HAND IMPAIRMENT OF

M. C. WILSON · 2026 · Case ID: A26039629

MIXED

Summary

The veteran, who served in the U.S. Navy from February 1966 to April 1986, including service in Vietnam, appeals the denial of service connection for right hand arthritis and a disability manifested by nocturia. The Board granted service connection for right hand arthritis, finding the evidence nearly equal and resolving doubt in the veteran's favor. The veteran, a cook for 20 years, claimed his arthritis was due to repetitive trauma from his MOS. While service treatment records showed an in-service laceration and post-service complaints, VA examiners found no nexus, citing lack of documented chronic issues or objective findings in service or immediately post-service. The Board found these opinions inadequate, noting they failed to adequately consider the veteran's credible lay testimony about symptom continuity and the MOS duties. The Board found the evidence preponderated in favor of service connection for the arthritis. The claim for nocturia, asserted as secondary to service-connected hypertension and its medication, was remanded. The Board found the VA examinations addressing nocturia inadequate, as they failed to complete necessary workups, applied an incorrect legal standard for secondary service connection (proximate cause instead of but-for causation), and did not address aggravation. The case was remanded for new VA examinations to address direct and secondary service connection for nocturia, including a proper nexus evaluation and consideration of the veteran's lay statements.

Rationale

Current disability: Degenerative arthritis of the right hand.; In-service event: Laceration of the medial joint of the fourth digit on the right hand on August 22, 1977.; Nexus: Evidence nearly equal; doubt resolved in veteran's favor due to credible lay testimony regarding MOS duties and symptom continuity, despite lack of chronic findings in service records.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260323-640150

Full Decision Text

Citation Nr: A26039629
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 260323-640150
DATE: April 28, 2026

ORDER

Service connection for right hand arthritis is granted.

REMANDED

Entitlement to service connection for a disability manifested by nocturia is remanded.

FINDING OF FACT

Resolving any doubt in his favor, the Veteran's right hand arthritis is caused by, or otherwise etiologically related to, his active service.

CONCLUSION OF LAW

The criteria for service connection for right hand arthritis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from February 1966 to April 1986. For his meritorious service, the Veteran was awarded (among other decorations) the Republic of Vietnam Gallantry Cross, the Vietnam Service Medal, and the Vietnam Campaign Medal.

This matter is before the Board of Veterans' Appeals (Board) on appeal of a March 2026 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).

Given the date of the rating decision on appeal, the Veteran's appeal is governed by the modernized review system, known by the Board as the Appeals Modernization Act (AMA). 38 C.F.R. §§ 3.2400, 19.2.

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), the Veteran elected the direct review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2026 rating decision (i.e., agency of original jurisdiction (AOJ) decision) on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim of entitlement to service connection for a disability manifested by nocturia, any evidence the Board could not consider may be considered by the AOJ on readjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

The Board observes that the denial of due process may include issuing a Board decision prior to the expiration of the one-year period for a claimant to request a docket change. This period expires after one year from the date the AOJ mailed the decision on appeal, or 60 days from the date the Board received the VA Form 10182, whichever is later. See Williams v. McDonough, 37 Vet. App. 305 (2024). In this case, the Board is granting one of the appealed matters in full, and with regard to the other matter, the Board is not rendering a decision on the merits but remanding the case. Accordingly, the Veteran's due process rights are not adversely affected by not waiting until March 23, 2027, the end of the period in which to request a docket change.

The Board notes that the Veteran's representative challenged the competency of the 2025 and 2026 VA examiners who have rendered medical opinions regarding the issues on appeal to date. The representative requests the examiners' curriculum vitae (CV), credentials, and specialties pursuant to Francway v. Wilkie, 930 F.3d 1377, 1381 (Fed. Cir. 2019). The representative has also submitted interrogatories for the examiners pursuant to Nohr v. McDonald, 27 Vet. App. 124 (2014). See, e.g., January 2026 and February 2026 Appellant Briefs. For the reasons discussed below, the Board finds the opinions rendered thus far to be inadequate. Because the Board is not relying on these opinions to make any decisions adverse to the Veteran, no further action is required.

Service Connection
date. The representative requests the examiners' curriculum vitae (CV), credentials, and specialties pursuant to Francway v. Wilkie, 930 F.3d 1377, 1381 (Fed. Cir. 2019). The representative has also submitted interrogatories for the examiners pursuant to Nohr v. McDonald, 27 Vet. App. 124 (2014). See, e.g., January 2026 and February 2026 Appellant Briefs. For the reasons discussed below, the Board finds the opinions rendered thus far to be inadequate. Because the Board is not relying on these opinions to make any decisions adverse to the Veteran, no further action is required.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

An alternative method of establishing the second and third criteria (i.e., Shedden elements) for disabilities identified as chronic diseases in 38 C.F.R. § 3.309(a) is through a demonstration of continuity of symptomatology. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be shown if "the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology." Savage v. Gober, 10 Vet. App. 488, 498 (1997).

Service connection is also warranted for disability due to, or caused by, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b); see also Ward v. Wilkie, 31 Vet. App. 233 (2019).

Moreover, under the causation standard of 38 U.S.C. § 1110, secondary service connection is warranted where a nonservice-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. See Spicer v. McDonough, 61 F. 4th 1360 (Fed. Cir. 2023).

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Service
a case-by-case basis, whether the veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d at 1376-77.

Service connection for right hand arthritis is granted.

The Veteran generally contends his right hand arthritis is due to his active service. See August 2023 VA Form 21-526EZ. More specifically, the Veteran argues that performing his military occupational specialty (MOS) duties as a cook for 20 years resulted in trauma to his right hand with pain that continued after service. See, e.g., September 2025 Veteran Statement; September 2025 Statement from the Veteran's Wife, S.A., RN; March 2026 Appellant Brief. The Veteran reports he was required to engage in continuous, physically demanding, and repetitive tasks. This included peeling and preparing large quantities of potatoes, lifting heavy food and supply containers, operating galley equipment, and cleaning industrial kitchen surfaces and equipment. The Veteran states these repetitive motions, performed daily over two decades, placed significant strain on his hand. He reports that he developed increased stiffness, chronic pain, and reduced mobility in his right hand. See September 2025 Veteran Statement.

The Veteran's December 20, 1965, enlistment examination was normal, with a normal clinical evaluation for his upper extremities. Other examinations the Veteran underwent while in service were also normal with normal clinical evaluations for his upper extremities. See December 9, 1971, July 6, 1982 (Re-enlistment Examinations), and March 12, 1986 (Separation Examination).

Despite this, the Veteran's service treatment records (STRs) reflect an injury, and treatment of, his right hand. On August 22, 1977, he lacerated the medial joint of the fourth digit on his right hand.

Post-service treatment records show the Veteran complained of hand pain associated with his work as a cook, and that he was eventually diagnosed with arthritis. See, e.g., September 12, 2025, and October 10, 2025, VA Treatment Records.

Turning to the direct service connection framework, in the March 2026 rating decision, the RO found the Veteran has been diagnosed with a disability, namely degenerative arthritis of the right hand. See also September 2025 VA Examination for Hand and Fingers.

Additionally, the RO found the evidence shows that a qualifying event, injury, or disease had its onset during the Veteran's service. Specifically, the RO noted the August 22, 1977, STR documenting complaints and treatment for a laceration on the medial joint of the fourth digit on the right hand. As the Board is bound by the RO's favorable findings, the first and second criteria for direct service connection, a current disability and an in-service incurrence, have been met. 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).

The Board also notes the Veteran's available personnel records confirm his MOS of chef/cook. See Form DD Form 214; also see generally Military Personnel Records. The Board finds the Veteran's report regarding his MOS duties while in service to be credible and consistent with the circumstances of his service. See 38 C.F.R. § 1154. Thus, the second criterion for direct service connection, an in-service incurrence, has been met by taking into consideration the Veteran's MOS as well.

Therefore, the remaining question is whether the Veteran's right hand arthritis is due to his service.

To that point, September 2025 and November 2025 VA examiners determined the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the September 2025 VA examiner stated his opinion is based on a review of the records, which did not indicate a hand condition during service.

The November 2025 VA examiner found the Veteran's reported longstanding hand pain did not align with the records. The examiner similarly noted there was no record of chronic or recurrent right hand problems, right hand pain or diagnosis, or a permanent residual or chronic disability in the Veteran's STRs or immediately following discharge/separation from service as the reason no nexus could be established. Additionally, the examiner indicated the Veteran's current degenerative changes, revealed on a September 2025 x-ray, follow the expected age-related pattern of degenerative arthritis rather than a condition that began in service.

With regard to a nexus between the Veteran's right hand arthritis and his 1977 laceration, the September 2025 VA examiner found the Veteran has no current abnormality related to laceration that would cause arthritis. See November 2025 Addendum Opinion. The November 2025 VA examiner stated the 1977 laceration was an acute soft tissue injury without any evidence of degenerative arthritis on examination or imaging.

The November 2025 VA examiner addressed the Veteran's right hand arthritis considering his daily duties and MOS-related activities conceded during service as well. See December 2025 Addendum Opinion. The examiner admitted that degenerative arthritis develops gradually and can result from a variety of factors, including aging and general use. However, she ultimately reasoned that a nexus could not be established because the Veteran's degenerative arthritis could not be confirmed with objective findings, such as imaging, in his service records or immediately post-service. Id.

The September 2025 and November 2025 VA examiners' opinions are inadequate because the lack of a documented diagnosis and treatment in service, and a long period after, is the sole basis for their negative findings without considering the Veteran's competent report regarding the onset and continuity of his symptoms since service. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Dalton v. Nicholson, 21 Vet. App. 23 (2007). Furthermore, the September 2025 VA examiner's opinion, with regard to a nexus between the Veteran's right hand arthritis and 1977 laceration, is inadequate because it is conclusory and not supported with a reasoned explanation based on the specific facts of the Veteran's case. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) (holding that a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion). Given the inadequacies of the September 2025 and November 2025 VA examiners' opinions, the Board assigns them minimal probative weight.

With that being said, in reading the November 2025 VA examiner's December 2025 addendum opinion as a whole, the Board finds that the examiner implies degenerative arthritis can develop gradually and result from factors such as general use. Yet, gradual development of arthritis from general use was discounted because of the lack of treatment records with objective findings, such as imaging, confirming any such development during the Veteran's service or immediately thereafter.

The Board notes that the Veteran is competent to report readily observable symptoms, such as hand pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Moreover, as previously mentioned, the Board finds the Veteran's statements regarding his MOS duties to be credible and consistent with the circumstances of his service. Thus, the Board assigns the Veteran's statements great probative weight.

After reviewing the above, the Board finds that the evidence is at least "nearly equal" as to whether his current right hand arthritis is caused by, or otherwise etiologically related to, his active service. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Therefore, resolving all doubt in his favor, the Board finds the final criterion for direct service connection, a nexus (i.e., link to service), has
2007). Moreover, as previously mentioned, the Board finds the Veteran's statements regarding his MOS duties to be credible and consistent with the circumstances of his service. Thus, the Board assigns the Veteran's statements great probative weight.

While the Board could obtain an additional medical opinion, remand is unnecessary at this juncture as the evidence is nearly equal. See Mariano v. Principi, 17 Vet. App. 305 (2003) (holding that the Board is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case).

In sum, the Board resolves all doubt in the Veteran's favor, and finds that each element of the direct service connection framework is met for this claim. Accordingly, service connection for right hand arthritis is granted.

REASONS FOR REMAND

Entitlement to service connection for a disability manifested by nocturia is remanded.

The Veteran contends that he has nocturia secondary to his service-connected hypertension, to include the medication used to treat hypertension. Specifically, the Veteran reports nocturia is a residual/side effect of prescribed Amlodipine therapy for his service-connected hypertension. See, e.g., October 2025 VA Form 21-526EZ; October 2025 Veteran Statement; October 2025 Statement from the Veteran's Wife, S.A., RN; February 2026 VA Form 20-0995, Supplemental Claim Application. The Veteran stated about three months after being prescribed Amlodipine, he began to experience frequent nighttime urination, often 4 to 5 times per night. The frequent nighttime urination leaves him exhausted and unrested. The issue began after starting Amlodipine and has persisted. See October 2025 Veteran Statement.

In addition to the Veteran's expressly raised theory of entitlement to service connection on a secondary basis, the Board notes that entitlement to service connection on a direct basis is reasonably raised by the record because VA conceded his participation in a toxic exposure risk activity (TERA). See Robinson v. Shinseki, 557 F.3d 1355 (2008). VA concedes the Veteran's exposure to herbicide agents and asbestos. See November 2023 Herbicide Exposure Verification Memorandum; November 2023 TERA Memorandum; March 2026 Rating Decision - Narrative.

Under the AMA, a remand by the Board is proper for correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors) and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the Veteran's claim. 38 C.F.R. § 20.802(a).

In the March 2026 AMA rating decision, the AOJ denied the claim without obtaining a new VA examination and new medical opinions to address the deficiencies discussed below. This was a pre-decisional duty to assist error, and a remand is necessary to correct it. 38 C.F.R. § 20.802(a).

Direct Service Connection

In November 2025, the Veteran underwent a VA examination for urinary tract conditions, where he was diagnosed with nocturia with an etiology that is unknown. The November 2025 VA examiner determined the claimed condition was less likely than not caused by the indicated TERAs, after considering the total potential exposure through all applicable military deployments, and the synergistic, combined effect of all TERAs, of the Veteran. As rationale, the examiner noted that nocturia is not considered a presumptive condition for veterans exposed to herbicide agent (i.e., Agent Orange), and nocturia is not a known medical complication for veterans exposed to asbestos. The examiner concluded there is no medical or scientific evidence available that provides any indication of a relationship between the development of the nocturia condition at issue and the TERA. Thus, a negative nexus was offered.

The November 2025 VA examiner's opinion is inadequate because it is conclusory and not supported with a reasoned explanation based on the specific facts of the Veteran's case. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (
. As rationale, the examiner noted that nocturia is not considered a presumptive condition for veterans exposed to herbicide agent (i.e., Agent Orange), and nocturia is not a known medical complication for veterans exposed to asbestos. The examiner concluded there is no medical or scientific evidence available that provides any indication of a relationship between the development of the nocturia condition at issue and the TERA. Thus, a negative nexus was offered.

The November 2025 VA examiner's opinion is inadequate because it is conclusory and not supported with a reasoned explanation based on the specific facts of the Veteran's case. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). Furthermore, the Board notes the opinion is also inadequate because the examiner's analysis (particularly with regard to herbicide agent exposure) is limited to whether nocturia is a presumptive condition. However, direct service connection can be established by evidence demonstrating a disease (i.e., a disability manifested by nocturia) is related to service, to include the Veteran's conceded exposure, even if the disorder is not a disease for which presumptive service connection is authorized. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Secondary Service Connection

A January 2026 VA examiner determined there was no pathology to warrant diagnosis for the claimed nocturia condition. The examiner noted that nocturia is a symptom, not a diagnosis, and provided a detailed medical explanation of the symptom. Notably, the examiner admitted the Veteran has not undergone a sufficient medical workup to explore and explain the underlying etiology of his nocturia. As a result, the examiner stated he could not give an opinion on a symptom.

Despite the January 2026 VA examiner's observation that the Veteran had not undergone a sufficient medical workup to address the etiology of his nocturia, another VA examination was not requested. Instead, an addendum opinion was obtained.

Another January 2026 VA examiner determined the Veteran's claimed condition was less likely than not proximately due to, or the result of, his service-connected condition. As rationale, the examiner essentially gave a detailed explanation for why the Veteran's etiologic workup is incomplete, before concluding that other Veteran-specific risk factors, such as diabetes and obesity, provide more plausible alternative explanations for nocturia.

Among other things, the examiner stated nocturia is multifactorial and commonly reflects non-medication etiologies. The examiner explained that nocturia is widely recognized as a multifactorial symptom that may be driven by systemic disease (e.g., diabetes, sleep disorders, cardiovascular/renal contributors) or lower urinary tract conditions (e.g., benign prostatic hypertrophy (BPH)/overactive bladder (OAB)), and it often requires structured evaluation (history, physical, urinalysis, and bladder diary) to determine cause.

The examiner highlighted that, in the Veteran's case, the disability benefits questionnaire (DBQ) documents unknown etiology, and the medical record does not show sufficient etiologic confirmation (e.g., bladder diary, targeted evaluation for nocturnal polyuria, BPH, OAB, sleep apnea, metabolic contributors), limiting the ability to attribute the symptom to antihypertensive medication. The examiner also pointed out that the record does not identify a specific hypertension medication with a clear mechanism causing nocturia or the Veteran's actual antihypertensive regimen, dosing, or timing. The examiner mentioned there was no documentation of symptom onset temporally linked to a medication start/change as well. The examiner stated without medication identification and temporal association, a causal attribution to "hypertension medication" is medically speculative.

The Board notes that once VA undertakes the effort to provide an examination or opinion, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Yet, both VA examiners have indicated the examination performed is not adequate to address the Veteran's contentions because the necessary workup has not been completed. However, the examiners' explanations for why an underlying etiology for nocturia cannot be determined without additional workup is not sufficient. If required, the additional workup must be completed.

Furthermore, the second January 2026 VA examiner's opinion is inadequate for two reasons. First, the VA examiner's opinion is inadequate because the incorrect standard for causation is applied. The United States Court of Appeals for the Federal Circuit (Federal Circuit) invalidated the requirement of "proximate cause." In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the Federal Circuit held a "but for" causation or aggravation is enough to show entitlement to secondary service connection. The Federal Circuit explained that "but-for causation" is a broader standard than proximate causation and can include multi-causal links, including action and inaction. Pursuant to Spicer, secondary service connection is warranted where a non-service-connected disability would have been less severe "but for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

The VA examiner's opinion is also inadequate because the nexus discussion is limited to whether the Veteran's claimed disability is caused by the medication prescribed to treat his service-connected hypertension. The examiner did not address whether the Veteran's claimed disability is aggravated by the medication prescribed to treat his service-connected hypertension. Therefore, the opinion is inadequate because it does not address both the "caused by" and "aggravation" avenues of secondary service connection associated with the Veteran's claimed disability. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013).

Additionally, the Board observes that the Veteran's representative argues that if there is no diagnosed disability manifested by nocturia, the symptom results in a functional impairment in earning capacity, constituting a disability under Saunders v. Wilkie, 886 F.3d 1356 (2018) (holding that pain alone, without a specific diagnosis or otherwise identified disease or injury, may constitute a disability under 38 U.S.C. § 1110 to establish service connection if the pain reaches the level of a functional impairment of earning capacity). See, e.g., February 2026 Appellant Brief. Notably, the Board finds that by virtue of adjudicating the issue of entitlement to service connection for nocturia, the RO acknowledges that there is potentially a disability manifested by this symptom.

While the Veteran does not contend that he experiences pain due to nocturia, he reports being exhausted and unrested due to frequent nighttime urination, causing daytime fatigue. See October 2025 Veteran Statement; October 2025 Statement from the Veteran's Wife, S.A., RN. Pursuant to Martinez-Bodon v. Wilke, 32 Vet. App. 393 (2020), the holding in Saunders, which defined a "disability" as a functional impairment of earning capacity, applies broadly to include more than just pain. However, this definition is limited by VA's authority to adopt and apply its rating schedule. Given the Veteran's report regarding nocturia, an examination is necessary to determine whether he has claimed disability that has resulted in functional impairment of earning capacity, as contemplated in Saunders, and is etiologically related to service.

The Board acknowledges that, in October 2025, a positive opinion provided by the Veteran's wife, S.A., RN, who concluded his nocturia is secondary to or aggravated by Amlodipine therapy for hypertension. Of note, RN S.A. acknowledges that nocturia is a symptom that began shortly after the Veteran began Amlodipine therapy for hypertension. However, RN S.A. does not identify a disability manifested by nocturia, nor does she opine that the level of functional impairment of earning capacity contemplated in Saunders is reached in order to find that there is a current disability. The existence of a current disability is a cornerstone of a claim for VA disability compensation, see Degmetich v. Brown, 104 F.3d 1328 (1997), and in the absence of proof of a present disability there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, RN S.A.'s opinion, which addresses the symptom of nocturia without identifying a current disability, cannot support a grant of service connection.

The matter is REMANDED for the following action:

Schedule the Veteran for a
functional impairment of earning capacity contemplated in Saunders is reached in order to find that there is a current disability. The existence of a current disability is a cornerstone of a claim for VA disability compensation, see Degmetich v. Brown, 104 F.3d 1328 (1997), and in the absence of proof of a present disability there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, RN S.A.'s opinion, which addresses the symptom of nocturia without identifying a current disability, cannot support a grant of service connection.

The matter is REMANDED for the following action:

Schedule the Veteran for a VA examination to address his claimed disability manifested by nocturia. The entire claim file, to include all electronic files, must be reviewed by the examiner.

(A) After examining the Veteran and reviewing the record, the examiner must identify all disabilities manifested by nocturia during the appeal period, even if such disability is currently asymptomatic or resolved during the pendency of the appeal. The examiner is advised that in identifying the current disability(-ies), they must address whether the Veteran's nocturia has been productive of functional impairment of earning capacity, sufficient to qualify the symptom as a disability under current caselaw.

Direct Service Connection

(B) For each diagnosis, the examiner must state whether it is at least as likely as not that the identified disability manifested by nocturia had its onset during the Veteran's active service, or is otherwise related to his active service, to include his conceded exposure to herbicide agents and asbestos.

In answering these questions, the examiner must consider the following: (1) the Veteran's total potential exposure through all applicable deployments, and (2) the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

Secondary Service Connection

(C) For each diagnosis, the examiner must state whether it is at least as likely as not that the Veteran's identified disability manifested by nocturia is due to, or caused by, his service-connected hypertension, to include the medication prescribed to treat hypertension.

(D) For each diagnosis, the examiner must state whether it is at least as likely as not that the Veteran's identified disability manifested by nocturia is aggravated by his service-connected hypertension, to include the medication prescribed to treat hypertension.

Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment in earning capacity, worsening of functionality) resulting from service-connected disabilities.

In answering all questions, the examiner must specifically consider the following lay evidence in addition to the medical evidence of record: (1) the October 2025 Statement from the Veteran's Wife, S.A., RN, in which she reports observing the Veteran's nocturia and resulting daytime fatigue from Amlodipine therapy for hypertension; and (2) the October 2025 Veteran Statement, in which he describes issues with nocturia after he began treatment for hypertension.

The examination report must include a complete rationale for all opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the likelihood is at least approximately balanced or nearly equal, if not higher.

The examiner is instructed that the lack of documented treatment in service, or a long period after, while probative, cannot serve as the sole basis for a negative finding.

The Veteran's, and his wife's, lay contentions must be considered and weighed in making the determination.

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Neal, Associate 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.

Analyze in VA Law Explorer