RIGHT HAND CONDITION

PAUL R. CASEY · 2026 · Case ID: A26039752

MIXED

Summary

The veteran, who served in the Army from June 1970 to February 1972, appeals the denial of service connection for neurosis and PTSD, and the remand of multiple other conditions. The Board granted service connection for allergic rhinitis, finding that the veteran's pre-existing hay fever was aggravated by service, leading to the development of allergic rhinitis. This was supported by an enlistment examination noting hay fever and a private medical opinion from a nurse practitioner linking the aggravation to service. The Board also granted service connection for a respiratory condition, finding that the allergic rhinitis aggravated by service led to chronic bronchitis, supported by a positive nexus opinion. Service connection for a heart condition was granted, finding that a pre-existing heart murmur was aggravated by service, leading to coronary bypass surgery, supported by a private nurse practitioner's opinion and a VA examiner's negative opinion which was not considered clear and unmistakable evidence to rebut the presumption of aggravation. Service connection for obstructive sleep apnea (OSA) was granted, based on a positive nexus opinion from a private nurse practitioner finding it was caused by active duty service. The claims for neurosis and PTSD were denied due to the lack of a current diagnosis, as the veteran had not provided sufficient medical evidence to establish these conditions. Numerous other claims, including chronic pain, gout, hypertension, thyroid, kidney, peripheral artery, right hand, right eye, skin, GI, sinusitis, back, wrist, ankle, shoulder, and neck conditions, were remanded due to duty to assist errors, including failure to obtain necessary VA examinations and nexus opinions, and failure to verify claimed exposures to mustard gas, asbestos, PFAS, and TCE.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250827-570883

Full Decision Text

Citation Nr: A26039752
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250827-570883
DATE: April 28, 2026

ORDER

New and relevant evidence has been received, and the request to readjudicate the claim for entitlement to service connection for a right hand condition is granted.

Entitlement to service connection for a respiratory condition (claimed as chronic obstructive pulmonary disease (COPD) and bronchitis) is granted.

Entitlement to service connection for allergic rhinitis is granted.

Entitlement to service connection for neurosis is denied.

Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied.

Entitlement to service connection for a heart condition is granted.

Entitlement to service connection for obstructive sleep apnea (OSA) is granted.

REMANDED

Entitlement to service connection for chronic pain is remanded.

Entitlement to service connection for gout is remanded.

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for a thyroid condition is remanded.

Entitlement to service connection for kidney condition is remanded.

Entitlement to service connection for peripheral artery condition is remanded.

Entitlement to service connection for a right hand condition is remanded.

Entitlement to service connection for a right eye condition is remanded.

Entitlement to service connection for a skin condition, other than PFB, is remanded.

Entitlement to service connection for a gastrointestinal (GI) condition is remanded.

Entitlement to service connection for sinusitis with headaches is remanded.

Entitlement to service connection for a back condition is remanded.

Entitlement to service connection for a right wrist condition is remanded.

Entitlement to service connection for a neck condition is remanded.

Entitlement to service connection for a left ankle condition is remanded.

Entitlement to service connection for a right ankle condition is remanded.

Entitlement to service connection for a left shoulder condition is remanded.

Entitlement to service connection for a right shoulder condition is remanded.

Entitlement to a rating in excess of 10 percent for pseudofolliculitis barbae (PFB) is remanded.

FINDINGS OF FACT

1. New evidence was received after the May 2024 rating decision denying service connection a right hand strain that is relevant to the elements of service connection.

2. The Veteran's pre-existing hay fever underwent an increase in severity in service and is presumed to have been aggravated by service, leading to allergic rhinitis; and the presumption of aggravation has not been rebutted by clear and unmistakable evidence.

3. The Veteran's service-connected allergic rhinitis caused the Veteran's respiratory condition.

4. The Veteran does not have a current diagnosis for neurosis or PTSD.

5. The Veteran's pre-existing heart murmur underwent an increase in severity in service and is presumed to have been aggravated by service, leading to coronary bypass surgery; and the presumption of aggravation has not been rebutted by clear and unmistakable evidence.

6. The Veteran's OSA was caused by active duty service.

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim for service connection for a right hand condition have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501.

2. The criteria for service connection for allergic rhinitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306.

3. The criteria for service connection for a respiratory condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

4. The criteria for service connection for neurosis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

6. The criteria for service connection for a heart condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306.

7. The criteria for service connection for O
§§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

6. The criteria for service connection for a heart condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306.

7. The criteria for service connection for OSA have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 1970 to February 1972.

In the August 27, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Regarding the service connection claims for gout, hypertension, a thyroid condition, a kidney condition, and PAD, the Board may only consider the evidence of record at the time of the March 7, 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

Regarding the increased rating claim for PFB, the Board may only consider the evidence of record at the time of the March 10, 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. Id.

Regarding the service connection claims for a right hand condition and a respiratory condition, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. Id.

Regarding the service connection claims for a right eye condition, a skin condition, neurosis, and PTSD, the Board may only consider the evidence of record at the time of the May 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. Id.

Regarding the service connection claims for a GI condition, allergic rhinitis, and sinusitis, the Board may only consider the evidence of record at the time of the June 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. Id.

Regarding the service connection claims for a back condition, a neck condition, a bilateral ankle condition, a bilateral shoulder condition, a right wrist condition, and OSA, the Board may only consider the evidence of record at the time of the July 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. Id.

If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claims of service connection for chronic pain, gout, hypertension, a thyroid condition, a kidney condition, PAD, a right hand condition, a right eye condition, a skin condition, a GI condition, a back condition, a neck
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 claims of service connection for chronic pain, gout, hypertension, a thyroid condition, a kidney condition, PAD, a right hand condition, a right eye condition, a skin condition, a GI condition, a back condition, a neck condition, a bilateral ankle condition, a bilateral shoulder condition, a right wrist condition; and an increased rating for PFB, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. New and relevant evidence has been received, and the request to readjudicate the claim for entitlement to service connection for a right hand condition

If?new?and?relevant?evidence has been presented or secured with respect to a supplemental claim, the AOJ will readjudicate the previously denied claim taking into consideration all of the evidence of record. 38 C.F.R. § 3.2501. New evidence is evidence not?previously part of the actual record before agency adjudicators at the time of the decision. 38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Id. Here, the AOJ declined to reopen the case based on a lack of new and relevant evidence submitted since the previous final denial.

The Board observes that the May 2024 rating decision denied service connection for right hand condition due to the lack of a nexus between active duty and the diagnosed right hand condition. In October 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, seeking review of the May 2024 rating decision denying service connection for a right hand condition. In April 2025 rating decision on appeal, the AOJ denied the request to readjudicate the claim due to the lack of new and relevant evidence. The Board now looks to evidence received since the denial in May 2024 rating decision.

Evidence since the May 2024 denial consist of citations to medical treatises to support finding that wrist sprains can lead to long-term damage. See October 2024 Supplemental Claim. The Veteran provided new lay evidence to support a nexus between the in-service hand injury and the current hand condition. As such, the Board finds that the lay evidence constitutes evidence that tends to prove or disprove a matter at issue and that was not previously part of the record. Therefore, the Board finds that?new?and?relevant?evidence has been received, and readjudication of the claim is warranted. 38 C.F.R. § 3.2501(a)(1).

Service Connection

Service connection may be granted for a 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). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C.
.R. § 3.303(d).

Every veteran who served in the active military, naval, or air service after December 31, 1946, is taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. §§ 1111, 1137. Only those conditions recorded in examination reports can be considered as "noted," 38 C.F.R. § 3.304(b), and a history of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions. 38 C.F.R. § 3.304(b)(1).

If a disorder noted at the time of a veteran's examination, acceptance, and enrollment into service undergoes a chronic or permanent increase in severity during service, it is presumed that the disability was aggravated by service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). This presumption can be rebutted only by clear and unmistakable evidence demonstrating that the increase was due to the natural progress of the condition. 38 C.F.R. § 3.306(b).

In order to correctly apply the law, the Board must first make a determination as to whether the Veteran's disability was noted on service entrance. As noted above, critical to determining whether a defect, infirmity, or disorder has been "noted" is whether the condition is "recorded" in an examination report; noting only a history of a condition at the time of the entrance examination" does not constitute a notation" of a preexisting condition. See McKinney v. McDonald, 28 Vet. App. 15, 22-23 (2016) (citing 38 C.F.R. § 3.304(b)(1) and Crowe v. Brown, 7 Vet. App. 238, 245 (1994) (noting that the presumption of soundness only attaches "where there has been an induction examination in which the later-complained-of-disability was not detected").

1. Service connection for allergic rhinitis

In this case, the Veteran was provided an enlistment examination in November 1969. At that time, the examiner noted "hay fever." In addition, an April 1970 form from the Veteran's treating physician noted treatment for hay fever that was treated with antihistamines. The Veteran apparently responded to treatment with antihistamines. Based on the clear identification and diagnosis made on the enlistment examination report, the Board finds that hay fever was noted or recorded at the time of his examination, acceptance, and enrollment into the Army. Therefore, because the disorder was noted on service entrance examination, the Veteran is not presumed sound and 38 U.S.C. § 1153 applies.

The law provides that a pre-existing injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153. In such cases, the evidence must only show that there was an increase in disability during service to trigger the presumption of aggravation. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). If the presumption of aggravation under
to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153. In such cases, the evidence must only show that there was an increase in disability during service to trigger the presumption of aggravation. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). If the presumption of aggravation under section 1153 arises, the burden then shifts to the government to show a lack of aggravation by establishing "that the increase in disability is due to the natural progress of the disease." Wagner, 370 F.3d at 1096 (citing 38 U.S.C. § 1153). This requires the government to show by clear and unmistakable evidence that any increase in disability was due to the natural progress of the condition. See Cotant v. Principi, 17 Vet. App. 116, 130-32 (2003); see also 38 C.F.R. § 3.306(b).

In light of the foregoing, the threshold inquiry as to aggravation is whether the evidence establishes that there was an increase in the Veteran's hay fever during service. After reviewing the record, the Board finds that the evidence establishes such an increase. The Veteran's STRs show treatment for allergies, including evidence May 1971 that the Veteran had persistent allergies which were not responding to medications. Prior to his military service, his physician noted that the Veteran' "responded to treatment." In addition, the Veteran provided an August 2025 nexus opinion from Dr. R.P. Dr. R.P. provided a lengthy and well explained rationale which detailed how the Veteran's pre-existing hay fever was aggravated by active duty service, including tear gas training, and developed into allergic rhinitis.

Having shown an increase in severity during service, the Veteran's pre-existing hay fever is presumed to have been aggravated by service unless VA can demonstrate by clear and unmistakable evidence that such increase was due to the natural progress of the condition. In order to rebut the presumption of aggravation, the evidence of natural progression must be unmistakable (i.e., clear, obvious, or manifest). The United States Court of Appeals for Veterans Claims has made clear that the clear-and-unmistakable-evidence standard is an onerous one and requires that the evidence be "undebatable." Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). Here, there is no medical examination or opinion on the matter or any other evidence rising to the level of "clear and unmistakable evidence" as is needed to rebut the presumption of aggravation.

Based on the available evidence, and with application of the presumption of aggravation, the Board finds that the Veteran's pre-existing hay fever is properly found to have been aggravated as a result of his active duty service, and service connection for allergic rhinitis is granted.

2. Service connection for a respiratory condition

The Veteran initially filed separate service connection claims for chronic obstructive pulmonary disease (COPD) and bronchitis. In Clemons v. Shinseki, 23 Vet. App. 1, 4-5(2009), the Court held that a claim should not be limited to the disorders characterized by the veteran but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim. In other words, and as discussed further below, the Board will combine the claims into a single claim of service connection for a respiratory condition.

The Veteran submitted an August 2025 examination and nexus opinion from Dr. R.P. The examiner provided a positive nexus opinion, finding the Veteran's allergic rhinitis lead to the development of chronic bronchitis. The Veteran provided a positive nexus opinion based upon review of the service treatment records, private medical records, and lay evidence. A review of the record shows there is no probative opinion of record to refute the findings of Dr. R.P. which show chronic bronchitis is secondary to allergic rhinitis. Accordingly, service connection for a respiratory condition is warranted, and the claim is granted in full.

3. Entitlement to service connection for neurosis and PTSD

The current disability requirement is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, or when the record contains a recent diagnosis
initis lead to the development of chronic bronchitis. The Veteran provided a positive nexus opinion based upon review of the service treatment records, private medical records, and lay evidence. A review of the record shows there is no probative opinion of record to refute the findings of Dr. R.P. which show chronic bronchitis is secondary to allergic rhinitis. Accordingly, service connection for a respiratory condition is warranted, and the claim is granted in full.

3. Entitlement to service connection for neurosis and PTSD

The current disability requirement is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, or when the record contains a recent diagnosis of disability prior to filing a claim for benefits based on that disability. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

The Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history; however, he is not competent to provide a diagnosis or an etiology opinion for psychiatric disorders. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Nevertheless, he is competent to relate what he has been told by a professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

Establishing service connection for PTSD requires specific findings. These are: (1) a current medical diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f). A diagnosis of PTSD must comply with the criteria set forth in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Id.; 38 C.F.R. § 4.125(a).

The question of whether a Veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. Wood v. Derwinski, 1 Vet. App. 190 (1991), aff'd on recon., 1 Vet. App. 406, 407 (1991). Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of PTSD is a question of fact for medical professionals and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators.

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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. Jandreau, 492 F.3d at 1377. Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006).

When the evidence is evenly balanced or approximately so regarding whether service connection is warranted, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102. To deny a claim on its merits, the evidence must persuasively weigh against the claim. Id.

The Veteran contends that he has additional psychiatric disorders which are separate from his service-connected bipolar disorder. Specifically, he contends that he
evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006).

The Veteran contends that he has additional psychiatric disorders which are separate from his service-connected bipolar disorder. Specifically, he contends that he has neurosis and PTSD. See June 2023 Supplemental Claim.

Based on a careful review of all the subjective and clinical evidence, the Board finds that the evidence persuasively weighs against finding service connection for either neurosis or PTSD are warranted.

The threshold question in any claim seeking service connection is whether the Veteran, in fact, has the disability for which service connection is sought. ee McClain, 21 Vet. App. at 321. In the absence of proof of a current disability, service connection is not warranted. Brammer, 3 Vet. App. at 225.

The evidence of record does not show a current diagnosis for neurosis or PTSD. The Veteran has not asserted, and the record does not show the Veteran has the medical expertise as a psychiatrist or psychologist to diagnose the Veteran with psychiatric disorders. Jandreau, 492 F.3d at 1377. Without any probative medical evidence showing a diagnosis for neurosis or PTSD, the Board finds that the Veteran does not have a current diagnosis for neurosis or PTSD. Service connection may only be granted for a current disability. When a claimed disability is not shown, there may be no grant of service connection. See 38 U.S.C. §§ 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). "In the absence of proof of a present disability there can be no valid claim."

Here, as the Veteran is not currently diagnosed with neurosis or PTSD, per DSM-5, his service connection claim must be denied. Since there is no current disability, a discussion of any in-service incurrence or aggravation of a disease or injury, or nexus, is unnecessary. Based on the analysis above, the Board must find that the evidence is not in approximate balance and that the evidence persuasively favors finding that the criteria for entitlement to service connection for neurosis and PTSD have not been met. Accordingly, the benefit-of-the-doubt doctrine does not apply, and the claims are denied. 38 U.S.C. § 5107(b).

4. Service connection for a heart condition

In this case, the Veteran was provided with an enlistment examination in November 1969. At that time, the examiner noted a heart murmur. In addition, an April 1970 Report of Special Disease diagnosed the Veteran with a functional systolic murmur. Based on the clear identification and diagnosis made on the enlistment examination report, the Board finds that hay fever was noted or recorded at the time of his examination, acceptance, and enrollment into the Army. Therefore, because the disorder was noted on service entrance examination, the Veteran is not presumed sound and 38 U.S.C. § 1153 applies.

In light of the foregoing, the threshold inquiry as to aggravation is whether the evidence establishes that there was an increase in the Veteran's heart murmur during service. After reviewing the record, the Board finds that the evidence establishes such an increase. The Veteran provided a November 2025 nexus opinion from P.S.W., a nurse practitioner (NP). The NP provided a lengthy and well explained rationale which detailed how the Veteran's pre-existing heart murmur was aggravated by active duty service and led to the coronary bypass surgery.

Having shown an increase in severity during service, the Veteran's pre-existing heart murmur is presumed to have been aggravated by service unless VA can demonstrate by clear and unmistakable evidence that such increase was due to the natural progress of the condition. In order to rebut the presumption of aggravation, the evidence of natural progression must be unmistakable (i.e., clear, obvious, or manifest). Although the July 2025 VA examiner provided a negative nexus opinion, there is no medical opinion on the matter or any other evidence rising to the level of "clear and unmistakable evidence" as is needed to rebut the presumption of aggravation.

Based on the available evidence, and with application of the
and led to the coronary bypass surgery.

Based on the available evidence, and with application of the presumption of aggravation, the Board finds that the Veteran's pre-existing heart murmur is properly found to have been aggravated as a result of his active duty service, and service connection for a heart condition is granted.

5. Service connection for OSA

The Veteran submitted an August 2025 examination and nexus opinion from Dr. R.P. The examiner provided a positive nexus opinion, finding the Veteran's diagnosed OSA was caused by active duty service. The Veteran provided a positive nexus opinion based upon review of the service treatment records, private medical records, and lay evidence. A review of the record shows there is no opinion of record to refute the findings of Dr. R.P. which show that OSA was related to the Veteran's active duty service. Accordingly, service connection for OSA is warranted, and the claim is granted in full.

REASONS FOR REMAND

The Veteran claimed he was exposed to mustard gas and asbestos in-service. See January 2004 Correspondence; July 2024 Hearing Transcript; August 2024 Hearing Transcript; September 2024 Correspondence. A review of the Veteran's claims file indicates that the AOJ did not attempt to verify whether the Veteran was exposed to mustard gas or asbestos. As such, remand is warranted so that this development may be completed.

The Veteran has also claimed he was exposed to polyfluorinated substances (PFAS) and trichloroethylene (TCE) in-service at Ft. Bragg. See November 2023 VA Form 21-526EZ; October 2024 Supplemental Claim. The Veteran's military personnel records confirm that he served at Ft. Bragg, and the VA's own public health website acknowledges health problems associated with PFAS. Despite this, the record does not reflect that the AOJ assisted the Veteran by attempting to verify his claimed exposure to toxic chemicals, to include PFAS and TCE during service.

Therefore, while the Board regrets the additional delay, a remand is necessary due to a pre-decisional duty to assist error. See 38 C.F.R. § 20.802. Specifically, remand is necessary for VA to assist the Veteran by attempting to verify his claimed exposure to mustard gas, asbestos, PFAS, and TCE during his service. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c).

1. Service connection for chronic pain is remanded.

2. Service connection for gout is remanded.

3. Service connection for hypertension is remanded.

4. Service connection for a thyroid condition is remanded.

5. Service connection for kidney condition is remanded.

6. Service connection for a peripheral artery condition is remanded.

Prior to the March 7, 2025 rating decision on appeal, the service connection claims for chronic pain, gout, hypertension, a thyroid condition, a kidney condition, and PAD were remanded by the Board on November 22, 2024. The Board remanded the aforementioned service connection claims in order to obtain VA examinations and nexus opinions regarding the nature and etiology of the claims. The Veteran did not show up to the scheduled VA examinations on January 9, 2025.

Although the Board regrets the additional delay, the Veteran's claims must be remanded before the Board is able to make determinations on the merits. Unfortunately, there has not been substantial compliance with the Board's previous remand directives.

The Veteran failed to report for the scheduled examinations without providing good cause. The Board finds no reason to expect that the outcome would change if it were to remand the Veteran's claims for another examination. Thus, remand to obtain in-person examinations are unnecessary.

However, the Board does find that nexus opinions can be obtained without in-person examinations by reviewing the available evidence within the Veteran's claims file. An examination and accompanying nexus opinion based upon the record are necessary for substantial compliance with the prior remand directives.

For the aforementioned reason, and based upon the evidence of record during the review period, the Board finds VA had not complied
the merits. Unfortunately, there has not been substantial compliance with the Board's previous remand directives.

For the aforementioned reason, and based upon the evidence of record during the review period, the Board finds VA had not complied with its duty to assist the Veteran. This is a pre-decisional duty to assist error requiring remand under AMA.

7. Entitlement to service connection for a right hand condition is remanded.

The AOJ denied the appellant's current claim of service connection for a right hand condition on the basis that new and relevant evidence had not been received to readjudicate the claims following a prior final denial. The Board has found that receipt of new and relevant evidence warrants the claim readjudicated and a de novo review of the appellant's claim. As the AOJ has not considered the appellant's claims of service connection for a right hand condition on its merits, and the appellant has not waived her right to AOJ initial consideration, the Board finds that a remand for the AOJ to adjudicate the appellant's claim in the first instance is necessary. See Hickson v. Shinseki, 23 Vet. App. 394 (2010).

8. Service connection for a right eye condition is remanded.

9. Service connection for a skin condition, other than PFB, is remanded.

In April 2025, the AOJ was unable to contact the Veteran in attempts to schedule VA examinations for the right eye and skin conditions; and therefore the AOJ did not conduct VA examinations for the aforementioned claims. However, although the AOJ was unable to contact the Veteran in April 2025 regarding the service connection claim for a respiratory condition, the AOJ still obtained an April 2025 VA examination for the respiratory condition without an in-person examination. The Board notes that the Veteran is 100 percent service connected for bi-polar disorder and has been deemed incompetent by VA; therefore, there may be issues in attempting to contact the Veteran.

Similar to the April 2025 VA respiratory condition examination, the Board does find that nexus opinions can be obtained without in-person examinations by reviewing the available evidence within the Veteran's claims file. An examination based upon the record and accompanying nexus opinion are necessary for to meet VA's duty to assist.

10. Service connection for a GI condition is remanded.

Generally, the scope of a claim includes any disorder that may reasonably be encompassed by a veteran's description of the claim, reported symptoms, and the other information of record. See Clemons, 23 Vet. App. at 5. The Veteran filed claims for hiatal hernia, duodenitis, and enteritis. Based upon claims for several GI conditions that may have overlapping symptoms, the service connection claims have been recharacterized as one service connection claim for a GI condition.

Prior to the June 2025 rating decision on appeal, the service connection claim for the hiatal hernia and duodenal ulcer was remanded by the Board on November 25, 2024. The Board remanded the claim in order to obtain a VA examination and nexus opinions regarding the nature and etiology of the claim. The Veteran did not show to the scheduled VA examination in December 2024, the AOJ was unable to contact the Veteran for an examination in April 2025, and the Veteran did not show to the scheduled VA examination in May 2025.

Although the Board regrets the additional delay, the Veteran's claim must be remanded before the Board is able to make a determination on the merits. Unfortunately, there has not been substantial compliance with the Board's previous remand directives.

The Veteran failed to report for the scheduled examination without providing good cause. The Board finds no reason to expect that the outcome would change if it were to remand the Veteran's claim for another examination. Thus, remand to obtain an in-person examination is unnecessary.

However, the Board does find that a nexus opinion can be obtained without an in-person examination by reviewing the available evidence within the Veteran's claims file. An examination and accompanying nexus opinion based upon
scheduled VA examination in May 2025.

11. Service connection for sinusitis with headaches is remanded.

Prior to the June 2025 rating decision on appeal, the service connection claim for sinusitis with headaches was remanded by the Board on November 25, 2024. The Board remanded the claim in order to obtain a VA examination and nexus opinions regarding the nature and etiology of the claim. The Veteran did not show to the scheduled VA examination in December 2024.

12. Service connection for a back condition is remanded.

13. Service connection for a right wrist condition is remanded.

Prior to the July 2025 rating decision on appeal, the service connection claims for the back and right wrist conditions were remanded by the Board in January 2025. The Board remanded the aforementioned service connection claims in order to obtain VA examinations and nexus opinions regarding the nature and etiology of the claims. The Veteran did not show to the scheduled VA examinations for his back and right wrist in June 2025.

14. Service connection for a bilateral ankle condition is remanded.

15. Service connection for a neck condition is remanded.

16. Service connection for a bilateral shoulder condition is remanded.

Prior to the July 2025 rating decision on appeal, the service connection claims for the bilateral ankle, neck, and bilateral shoulder were remanded by the Board in January 2025. The Board remanded the aforementioned service connection claims in order to obtain conduct necessary development in an attempt to verify the in-service arrest claimed by the Veteran as the basis for his service-connected conditions. Within the remand, the AOJ was directed to make a formal finding indicating whether there is credible supporting evidence to show the Veteran was arrested in-service.

Although the Board regrets the
connection for a bilateral ankle condition is remanded.

15. Service connection for a neck condition is remanded.

16. Service connection for a bilateral shoulder condition is remanded.

A review of the record is negative for formal finding which addresses whether there is credible supporting evidence that the Veteran was arrested in-service. The March 2025 Final Attempt Letter generally found that all efforts to obtain the needed information had been exhausted, but there is no formal finding which actually discussed whether any evidence supported an in service arrest.

17. Entitlement to a rating in excess of 10 percent for PFB is remanded.

The Veteran's PFB is currently rated by analogy under Diagnostic Code 7806 for dermatitis or eczema. The decision herein has remanded the service connection claim for other skin condition, to include dermatitis. The May 2025 rating decision found the Veteran had a diagnosis for dermatitis, and the Board is bound by this favorable finding. Therefore, the Board finds that the claim for an increased rating for PFB is inextricably intertwined with the service connection claim for a skin condition remanded herein. See Harris v. Derwinski, 1 Vet. App. 180 (1991).

The matters are REMANDED for the following action:

1. Attempt to verify whether the Veteran was exposed to mustard gas, asbestos, PFAS, and TCE during his active-duty service or participated in toxic exposure risk activity.

Such development should include contact with the Compensation Service, relevant Department of Defense sources, and/or any other appropriate source, to attempt to verify the contended exposure.

If more details are needed to fulfill any verification request, contact the Veteran so that he may have an opportunity to provide the requested information.

2. After all development has been completed to verify participation in claimed TERA, issue a new TERA Memorandum.

3. Make a formal finding for the record indicating whether there is credible supporting evidence that the Veteran was arrested in-service.

4. Schedule the Veteran a VA examination with a qualified medical professional regarding the nature and etiology of the Veteran's chronic pain. An in-person examination is not required unless deemed necessary to provide a nexus opinion, and such a determination must be documented in the claims file. The claims file should be made available to the examiner.