PSYCHOSIS

Summary

The Veteran served from December 1984 to December 1987 and September 1988 to August 1996, including service during the Persian Gulf War era. The Veteran initially appealed the denial of service connection for a psychiatric disability, allergic rhinitis, sinusitis, lumbar spine disability, cervical spine disability, heart disability, and GERD. However, the Veteran withdrew the appeal for the psychiatric disability, which was subsequently dismissed. Service connection for allergic rhinitis and sinusitis was granted under the PACT Act due to a presumption of exposure to fine particulate matter related to Persian Gulf service. The remaining claims for lumbar spine, cervical spine, heart disability, and GERD were remanded for additional development. The Board found that while service medical records indicated some relevant diagnoses and the Veteran alleged causation, adequate VA examinations addressing the nexus to service were not provided for these conditions. Specifically, the remand instructions require new VA opinions to determine the relationship between the claimed lumbar and cervical spine disabilities, heart disability, and GERD to service, including consideration of in-service complaints, continuity of symptoms, and exposure to toxic environmental hazards. For rhinitis and sinusitis, the remand also requires consideration of direct causation or other bases besides the PACT Act presumption.

Rationale

Veteran notified Board of intent to withdraw appeal at hearing.; Withdrawal was explicit, unambiguous, and understood.; No allegation of error of fact or law remains for this claim.

Full Decision Text

Citation Nr: A26039291
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 210604-164366
DATE: April 28, 2026

ORDER

Entitlement to service connection for a psychiatric disability has been withdrawn and is dismissed.

Entitlement to service connection for allergic rhinitis pursuant to the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) is granted.

Entitlement to service connection for sinusitis pursuant to the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) is granted.

REMANDED

Entitlement to service connection for a lumbar spine disability is remanded.

Entitlement to service connection for a cervical spine disability is remanded.

Entitlement to service connection for a heart disability is remanded.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Entitlement to service connection for rhinitis, on a basis other than as pursuant to the PACT Act, is remanded.

Entitlement to service connection for sinusitis, on a basis other than as pursuant to the PACT Act, is remanded.

FINDINGS OF FACT

1. On February 6, 2025, prior to the promulgation of a decision in the appeal, the Board received notification that the Veteran no wanted to withdraw the appeal seeking entitlement to service connection for a psychiatric disability.

2. The Veteran has a current diagnosis of allergic rhinitis and is entitled to a presumption of exposure to particulate matter based on the Veteran's service locations during the Persian Gulf War era.

3. The Veteran has a current diagnosis of sinusitis and is entitled to a presumption of exposure to particulate matter based on the Veteran's service locations during the Persian Gulf War era.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of entitlement to service connection for a psychiatric disability by the Veteran have been met.  38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for Entitlement to service connection for rhinitis pursuant to the PACT Act have been met.  38 U.S.C. §§ 1110, 1112, 1117, 1119, 1120, 1131; 38 C.F.R. §§ 3.30, 3.307.

3. The criteria for Entitlement to service connection for sinusitis pursuant to the PACT Act have been met.  38 U.S.C. §§ 1110, 1112, 1117, 1119, 1120, 1131; 38 C.F.R. §§ 3.30, 3.307.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from December 1984 to December 1987 and from September 1988 to August 1996.

A July 2020 rating decision denied the service connection claims.  In June 2021, VA received a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), which requested a hearing docket review of the appeal by the Board. Consequently, this appeal comes before the?Board of Veterans' Appeals (Board) on appeal from the July 2020 rating decision by the Department of Veterans Affairs (VA)?Veterans Benefits Administration Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ).

In February 2025, the Veteran attended?a hearing before the undersigned Veterans Law Judge.  A transcript of that hearing is of record.? 

Under the?hearing?review election, the Board may consider?evidence submitted to VA at the time of the AOJ?decision on the issues on appeal in July 2020,?any evidence submitted at the February 2025 Board hearing,?and any evidence submitted within 90 days after the scheduled hearing. VA will not seek additional evidence as part of the review.  38?C.F.R. §?20.303.

1. Entitlement to service connection for a psychiatric disability.

The Board may dismiss any appeal which does not allege specific error of fact or law in the determination being appealed.? 38?U.S.C. §?7105.? A substantive appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38?C.F.R. §§?20.202, 20.204.? An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. §?20.204.  Withdrawal may be made by the
 of the review.  38?C.F.R. §?20.303.

1. Entitlement to service connection for a psychiatric disability.

The Board may dismiss any appeal which does not allege specific error of fact or law in the determination being appealed.? 38?U.S.C. §?7105.? A substantive appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38?C.F.R. §§?20.202, 20.204.? An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. §?20.204.  Withdrawal may be made by the claimant or the authorized representative.  38?C.F.R. §?20.204.? 

At a February 2025 Board hearing, the Veteran notified the Board that the Veteran no longer wanted to proceed with the appeal for entitlement to service connection for a mental health disability, to include posttraumatic stress disorder.  The Veteran's statement indicating?the Veteran's intent to withdraw the appeal is explicit, unambiguous, and done with a full understanding of the consequences of that action.  Warren v. McDonald, 28?Vet. App. 214 (2017); DeLisio?v. Shinseki, 25 Vet. App.?45 (2011).  The Board finds that communication constitutes a valid withdrawal of the appeal.

As a result of the withdrawal of the claim on appeal, no allegation of error of fact or law remains before the Board for consideration with regard to that claim. Therefore, the Board finds that the Veteran has withdrawn the appeal for entitlement to service connection for a psychiatric disability.  The Board does not have jurisdiction to review that claim.  Therefore, that claim is dismissed.

2. Entitlement to service connection for rhinitis pursuant to the PACT Act.

Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of incurrence or aggravation of a disease or injury in service; and (3) evidence, generally medical, of a causal relationship between the disease or injury in service and the current disability.  Hickson v. West, 12 Vet. App. 247 (1999).

Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service.  38 U.S.C. § 1113; 38 C.F.R. § 3.303; Cosman v. Principi, 3 Vet. App. 503 (1992).  The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature.  For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic.  Furthermore, service incurrence will be presumed for certain chronic diseases if manifest to a compensable degree within the year after active service.  38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309

While the Veteran's appeal was pending, Congress passed the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act). Pub. L. No. 117-168, § 405, 136 Stat. 1759 (2022).  The PACT Act is a liberalizing law which, in relevant part, provides for presumptive service connection for chronic rhinitis for covered Veterans.  38 U.S.C. § 1120.  A covered Veteran is any Veteran who, on or after August 2, 1990, performed active service while assigned to a duty station, including airspace above, in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or United Arab Emirates; or any Veteran who, on or after September 11, 2001, performed active service while assigned to a duty station, including airspace above, in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, or any other country determined relevant by the Secretary.  38 U.S.C. §§ 1117, 1119.

Under the PACT Act, service connection may be presumed for certain listed chronic diseases associated with exposure to fine particulate matter even though there is no evidence that the
2, 1990, performed active service while assigned to a duty station, including airspace above, in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or United Arab Emirates; or any Veteran who, on or after September 11, 2001, performed active service while assigned to a duty station, including airspace above, in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, or any other country determined relevant by the Secretary.  38 U.S.C. §§ 1117, 1119.

Under the PACT Act, service connection may be presumed for certain listed chronic diseases associated with exposure to fine particulate matter even though there is no evidence that the disease was incurred in or aggravated during service.  38 C.F.R. § 3.320.  Service connection may be presumed under 38 C.F.R. § 3.320 if the listed disease becomes manifest to any degree at any time following separation from a qualifying period of service.  Chronic rhinitis is among the enumerated diseases associated with exposure to fine particulate matter.  38 C.F.R. § 3.320.

The Veteran is a Persian Gulf Veteran and is presumed to have been exposed to fine particulate matter.  38 U.S.C. § 1119.  

Post-service medical evidence demonstrates a current allergic rhinitis diagnosis. 

Accordingly, the Board finds that the criteria for service connection for chronic rhinitis pursuant to the PACT Act are met and service connection for chronic allergic rhinitis is granted pursuant to the PACT Act.

3. Entitlement to service connection for sinusitis pursuant to the PACT Act.

The Veteran asserts that chronic sinusitis is the result of service.

The Veteran is a Persian Gulf Veteran and is presumed to have been exposed to fine particulate matter.  38 U.S.C. § 1119.  

The Veteran's medical records show a diagnosis of chronic sinusitis, which is a qualifying chronic disability under the PACT Act.  Therefore, the Board finds that the Veteran is a covered Veteran with a disability presumed to be a result of the Veteran's service during the Persian Gulf War.

As the Veteran is presumed to have been exposed to toxic environmental hazards while serving in in the Persian Gulf, and has been diagnosed with chronic sinusitis, the criteria for service connection for chronic sinusitis pursuant to the PACT Act are met and service connection is warranted pursuant to the PACT Act.

Accordingly, the Board finds that service connection for sinusitis is warranted, and the claim is granted.  38 U.S.C. §§ 1117, 5107; 38 C.F.R. § 3.102.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to service connection for a lumbar spine disability is remanded.

2. Entitlement to service connection for a cervical spine disability is remanded.

Although the Board regrets the delay, additional development is needed prior to further disposition of the claims of entitlement to service connection for back and neck disabilities.  

The Veteran contends that back and neck disabilities began during service and continue to the present.

A July 2020 rating decision found that a qualifying event, injury, or disease had its onset during service in that service medical records indicates a diagnosis of lumbar strain in April 1995 and cervical strain in June 1992.  The Board is bound by those favorable findings.

During an appropriate evidentiary period, the Veteran submitted post-service medical records that show the Veteran had degenerative change of the cervical spine.  The Veteran has also alleged back pain.  The Board notes that pain?may be a disability for VA purposes if it results in?functional loss. 

The record shows potential neck and back diagnoses, and alleged potential causation related to service.  However, the Veteran has not been provided adequate VA examination which addresses any relationship between the claimed disabilities and service.  That is a pre-decisional duty to assist error.  Therefore, the Board finds that a VA opinion to determine any relationship between the claimed disabilities and active service should be scheduled.

The Veteran is reminded that the duty to assist is not a one-way street. A Veteran is required to cooperate with the examiner's efforts to evaluate the nature and current severity of symptomology.  Wood v. Derwinski, 1 Vet. App. 190 (1991).  The Veteran is notified that it is the Veteran's responsibility to report for any scheduled examination and to cooperate in the development of the claim.  The consequences for failure to cooperate with or report for a VA examination without good cause may include denial of the claim.  38 C.F.R. § 3.655.  The Veteran is notified that failure to
 that a VA opinion to determine any relationship between the claimed disabilities and active service should be scheduled.

The Veteran is reminded that the duty to assist is not a one-way street. A Veteran is required to cooperate with the examiner's efforts to evaluate the nature and current severity of symptomology.  Wood v. Derwinski, 1 Vet. App. 190 (1991).  The Veteran is notified that it is the Veteran's responsibility to report for any scheduled examination and to cooperate in the development of the claim.  The consequences for failure to cooperate with or report for a VA examination without good cause may include denial of the claim.  38 C.F.R. § 3.655.  The Veteran is notified that failure to cooperate during the requested VA examination may result in an adverse determination.  38 C.F.R. § 3.655; Connolly v. Derwinski, 1 Vet. App. 566 (1991).]

3. Entitlement to service connection for a heart disability is remanded.

Although the Board regrets the delay, additional development is needed prior to further disposition of the claim of entitlement to service connection for a heart disability.

The Veteran contends that a heart disability began during service and continues to the present. 

At the time of the July 2020 rating decision on appeal, post-service medical records show the Veteran's past medical history includes atrial fibrillation.

At the time of the rating decision on appeal, the record showed a potential heart diagnosis and alleged potential causation related to service.  However, the Veteran has not been provided adequate VA examination which addresses any relationship between the claimed disability and service.  That is a pre-decisional duty to assist error.  Therefore, the Board finds that a VA opinion to determine any relationship between the claimed disability and active service should be scheduled.

4. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Although the Board regrets the delay, additional development is needed prior to further disposition of the claim of entitlement to service connection for GERD.

The Veteran contends that GERD began during service and continues to present day. 

A July 2020 rating decision found that the evidence shows a qualifying event, injury, or disease had its onset during service in that service treatment records indicated treatment for stomach cramps, epigastric pain, and diarrhea in March 1995, October 1995, and February 1996. The rating decision also noted that VA treatment records note a diagnosis of gastroesophageal reflux in May 2017. The Board is bound by these favorable findings. 

At the time of the rating decision on appeal, the record showed a GERD diagnosis and alleged potential causation related to service.  However, the Veteran has not been provided adequate VA examination which addresses any relationship between the claimed disability and service.  That is a pre-decisional duty to assist error.  Therefore, the Board finds that a VA opinion to determine any relationship between the claimed disability and active service should be scheduled.

5. Entitlement to service connection for rhinitis, on a basis other than as pursuant to the PACT Act, is remanded.

6. Entitlement to service connection for sinusitis, on a basis other than as pursuant to the PACT Act, is remanded.

A July 2020 rating decision found that the evidence showed a qualifying event, injury, or disease had its onset during service in that service medical records indicated treatment for left maxillary sinusitis in June 1992 and treatment for allergies in June 1995. The Board is bound by those favorable findings.

Post service medical records show diagnoses of sinusitis and allergic rhinitis.  

The Veteran has not been provided a VA examination to determine the nature and etiology of the claimed disabilities, and the Board is not free to substitute its own judgment for that of a medical expert.  Colvin v. Derwinski,1 Vet. App. 171 (1991). 

VA must provide an examination or obtain a medical opinion in a claim for service connection when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim.  38 U.S.C. § 5103A; McLendon v. Nicholson, 20 Vet. App. 79 (2006).  The threshold for finding a link between current disability and service is low.  Locklear v. Nicholson, 20 Vet. App. 410 (2006).

The Board finds that while the noted sinus and rhinitis symptoms in service and the Veteran's assertions are not dispositive of the claims, the evidence is sufficient to overcome the low threshold necessary to trigger VA's duty
 and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim.  38 U.S.C. § 5103A; McLendon v. Nicholson, 20 Vet. App. 79 (2006).  The threshold for finding a link between current disability and service is low.  Locklear v. Nicholson, 20 Vet. App. 410 (2006).

The Board finds that while the noted sinus and rhinitis symptoms in service and the Veteran's assertions are not dispositive of the claims, the evidence is sufficient to overcome the low threshold necessary to trigger VA's duty to provide an examination.  Not obtaining an etiology opinion is a pre-decisional duty to assist error.  Therefore, remand for a VA examination is necessary to correct the pre-decisional duty to assist error.

Additionally, the Board notes that the claims for entitlement to service connection for sinusitis and rhinitis were pending prior to the enactment of the PACT Act.  Therefore, order to fully consider the claim, remand is necessary for a medical opinion which considers whether there is a basis for establishing service connection for sinusitis and rhinitis based on direct causation, or on any basis other than as pursuant to the PACT Act.  Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination to diagnose and determine the nature and etiology of any neck and back disabilities.  The examiner must review the claims file and the Veteran's lay statements and should indicate review of the file in the report.  The examiner should diagnose all neck and back disabilities?found or shown in the record during the pendency of the claim.  Pain or other factors causing functional limitation can constitute a disability.  For each neck and back disability diagnosed or shown during the pendency of the claim, to include any pain resulting in?functional loss that constitutes a disability, the examiner must opine whether it is as likely as not that any neck or back disability is etiologically related to active service or any event, disease, or injury during service, including whether any neck and back disability (1) began during active service or is related to any incident during service, to include complaints and diagnoses of strain during service, (2)?manifested as arthritis within one year after separation from service, (3) was noted during service with continuity of the same symptomatology since service.  Please cite to any evidence to support a finding of arthritis within one year following separation from service.  (4) The examiner is specifically asked to opine whether it is as likely as not that the physical nature of active service contributed to or caused the claimed disabilities.  A clearly stated rationale for each opinion should be provided and cannot be based solely on the lack of a record in service of the claimed disability.  The?examiner should refer service medical records indicating treatment in service for neck or back complaints, to specifically include an April 1995 back strain and a June 1992 cervical strain.

2. Schedule the Veteran for an examination to determine the nature and etiology of any heart disabilities, to include atrial fibrillation.  The examiner must review the claims file, including this Remand, and should indicate review of the file in the report.  The examiner should diagnose all heart disabilities?found or shown in the record during the pendency of the claim.  For each chronic heart disability diagnosed or shown during the pendency of the claim the examiner must opined whether it is as likely as not that each heart disability is etiologically related to active service or any event, disease, or injury during service, including whether any heart disability (1)?began during active service or is related to any incident during service; or (2) was noted during service with continuity of the same symptomatology since service; (3) manifested within one year following separation from service as cardiovascular-renal disease; or (4)?is related to conceded toxic exposure risk activities during active service.  When providing the opinion, the examiner must consider the total potential exposure through all applicable deployments; and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  A clearly stated rationale for each opinion should be provided and cannot be based solely on the lack of a record in service of the claimed disability.  The examiner is advised that the absence of a diagnosed disability from the list of disabilities which are presumed to be the result of exposure is not a sufficient explanation for a negative opinion.  The?examiner should refer to?any service medical records indicating treatment in service for heart related complaints.

3. Schedule the Veteran for an examination to determine the nature and etiology
is related to conceded toxic exposure risk activities during active service.  When providing the opinion, the examiner must consider the total potential exposure through all applicable deployments; and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  A clearly stated rationale for each opinion should be provided and cannot be based solely on the lack of a record in service of the claimed disability.  The examiner is advised that the absence of a diagnosed disability from the list of disabilities which are presumed to be the result of exposure is not a sufficient explanation for a negative opinion.  The?examiner should refer to?any service medical records indicating treatment in service for heart related complaints.

3. Schedule the Veteran for an examination to determine the nature and etiology of any gastrointestinal disabilities, to include GERD.  The examiner must review the claims file, including this Remand, and should indicate review of the file in the report.  For each chronic gastrointestinal disability diagnosed or shown during the pendency of the claim the examiner must opined whether it is as likely as not that each disability is etiologically related to active service or any event, disease, or injury during service, including whether any gastrointestinal disability, to specifically include GERD, (1)?began during active service or is related to any incident during service; or (2) was noted during service with continuity of the same symptomatology since service; or (3)?is related to conceded toxic exposure risk activities during active service.  When providing the opinion, the examiner must consider the total potential exposure through all applicable deployments; and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  A clearly stated rationale for each opinion should be provided and cannot be based solely on the lack of a record in service of the claimed disability.  The examiner is advised that the absence of a diagnosed disability from the list of disabilities which are presumed to be the result of exposure is not a sufficient explanation for a negative opinion.  The?examiner should refer to?any service medical records indicating treatment in service for gastrointestinal related complaints, to specifically include March 1995, October 1995, and February 1996 stomach complaints.

4. Schedule the Veteran for an examination to determine etiology of any sinus or rhinitis disabilities.  The examiner must review the claims file, to include a copy of this Remand, and consider the Veteran's lay statements regarding symptoms during and since service.  A clearly stated rationale should be provided for each opinion.  The examiner should:

(a.) Opine whether it is as likely as not that sinusitis or rhinitis had its onset in or is otherwise related to service or any incident of service.  The examiner is advised that an opinion based solely on the lack of medical evidence without considering the Veteran's lay reports is inadequate. The?examiner should refer to any service medical records indicating treatment in service for sinus complaints.

(b.) Opine whether it is as likely as not that sinusitis or rhinitis is due to, the result of, or caused by the service-connected disabilities or treatment for the service-connected disabilities.

(c.) Opine whether it is as likely as not that sinusitis or rhinitis has been aggravated (increased in severity) by the service-connected disabilities or treatment for the service-connected disabilities.  Aggravation need not be permanent.  Aggravation can be found where the service-connected disability prevents treatment of, or lessens the efficacy of treatment of, the nonservice-connected disability, resulting in increase in the nonservice-connected disability.

(d.) Opine whether it is as likely as not that sinusitis or rhinitis was caused or aggravated by exposure to toxic or environmental hazards during service.  The examiner should specifically consider and discuss the synergistic, combined effect of all of the Veteran's toxic exposure risk activities.

 

 

Harvey P. Roberts

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Mondesir, 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. 


 C.F.R. § 20.1303.