantar fasciitis, asthma, a deviated septum, CHF, hypothyroidism, and non-Hodgkin lymphoma.

For the claims for service connection for IBS and rhinitis, the Board may only consider the evidence of record at the time of the June 2025 rating decision.

For the claim for an earlier effective date for the award of a 60 percent rating for tinea cruris, the Board may only consider the evidence of record at the time of the December 1, 2025 rating decision on appeal.

For the claims of entitlement to a TDIU and propriety of the reduction of the rating for tinea cruris, the Board may only consider the evidence of record at the time of the December 16, 2025 rating decision on appeal.

Any evidence submitted after the above-identified AOJ decisions cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300. Regarding the issues the Board is remanding, any such evidence will be considered by the AOJ on remand. Regarding the issues the Board is deciding, if the Veteran would like VA to consider any evidence that was added to the claims file 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 related 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.

1. TDIU is granted.

A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). TDIU may be assigned on either a schedular or extraschedular basis. 38 C.F.R. § 4.16.

Although the Veteran is in receipt of a combined 100 percent rating effective September 26, 2025, the claim period for TDIU predates that award. Thus, the issue remains on appeal.

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The United States Court of Appeals for Veterans Claims has defined "employment in a protected environment" to unambiguously mean "a lower-income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024).

The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required
-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024).

The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.

An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

The Veteran filed a VA Form 21-8940 in February 2023, asserting that his service-connected disabilities have precluded him from working since November 2022.

In January 28, 2022, the Veteran underwent a VA psychiatric evaluation per referral by Dr. O.B. for concerns of depression, anxiety, panic attacks, sleep disturbance, and bothersome tinnitus, all of which were noted to affect the Veteran's work and home functioning. The Veteran reported panic attacks where he experienced palpitations, shaking, shortness of breath, and feeling as though he might faint or die. Due to his panic attacks, he had been demoted at work and reduced his hours to part time. He also reported that he often felt sleepy at work and "used to be very smart, now I don't know what I am reading." The Veteran indicated that he lost confidence in his ability to do his work. He endorsed making mistakes at work due to diminished memory and concentration. Specifically, he described having trouble with word retrieval, putting thoughts and words together, getting lost while driving, and trouble remembering names and conversations. These symptoms caused the Veteran to become more socially withdrawn, more self-conscious, and wary of being around others.

An April 11, 2023 statement from the Veteran indicated that he was working in sales and his tinnitus made it difficult for him to understand requests from customers. He reported that in the last 4 to 5 years of working he was "guessing things" and making mistakes which could cost his employer money.

An October 2, 2025 private medical opinion concluded that the Veteran had been unable to work at substantially gainful employment since at least January 2023. The provider noted that from age 65 to 71, the Veteran worked part-time due to difficulties with concentration, memory, and temper. He reported that he was able to leave work if upset or irritated and left around three times per week in the final years of his employment. He stated that he retired because he began to make significant mistakes at work and he was losing money for the company. The opinion further provided that due to his sleep apnea, the Veteran lost his commercial driver's license at the end of his career due to a medical evaluation. The Veteran reported that he fell asleep while driving on multiple occasions; usually at stop signs and red lights.

A November 2025 VA examination noted that the Veteran would be limited to work that did not require walking or standing.

A November 2025 VA mental health examination indicated that the Veteran had difficulty staying on task, difficulty concentrating, and reported irritability and panic which interfered with his ability to work.

The AOJ has favorably found that the Veteran is not working, and there is no clear and unmistakable evidence to rebut that finding. Thus, the Veteran meets the economic component of TDIU eligibility.

The evidence of record also indicates the Veteran meets the non-economic component of TDIU eligibility. In that regard, the Board finds that the conclusions and findings of the relevant VA examination reports are supported by the relevant evidence of record and that the evidence of record is in relative equipoise regarding whether the combined effects of the Veteran's service-connected tinnitus, OSA, and mental health disabilities have precluded him from securing and following a substantially gainful occupation during the claim period. (Notably, service connection for OSA and generalized anxiety disorder with panic attacks was granted effective January 19, 2023.) Specifically, the Board finds that the effects of those disabilities render him unable to secure or maintain substantially gainful employment in light of his work history, education, skills, and training. He has lacked the physical and mental ability to perform the types of activities required by his employment, including maintaining customer relationships, completing tasks requiring memory and concentration, staying at work for a full day, or driving. These limitations also preclude other similar positions for which he would be qualified. Thus, resolving all reasonable doubt in the Veteran's favor, the Board finds that the limitations caused by his service-connected disabilities prevent him from securing or maintaining substantially gainful employment. See Ray, 31 Vet. App. at 73.

Accordingly, the Board finds that a TDIU is warranted, and the claim is granted. The AOJ will assign the effective date for TDIU in the first instance.

Service Connection

Service connection will be granted for a disability resulting from an injury or disease contracted during military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Direct service connection may be granted if the evidence supports (1) a current disability, (2) an in-service incurrence or aggravation of that disability, and (3) a causal nexus between the current disability and the in-service event. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.304. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364, 1366 n.1 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability" and noting that, apart from distinguishing whether service was during a period of war, 38 U.S.C. §§ 1110 and 1131 are identical).

After careful consideration of the evidence, any reasonable doubt remaining is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

1. Service connection for IBS as secondary to anxiety disorder is granted.

The Veteran maintains entitlement to service connection for IBS. He reports the symptoms of diarrhea, abdominal pain, and constipation had their onset during service.

The Veteran has been diagnosed with IBS. Further, the record reflects that the Veteran is currently service connected for anxiety disorder. The Board finds that the first and second elements of service connection on a secondary basis have been met. At issue in this case is whether the Veteran's IBS is caused or aggravated by his service-connected anxiety disorder.

In an April 2025 VA examination, the examiner found that the Veteran's IBS was not caused by his service-connected anxiety disorder. However, the examiner further opined that the symptoms of IBS can be exacerbated by anxiety and depression. Thus, although the examiner did not find causation, the opinion serves to provide evidence that the Veteran's IBS has been aggravated by his service-connected anxiety disorder. The medical opinion is not flawless. However, the Board finds the evidence is sufficient to adjudicate the claim with consideration of the benefit of the doubt doctrine, and the Board further notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case. See Mariano v. Principi, 17 Vet. App. 305 (2003).

In short, the Board finds that the evidence is sufficient to link the Veteran's diagnosed IBS to his service-connected anxiety disorder. The Board emphasizes the Court's holding in Ward v. Wilkie, 31 Vet. App. 233, 240-41 (2019), that aggravation in this context is any incremental increase in disability attributable to service-connected disability (i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence). Here, with resolution of reasonable doubt in the Veteran's favor, the record establishes that his IBS is aggravated by his service-connected anxiety disorder, and service connection for IBS is granted. The nature and extent of the disability is not before the Board at this time.

2. Service connection for non-Hodgkin lymphoma is denied.

The Veteran contends that he is entitled to service connection for his non-Hodgkin lymphoma.

The AOJ has made several favorable findings relevant to the Veteran's claim. First, the Veteran has a confirmed diagnosis of non-Hodgkin lymphoma. Second, the Veteran participated in a TERA during his military service. See July 21, 2023 TERA Memorandum (finding possible exposure to diesel exhaust, fuels, VOCs, oils, solvents, cleaning chemicals, lubrication chemicals, fumes, and other vehicle chemicals when operating and maintaining wheeled vehicles). Absent clear and unmistakable error, which is not present here, these favorable findings are binding on the Board. 38 C.F.R. § 3.104(c).

Based on these favorable findings, the first two elements necessary to establish service connection are met. The Board notes that the Veteran's TERA is not the type that permits the award of service connection for non-Hodgkin lymphoma on a presumptive basis. Thus, a medical nexus is required.

Turning to that third and final element, the AOJ obtained a TERA opinion related to the Veteran's claim for service connection in February 2024. The VA examiner determined that the Veteran had a current diagnosis of non-Hodgkin lymphoma. However, the examiner concluded that the Veteran's disability was not related to his in-service TERA. As rationale, the examiner provided that "non-Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called lymphocytes. It is more common with age and in males. There is no evidence to support that NHL is caused by exposure to diesel exhaust, fuels, VOC's, oils, solvents, cleaning chemicals, lubrication chemicals, fumes, and other vehicle chemicals." The examiner stated that medical literature has not shown that the specific exposure events experienced by the Veteran are related to NHL.

The February 2024 examiner reviewed the evidence and provided an opinion with a rationale based on the specific facts of the case and established medical principles as to whether the Veteran's non-Hodgkin lymphoma is related to his TERA. The examiner performed analyses regarding the lack of scientific evidence connecting the Veteran's non-Hodgkin lymphoma to his TERA. Thus, the Board affords the opinion high probative value and finds that it serves as evidence against a finding that the claimed disability is related to the Veteran's TERA.

As the evidence is persuasively against the claim, the benefit-of-the-doubt doctrine is not applicable, and service connection for non-Hodgkin lymphoma must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

3. Service connection for CHF, bradycardia with implanted
lymphoma is related to his TERA. The examiner performed analyses regarding the lack of scientific evidence connecting the Veteran's non-Hodgkin lymphoma to his TERA. Thus, the Board affords the opinion high probative value and finds that it serves as evidence against a finding that the claimed disability is related to the Veteran's TERA.

3. Service connection for CHF, bradycardia with implanted cardiac pacemaker, as secondary to hypertension is granted.

The Veteran maintains entitlement to service connection for CHF due to his active duty service.

The Veteran has a diagnosis of CHF with bradycardia and implanted cardiac pacemaker.

Further, the record reflects that the Veteran is currently service connected for hypertension. The Board finds that the first and second elements of service connection on a secondary basis have been met. At issue in this case is whether the Veteran's CHF was caused or aggravated by his service-connected hypertension.

In a January 2024 VA examination, the examiner noted that CHF develops over time from hypertension or congenital causes. The examiner noted that these causes outweighed the risk of the Veteran's TERA. The examiner also diagnosed the Veteran with "CHF from hypertension."

This medical opinion is not flawless. However, the Board finds the evidence is sufficient to adjudicate the claim with consideration of the benefit of the doubt doctrine, and the Board again notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case. See Mariano, 17 Vet. App. 305.

Further, there is no contradictory medical opinion of record concerning secondary service connection. The Board finds that the evidence is sufficient to connect the Veteran's diagnosed CHF to his service-connected hypertension. The Board finds that, resolving reasonable doubt in the Veteran's favor, the third and final element of service connection has been met, and the claim for service connection for CHF with bradycardia and pacemaker is granted.

Dismissed Claims

1. The issue of the propriety of the reduction of the rating for tinea cruris from 60 percent to 10 percent effective September 26, 2025 is dismissed.

2. The issue of entitlement to an effective date prior to September 26, 2025 for the award of a 60 percent rating for the Veteran's tinea cruris is dismissed.

The Veteran appealed the effective date of the 60 percent rating assigned for his tinea cruris in a December 1, 2025 rating decision, as well as the subsequent reduction of that 60 percent rating to 10 percent, effective November 10, 2025, in a December 16, 2025 rating decision. As explained below, the appeal as to these issues must be dismissed based on action taken by the AOJ in an April 8, 2026 rating decision.

The AOJ issued a rating decision in April 2026 which reversed the December 1, 2025 rating decision assigning a 60 percent rating for the Veteran's tinea cruris.

Previous determinations on which an action was predicated will be accepted as correct in the absence of CUE. Where evidence establishes such error, the prior decision will be reversed or amended. For the purpose of authorizing benefits, the rating or other adjudicative decision which constitutes a reversal of a prior decision on the grounds of CUE has the same effect as if the corrected decision had been made on the date of the reversed decision. 38 C.F.R. § 3.105(a).

Here, the reversal of a prior decision on the grounds of CUE has the same effect as if the corrected decision had been made on the date of the reversed decision. Thus, the issue of the propriety of the reduction of the 60 percent rating for tinea cruris and appeal for an earlier effective date for the grant of the 60 percent rating are moot. As there is no further issue in controversy presently before the Board, the appeal as to these issues must be dismissed, as there is no justiciable case or controversy remaining for appellate review.

Should the Veteran disagree with the AOJ's April 2026 decision, he may seek further review of that decision via one of the review options described in the April 9, 2026 Notification Letter that informed him of the decision.

REASONS FOR REMAND

1. The issue of entitlement to service connection for allergic rhinitis is remanded.

The Veteran asserts that his rhinitis is due to his active duty service. Specifically
uris and appeal for an earlier effective date for the grant of the 60 percent rating are moot. As there is no further issue in controversy presently before the Board, the appeal as to these issues must be dismissed, as there is no justiciable case or controversy remaining for appellate review.

REASONS FOR REMAND

1. The issue of entitlement to service connection for allergic rhinitis is remanded.

The Veteran asserts that his rhinitis is due to his active duty service. Specifically, he reports exposure to a gas chamber during service.

The AOJ has made several favorable findings relevant to the Veteran's claim. First, the Veteran has a confirmed diagnosis of rhinitis. Second, the Veteran participated in a TERA during his military service. Absent clear and unmistakable error, which is not present here, these favorable findings are binding on the Board. 38 C.F.R. § 3.104(c).

Based on these favorable findings, the first two elements necessary to establish service connection are met.

When VA undertakes to provide a VA examination or medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, in February 2022, March 2023, August 2023, and April 2025, the Veteran underwent examinations in relation to his rhinitis. The VA examiners provided negative nexus opinions for service connection as both a result of his TERA and due to direct causation. As rationale, all the examiners relied primarily on lack of treatment records following service and noted that without chronicity of symptoms a nexus could not be established. However, these opinions are inadequate because none considered the Veteran's lay statements regarding continuous nasal and sinus issues following service.

The AOJ denied the claim without obtaining an addendum opinion to address the above-noted deficiencies in the February 2022, March 2023, August 2023, and April 2025 VA opinions. This is a pre-decisional duty to assist error. A remand is necessary to correct it. 38 C.F.R. § 20.802(a).

2. The issue of entitlement to service connection for plantar fasciitis is remanded.

The Veteran claims his plantar fascitis had its onset during service. Specifically, he reports walking in military boots, which caused pain that has persisted since service. He also notes that he did not report any pain during service for fear of retaliation.

The Veteran was afforded a VA examination in March 2023, and the examiner diagnosed him with plantar fascitis; however, no opinion was obtained in connection with that examination.

The evidence of record at the time of the decision on appeal indicated that the Veteran's plantar fascitis may have begun in service or may be etiologically related to service. As a result, VA had a duty to secure an opinion as to that claim, and the failure to do so constitutes a pre-decisional duty to assist error that must be corrected on remand. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006) ("[T]he Secretary must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.").

3. The issue of entitlement to service connection for hypothyroidism is remanded.

The Veteran asserts that his hypothyroidism is due to his active duty service. Specifically, he reports exposure to a gas chamber during service.

The AOJ has made several favorable findings relevant to the Veteran's claim. First, the Veteran has a confirmed diagnosis of hypothyroidism. Second, the Veteran participated in a TERA during his military service. Absent clear and unmistakable error, which is not present here, these favorable findings are binding on the Board. 38 C.F.R. § 3.104(c).

Based on these favorable findings, the first two elements necessary to establish service connection are met.

As discussed above, when VA undertakes to provide a VA examination or medical opinion, it must ensure that the examination or
his hypothyroidism is due to his active duty service. Specifically, he reports exposure to a gas chamber during service.

Based on these favorable findings, the first two elements necessary to establish service connection are met.

As discussed above, when VA undertakes to provide a VA examination or medical opinion, it must ensure that the examination or opinion is adequate. Barr, 21 Vet. App. at 312. Here, in February 2024, a VA examiner provided a negative nexus opinion for the Veteran's hypothyroidism, finding it was less likely than not due to his active duty service. However, this opinion is inadequate. In providing a rationale for the negative nexus, the examiner described the disability as obstructive sleep apnea (OSA) and found that "hyperthyroidism" is an autoimmune disease, implying the hypothyroidism resulted from treatment of hyperthyroidism. However, the examiner did not adequately address why the initial hyperthyroidism, regardless of disease type, was less likely than not related to the Veteran's TERA.

The AOJ denied the claim without obtaining an addendum opinion to address the above-noted deficiencies in the February 2024 VA opinion. This is a pre-decisional duty to assist error. A remand is necessary to correct it.

4. The issue of entitlement to service connection for diabetes mellitus is remanded.

The Veteran asserts that his diabetes mellitus Type II is due to his active duty service. Specifically, he reports exposure to a gas chamber during service.

The AOJ has made several favorable findings relevant to the Veteran's claim. First, the Veteran has a confirmed diagnosis of diabetes mellitus, Type II. Second, the Veteran participated in a TERA during his military service. Absent clear and unmistakable error, which is not present here, these favorable findings are binding on the Board. 38 C.F.R. § 3.104(c).

Based on these favorable findings, the first two elements necessary to establish service connection are met.

The Board again notes that when VA undertakes to provide a VA examination or medical opinion, it must ensure that the examination or opinion is adequate. Barr, 21 Vet. App. at 312. Here, in February 2024, a VA examiner provided a negative nexus opinion for the Veteran's diabetes mellitus, Type II, finding it was less likely than not due to his active duty service. As rationale, the examiner stated that "diabetes has a genetic component and usually develops over time. It can happen because of unhealthy lifestyle choices, such as not getting enough regular physical activity and elevated calorie intake. These risks greatly outweigh the risk in the TERA." However, this opinion is inadequate because it does not discuss whether the Veteran's diabetes might be granted on a direct basis as incurred in service, or on a presumptive basis as a chronic disease. 38 C.F.R. §§ 3.307, 3.309. In that regard, the February 2024 examiner noted that "the condition began with elevated blood sugar levels on routine lab work in 1976." The Veteran separated from active service in January 1976. Thus, the opinion should have addressed whether an elevated blood sugar level in 1976 suggests the Veteran's diabetes developed in service or within a year of his discharge.

5. The issue of entitlement to service connection for deviated septum is remanded.

The Veteran asserts that his deviated septum is due to his active duty service. Specifically, he reports facial trauma in service caused the condition.

The Veteran is currently diagnosed with a deviated septum.

The Board again notes that when VA undertakes to provide a VA examination or medical opinion, it must ensure that the examination or opinion is adequate. Barr, 21 Vet. App. at 312. Here, in February 2024, a VA examiner provided a negative nexus opinion for the Veteran's deviated septum, finding it was less likely than not due to his active duty service. As rationale, the examiner stated that "[d]eviated septum is not incurred due to hazardous material exposure. Medical literature has not shown that specific exposure events experienced by the Veteran during service in Southwest Asia are related to this condition." However, this opinion is inadequate because it relied primarily on lack of treatment records in service and did not consider the Veteran's report of facial trauma in service. Furthermore, it mischaracterized the nature of the Veteran's TERA, as it is not based on service in Southwest Asia.

6. The issue of entitlement to service connection for bronchial asthma is remanded.

Regarding this condition, the Veteran underwent a VA examination in February 2024. The examiner diagnosed the Veteran with asthma. In describing the disability, the Veteran reported an onset of symptoms in 1975 including wheezing, cough, and shortness of breath. The Veteran also reported that his current symptoms included worsening shortness of breath and use of an albuterol inhaler. The examiner provided a negative TERA opinion, stating that "asthma is primarily caused by environmental allergies that damages the lungs and airways, which outweighs the risk of the TERA." However, the examiner did not reconcile that conclusion with the fact that the Veteran's TERA presumably involved inhalation of some of the contaminants (for example, diesel exhaust). The AOJ should have obtained an adequate addendum opinion, and this pre-decisional duty to assist error must be corrected on remand.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion addressing whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that there is a nexus between the Veteran's allergic rhinitis and his service, to include his TERA. Please explain why or why not, specifically considering and discussing 1) the total potential exposure through all applicable military deployments of the Veteran; 2) the synergistic, combined effect of all toxic exposure risk activities of the Veteran; and 3) the Veteran's lay statements reporting constant sinus and nasal symptoms since service.