Case A26038976

REBECCA N. POULSON · 2026 · Case ID: A26038976

GRANTED

Summary

The Veteran, a U.S. Navy Veteran who served from September 1977 to September 1981, appeals the denial of service connection for psoriasis and psoriatic arthritis (PSA), and seeks an earlier effective date for sleep apnea. The Board granted service connection for sleep apnea, finding the evidence in approximate balance and resolving doubt in the Veteran's favor, thus granting an earlier effective date of September 9, 2021, based on his continuous pursuit of the claim. For psoriasis, the Veteran claimed in-service exposure to jet fuel. While VA examiners opined the condition was less likely related to service and potentially linked to other comorbidities, their opinions were found conclusory and lacking adequate rationale. Conversely, a private dermatologist's opinion, supported by studies on jet fuel exposure and autoimmune disorders, found the Veteran's psoriasis more likely related to repeated jet fuel exposure in service. The Board found this private opinion competent, credible, and probative, granting service connection for psoriasis. For PSA, the Board relied on a favorable VA examiner opinion that found it was at least as likely as not incurred due to psoriasis, which was also granted service connection. The Board found the Veteran's claims for psoriasis and PSA are granted.

Rationale

Evidence in approximate balance regarding relation to service; Doubt resolved in Veteran's favor; Earlier effective date granted due to continuous pursuit

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250923-590734

Full Decision Text

Citation Nr: A26038976
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250923-590734
DATE: April 27, 2026

ORDER

Entitlement to effective date of September 9, 2021, for service connection for obstructive sleep apnea is granted.

Entitlement to service connection for psoriasis is granted.

Entitlement to service connection for psoriatic arthritis secondary to psoriasis is granted.

FINDINGS OF FACT

1. The record contains an intent to file from September 9, 2021, reasonably related to the Veteran's claim for service connection for obstructive sleep apnea (hereinafter sleep apnea).

2. On November 22, 2021, within a year of the intent to file, the Veteran filed a Fully Developed Claim for service connection for sleep apnea.

3. The Veteran was granted service connection for sleep apnea on a presumptive basis, and therefore his effective date was August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) became effective.

4. The evidence is in approximate balance that the Veteran's current sleep apnea is related to his active service, to include exposure therein.

5. The Veteran's psoriasis is due to his in-service toxic exposure risk activity.

6. The Veteran's psoriatic arthritis is caused or aggravated by his psoriasis.

CONCLUSIONS OF LAW

1. The criteria for an earlier effective date of September 9, 2021, for service connection for sleep apnea are met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.156, 3.400, 3.250.

2. The criteria for service connection for psoriasis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for psoriatic arthritis secondary to psoriasis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had honorable active-duty service with the United States Navy from September 1977 to September 1981, with subsequent Reserve service.

These matters are before the Board of Veterans' Appeals (Board) from the October 2024 and November 2024 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO).

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

The Board may only consider the evidence of record at the time of the August 23, 2023, agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review for the issue of an earlier effective date for sleep apnea. 38 C.F.R. § 20.301. The Board may only consider the evidence of record at the time of the November 1, 2024, agency of original jurisdiction (AOJ) supplemental claim decision on appeal for the issues of service connection for psoriasis and psoriatic arthritis. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the rating decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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 of earlier effective date and service connection, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In December 2025 the Veteran submitted correspondence which waived his right to select a different Board review option. See Williams v. McDonough, 37 Vet. App. 305 (2024).

Entitlement to effective date earlier than August 10, 2022 for service connection for sleep apnea

The August 2023 rating decision granted service connection for sleep apnea syndrome with an effective date of August 10, 2022, the date the PACT Act was signed into law
is new and relevant, VA will issue another decision on the claims of earlier effective date and service connection, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In December 2025 the Veteran submitted correspondence which waived his right to select a different Board review option. See Williams v. McDonough, 37 Vet. App. 305 (2024).

Entitlement to effective date earlier than August 10, 2022 for service connection for sleep apnea

The August 2023 rating decision granted service connection for sleep apnea syndrome with an effective date of August 10, 2022, the date the PACT Act was signed into law.

At issue is whether the Veteran's sleep apnea can be granted on a basis other than the PACT Act, such as on a direct or secondary basis, such that he would be entitled to an earlier effective date for the grant of service connection. Here, the record shows that the Veteran filed for sleep apnea in November 2021 and was originally denied in March 2022, before the passage of the PACT Act. With continuous pursuit, this matter has been pending prior to the PACT Act so an effective date prior to August 10, 2022, is available.

Generally, the effective date for the grant of service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after discharge from service. Otherwise, for an award based on an original claim, claim reopened after a final disallowance, or claim for an increased rating, the effective date is the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400.

The record shows that the Veteran has continuously pursued service connection for sleep apnea since filing an intent to file from September 9, 2021, and a Fully Developed Claim for "sleep issues" on November 22, 2021. As such, the Board finds that an earlier effective date would be available if service connection for sleep apnea was granted on a direct or secondary basis.

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).

The July 2023 VA examiner opined that the Veteran's sleep apnea is at least as likely as not related to his active service. Specifically, the examiner indicated that the Veteran's in-service exposure to jet fuel and fumes resulted in an accumulation of molecules of jet fuel and could damage the airway, cause restricted airflow, and cause sleep apnea. See C & P Exam submitted July 2023.

Upon review of the record, the Board finds the evidence to be in approximate balance as to whether the Veteran's current sleep apnea is at least as likely as not related to his active service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted.

Therefore, the Board will grant an earlier effective date for service connection for sleep apnea to the earliest date possible. The Veteran filed his November 2021 claim for service connection for sleep apnea within one year of his September 2021 intent to file, as such the date VA received the intent file, September 9, 2021, is the proper effective date. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400.

Entitlement to service connection for psoriasis

Entitlement to service connection for psoriatic arthritis secondary to psoriasis

The Veteran contends he is entitled to service connection for psoriasis due to exposure in service to jet fuel.

As a threshold matter the Veteran contends his psoriatic arthritis has affected his bilateral hands and fingers. However, the Board finds the evidence indicates there are multiple joints affected by the Veteran's psoriatic arthritis (hereinafter PSA) and has expanded the claim to encompass all joints affected by PSA. Furthermore, the Veteran contends that his psoriatic arthritis is secondary to his psoriasis.

The Veteran contends he is entitled to service connection for psoriasis due to exposure in service to jet fuel.

In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

Service connection under 38 U.S.C. § 1110 may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury." See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023). For "aggravation of non-service-connected disabilities" it is enough to show that 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, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

The Secretary shall consider all information and lay and medical evidence of record in a case and make appropriate determinations as to competence, credibility, and weight. 38 U.S.C. § 5107; 38 C.F.R. § 3.303; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience, if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159.

When there is an approximate balance between positive and negative evidence, equipoise, the benefit of the doubt doctrine must apply in favor of the Veteran. But when the evidence persuasively favors one side, the claim will be decided on its merits, and the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Procedural History

Initially the Veteran filed for service connection for psoriasis and PSA in November 2021, with an Intent to File submitted in September 2021. These claims were denied in the March 2022 rating decision.

The March 2022 rating decision made favorable findings that the Veteran had an in-service in March 1980 of a documented rash on the upper trunk and bilateral hands post contact with jet fuel; that he had a current diagnosis of psoriasis; and that his PSA was secondary to his psoriasis as indicated in the February 2022 VA examination. The Board is bound by these favorable findings absent a finding of clear and unmistakable error. 38 C.F.R. § 3.104 (c).

The Veteran in March 2023 filed a supplemental claim for psoriasis and PSA. The RO in the August 2023 rating decision found new and relevant evidence had been submitted with respect to both claims, but denied both claims on the merits.

In July 2024 the Veteran filed another supplemental claim. The November 2024 rating decision implicitly found new and relevant evidence had been submitted, but denied both claims on the merits. The Board is bound by the favorable finding of new and relevant evidence absent a finding of clear and unmistakable error. 38 C.F.R. § 3.104 (c).

The RO made another favorable finding that conceded participation in a TERA. TERA Memoranda dated March 2023 and March 2024 acknowledge the Veteran's exposure to jet fuel and probable exposure to asbestos based on his military occupational specialty (MOS) of Aviation Boatswain's Mate. The Board is bound by this favorable finding absent a finding of clear and unmistakable error. 38 C.F.R. § 3.104
2024 rating decision implicitly found new and relevant evidence had been submitted, but denied both claims on the merits. The Board is bound by the favorable finding of new and relevant evidence absent a finding of clear and unmistakable error. 38 C.F.R. § 3.104 (c).

Factual History and Analysis

The Veteran has a current diagnosis of psoriasis and has met the first element of service connection for direct service connection. The Veteran has an inservice event of exposure to jet fuel and a report of having a rash inservice and has met the second element of direct service connection. The remaining question for psoriasis is whether there is a causal relationship between the Veteran's inservice event and his current diagnosis.

The Veteran's service treatment records show the Veteran in March 1980 reported a rash on his upper trunk and his bilateral hands, with a finding of "peeling, cracking, dryness, contact JP5." His separation examination in September 1981 noted a fine rash over his back that "clears up when he gets away from JP5."

The Veteran submitted private treatment records that indicated his pustular psoriasis was diagnosed in the 1990's.

The Veteran's VA treatment records indicate treatment for both psoriasis and PSA.

A fellow service member who worked and served with the Veteran submitted a statement in November 2021 and described the duties of refueling and repairing equipment in aircraft. The statement indicated being soaked with jet fuel from head to toe many times and many had skin irritations but none like the Veteran. The statement noted the Veteran's skin irritations were never resolved and caused him pain and discomfort. See Buddy/Lay Statement submitted November 2021.

In February 2022, the Veteran submitted a letter from his treating dermatologist, Dr. R.N. The doctor noted the Veteran had been under his care for psoriasis since 1993, with recurrent bouts of pustular lesions with denuding and erosion of his skin. His condition was noted as chronic.

In February 2022 the Veteran underwent several VA examinations.

The Veteran's VA skin examination included the Veteran's reports of being diagnosed in 1993 with psoriasis and pustular psoriasis in 1994. The examiner found the Veteran's psoriasis was less likely caused by his regular exposure to jet fuels in service. The rationale found there was no medical evidence that his psoriasis was incurred in or was caused by being exposed to JP5 and JP8 jet fuels in service. His separation physical report of rash was found to be consistent with a contact dermatitis and not diagnostically characteristic of psoriasis. The most likely cause of psoriasis was found to be a multisystem chronic inflammatory disorder associated with multiple co-morbidities such as his diabetes mellitus (DMII) and hypertension combined with genetics. The Board finds the examiner's opinion for service connection for psoriasis is conclusory because did not explain why the Veteran's rash upon discharge was diagnostically characteristic of dermatitis or why one of the Veteran's comorbid conditions was the cause. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). As such the Board gives the examiner's opinion no probative weight.

The Veteran's VA hand and finger VA examination found the Veteran had a current diagnosis of PSA in both hands.

The Veteran's VA non-degenerative arthritis and foot examination documented the Veteran's reports of onset of symptoms in his hands, feet, and knees in 1995. The examiner noted that although the Veteran reported symptoms in his feet and knees there was insufficient evidence to find a diagnosis at this time in those joints. The examiner opined that the Veteran's psoriatic arthritis developed several years after his diagnosis of psoriasis. He explained that psoriatic arthritis was documented as a known progression of psoriasis skin lesions. Therefore, the psoriatic arthritis was at least as likely as not incurred in or caused by the Veteran's psoriasis. The Board finds the examiner's opinion for PSA as secondary to psoriasis has significant probative weight because it is based on an examination of the Veteran and review of the file, and it contains a sufficient rationale.

In February 2022 the Veteran submitted two different statements from fellow service members which described the
the Veteran reported symptoms in his feet and knees there was insufficient evidence to find a diagnosis at this time in those joints. The examiner opined that the Veteran's psoriatic arthritis developed several years after his diagnosis of psoriasis. He explained that psoriatic arthritis was documented as a known progression of psoriasis skin lesions. Therefore, the psoriatic arthritis was at least as likely as not incurred in or caused by the Veteran's psoriasis. The Board finds the examiner's opinion for PSA as secondary to psoriasis has significant probative weight because it is based on an examination of the Veteran and review of the file, and it contains a sufficient rationale.

In February 2022 the Veteran submitted two different statements from fellow service members which described the daily duties of the Veteran and constant exposure to jet fuel. This included being completely soaked or inhaling the fumes throughout service and developing a scaly skin rash when the fuel is exposed to skin. See Buddy/Lay statements submitted February 2022.

In March 2023 the Veteran submitted multiple articles of the neurotoxicity of certain hydrocarbon fuels and their absorption into the skin and affect with both acute and chronic symptoms. See Correspondence submitted March 2023.

In July 2023 the Veteran underwent VA examinations for his skin, hands, and non-degenerative arthritis. The skin examiner noted a 2023 diagnosis of psoriasis and his reports of a rash all over his body in service and contention that the cause of the rash was his exposure to jet fuel "JP5." He reported his rash occurred after working with jet fuel and got bigger as his clothes and body were generally covered in jet fuel and fumes. His July 2023 VA hand and finger examiner and non-degenerative arthritis examiner confirmed his PSA diagnosis in his hands and fingers. The examiner opined that his psoriasis and PSA were less likely caused by his TERA. The rationale was there was no medical literature to support that toxic exposure caused psoriasis and PSA.

The Board finds the examiner's opinion is conclusory and without adequate rationale and is therefore inadequate for VA purposes. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, the Board gives the opinion no probative value.

In July 2024 the Veteran submitted a private doctor's opinion from a Dr. A.B. that reviewed the Veteran's record. The doctor noted the Veteran's reports of rash in service and his separation examination. The Veteran was formally diagnosed with psoriasis in 1994. He was found to have arthritis of his hands and fingers which the doctor found indicated a systemic and rheumatic involvement rather than simply dermatological. The doctor discussed multiple studies that found jet fuel can cause irritation in humans at the site of exposure and absorb systemically. The dermal exposure of jet propulsion fuel (JP) lead can activate immune suppressive pathways and molecular pathways leading to an upregulation of enzymes which control prostaglandin synthesis. Thus, the doctor found that exposure to JP can potentially be linked to several autoimmune conditions in which dysregulation of the immune system play a role. The doctor found that recent studies have associated exposure to JP with other autoimmune disorders such as rheumatoid arthritis and recommended ongoing investigation into other rheumatoid disorders. Some of the studies noted a long-term effect observed in those who only had dermal exposure in which neurological changes were found years later in people exposed to jet fuel.

The doctor found the Veteran was exposed to JP in service based on his MOS. He was noted as having repeated dermal exposures, sought care for contact dermatitis and irritation while in service, had a documented dermatitis at discharge, and was finally diagnosed in 1994 with psoriasis. The doctor found his psoriasis was more likely related to repeated exposure to JP in service because the repeated exposures more likely led to changes within his genetics and dysregulation of his immune system resulting in an auto-immune type condition and rheumatological disorder affecting both his skin and joints.

The Board finds the private doctor's opinion to be competent, credible, and with significant probative weight. The doctor relies on the Veteran's claims file, cited recent relevant studies, and provides an adequate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008)

In August and September 2024, the Veteran underwent VA examinations for his skin, hand and fingers, non-degenerative arthritis, elbows, feet, wrists, knees, and shoulders.

The skin examiner noted his onset of psoriasis in 1993 and development of PSA. He was found to have raised scaly plaques on his elbows, ankles, back, and axilla bilaterally.

The hands and finger examiner found bilateral hand PSA.
, credible, and with significant probative weight. The doctor relies on the Veteran's claims file, cited recent relevant studies, and provides an adequate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008)

In August and September 2024, the Veteran underwent VA examinations for his skin, hand and fingers, non-degenerative arthritis, elbows, feet, wrists, knees, and shoulders.

The skin examiner noted his onset of psoriasis in 1993 and development of PSA. He was found to have raised scaly plaques on his elbows, ankles, back, and axilla bilaterally.

The hands and finger examiner found bilateral hand PSA. The Veteran reported he developed nail pitting in 1993. The wrist examiner noted his PSA diagnosis and pain with polyarthritis due to PSA and swelling in his wrists. The Veteran's elbow examiner found triceps tendinitis bilaterally. No PSA was noted.

The Veteran's shoulder examiner noted multiple diagnoses of tendonitis, rotatory cuff tendonitis, glenohumeral joint osteoarthritis, acromioclavicular (AC) joint osteoarthritis, and PSA.

The Veteran's foot examiner found no diagnosis of PSA. However, the examiner noted the Veteran had psoriatic polyarthritis with swelling and pain in multiple joints of his body. The knee examiner noted the Veteran's PSA in his left knee only, and documentation of psoriatic polyarthritis.

The non-degenerative arthritis examiner noted joint involvement of the shoulder, wrists, hand and fingers, left knee, and bilateral feet and toes. His right knee and elbows were found to be normal on x-rays and without pain in his elbows.

The VA examiner opined that the Veteran's psoriasis and PSA were less likely due to his TERA. The Veteran's exposure to JP5 jet fuel was noted. The examiner documented that the Veteran did not develop psoriasis until 1993 to 1994. The Veteran's PSA was noted as affecting multiple joints, severely affecting his hands. The examiner found his psoriasis was not a medically associated condition with asbestos and no formal nexus with jet fuel.

The Board finds the examiner's opinion is without adequate rationale and is therefore inadequate for VA purposes. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board gives it no probative value.

The Veteran in his March 2023 supplemental claim submitted medical treatises regarding skin absorption from jet fuel and how jet fuel can cause issues with the nervous system.

The Veteran further argued in his July 2024 supplemental claim and September 2025 Notice of Disagreement that the July 2023 TERA medical opinion is inadequate and maintains that Dr. A.B.'s opinion has more probative weight.

The Board finds there is both positive and negative evidence as to whether the Veteran's psoriasis is related to his exposure to jet fuel in service. As explained above, the VA negative opinions do not have any probative value, while the positive private opinion has great probative value. Thus, the Board finds the Veteran is entitled to service connection for psoriasis based on his inservice toxic exposure.

Regarding PSA, he has a current diagnosis and has met the first element of secondary service connection. He has a diagnosis of psoriasis which is being granted service connection in this opinion and has met the second element of service connection. See also February 2022 VA non-degenerative arthritis and foot examination report. Based on the favorable finding in the March 2022 rating decision that the Veteran's PSA was caused by his psoriasis, the Veteran has met all three elements of secondary service connection.

The Veteran's claims for service connection for psoriasis and PSA are granted.

Rebecca N. Poulson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Teich, 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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