MYOCARDIAL INFARCTION

A. C. MACKENZIE · 2026 · Case ID: A26039843

MIXED

Summary

The veteran, who served from July 1973 to July 1993, appeals the denial of service connection for a heart condition (to include myocardial infarction), GERD, and allergic rhinitis. The veteran also appeals the denial of a compensable rating for allergic rhinitis. The Board denied service connection for the heart condition and GERD, finding the evidence persuasively against the claims. While a VA TERA memorandum indicated a positive exposure, subsequent VA medical opinions from August 2024 and March 2025 concluded the conditions were less likely than not caused by TERA, citing the veteran's history of smoking and non-service-connected conditions like hypertension and diabetes as more probable causes. The Board gave significant weight to these opinions. For allergic rhinitis, the Board denied a compensable rating, finding the evidence against the claim. A June 2024 VA examination found chronic sinusitis and allergic rhinitis but no characteristics for a compensable rating, and private/VA treatment records were negative for symptoms warranting such a rating. The Board noted the veteran's lay assertions were outweighed by the medical evidence. The claim for tinnitus was remanded due to an inadequate VA examination, which failed to explain a negative diagnosis despite positive lay and treatment record evidence.

Rationale

Service treatment records negative for heart condition; VA and private treatment records negative for heart condition within 12 months of separation; August 2024 and March 2025 VA medical opinions found condition less likely than not caused by TERA; Examiners cited smoking, hypertension, and diabetes as more likely causes; Board found opinions highly probative and evidence persuasively against claim

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6522

Docket No.

250613-556765

Full Decision Text

Citation Nr: A26039843
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250613-556765
DATE: April 28, 2026

ORDER

Entitlement to service connection for a heart condition, to include a myocardial infarction, is denied.

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

Entitlement to a compensable disability rating for allergic rhinitis is denied.

REMANDED

Entitlement to service connection for tinnitus is remanded.

FINDINGS OF FACT

1. The evidence of record is persuasively against concluding that the Veteran experiences a heart condition, to include a myocardial infarction, that arose during or as a result of his active service, including as a result of a Toxic Exposure Risk Activity (TERA).

2. The evidence of record is persuasively against concluding that the Veteran's GERD arose during or as a result of his active service, including as a result of a TERA.

3. The Veteran has not exhibited 50 percent obstruction in both nasal passages, total obstruction in one nasal passage, or nasal polyps at any point during the appeal period.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a heart condition, to include myocardial infarction, have not been met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to a compensable disability rating for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code (DC) 6522.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active military service from July 1973 to July 1993.

The Board notes that the June 2024, February 2025, and March 2025 rating decisions on appeal were issued after February 19, 2019, so they were subject to the Appeals Modernization Act (2019) (herein after "AMA"). 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (codified at 38 C.F.R. § 19.2(d)). The Veteran timely appealed these rating decisions to the Board of Veterans' Appeals (Board) and, in a June 2025 VA Form 10182, Decision Review Request, requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ).

The Veteran asserts that he experiences myocardial infarction of residuals thereof as a result of his active service. Pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board has recharacterized the Veteran's claim to include any heart condition, to include myocardial infarction. As emphasized in Clemons, although a Veteran may only seek service connection for a particular condition, the Veteran's claim cannot be limited only to that diagnosis but must rather be considered a claim for any mental disability that may be reasonably encompassed.

Service Connection

Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

1. Entitlement to service connection for a heart condition, to include a myocardial infarction

The Veteran asserts that he experienced a myocardial infarction (MI), residuals of an MI, or another heart condition that arose as a result of in-service TERA.

The Veteran's service treatment records (STRs) are negative for complaints, diagnosis, or treatment for MI or heart problems.

The Veteran's VA and private treatment records are negative for complaints, treatment, or diagnosis of MI or heart problems within 12 months of separation from service or for medical opinions supporting his claim.

In May 2023, the
ki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

1. Entitlement to service connection for a heart condition, to include a myocardial infarction

The Veteran asserts that he experienced a myocardial infarction (MI), residuals of an MI, or another heart condition that arose as a result of in-service TERA.

The Veteran's service treatment records (STRs) are negative for complaints, diagnosis, or treatment for MI or heart problems.

In May 2023, the Veteran filed a claim for service connection for MI.

A December 2023 VA TERA Memorandum indicates that he was positive for an in-service TERA.

During the Veteran's February 2024 VA examination for heart conditions, the VA examiner indicated he was positive for a myocardial infarction that occurred during 2000 and mild tricuspid regurgitation with a diagnosis dating to 2024.

In a February 2024 VA medical opinion, the VA examiner opined that his claimed condition was less likely than not due in-service TERA; however, their rationale indicated that the VA TERA memorandum reflected that he was negative for in-service TERA. Based on this erroneous rationale, the Board lends this medical opinion no probative weight.

In an August 2024 addendum VA medical opinion, the VA examiner opined that his claimed condition was less likely than not caused by the TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner noted that the Veteran was positive for exposure to Gulf War oil fires. In their rationale, they noted that according to VA Public Health, "Health effects of exposure to oil well fires. Particles from oil well fires may cause skin irritation, runny nose, cough, shortness of breath; eye, nose, and throat irritation; and aggravation of sinus and asthma conditions. Most of the irritation is temporary and resolves once the exposure is gone. Research does not show evidence of long-term health problems from exposure to oil well fires at this time." The examiner then concluded that the claimed MI was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

Given the examiner's education, expertise, and review of the claims file-along with the detailed rationale for their opinion-the Board lends the August 2024 addendum opinion significant probative weight.

During the Veteran's September 2024 VA examination for heart conditions, the VA examiner noted diagnoses for myocardial infarction and arteriosclerotic heart disease (coronary artery disease), each dating to 2000.

In a March 2025 VA medical opinion, the VA examiner opined that he claimed heart conditions were less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. In their rationale, the examiner noted that his heart conditions were more likely caused by a long history of smoking tobacco and non-service-connected conditions such as hypertension, diabetes mellitus, and dyslipidemia. Given the examiner's expertise and review of the entire claims file at the time of the opinion, the Board lends the March 2025 VA medical opinion significant probative weight.

The Veteran has consistently asserted that his MI or heart condition is due to in-service TERA. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). His lay contentions are thus of markedly lower probative value than, and are outweighed by, the August 2024 VA examination and March 2025 opinions and medical evidence of record.

The Board finds the evidence of record is persuasively against the Veteran's claim. There is no evidence of an MI or heart problems during service or until many years post service. No medical opinion supports his claim, and the August 2024 addendum VA medical opinion and March 2025 VA medical opinions indicates that his MI and other diagnosed heart conditions are less likely than not caused by his conceded in-service TERA. Based on these facts, the Board finds the criteria for service connection have not been met.

Accordingly, entitlement to service connection for
His lay contentions are thus of markedly lower probative value than, and are outweighed by, the August 2024 VA examination and March 2025 opinions and medical evidence of record.

Accordingly, entitlement to service connection for a heart condition, to include MI, is denied.

In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable in this appeal. 38 U.S.C. 5107(b).

2. Entitlement to service connection for GERD

The Veteran asserts that he experiences GERD that arose as a result of in-service TERA.

The Veteran's STRs are negative for complaints, diagnosis, or treatment for GERD.

The Veteran's VA and private treatment records are negative for complaints, treatment, or diagnosis of GERD within 12 months of separation from service or for medical opinions supporting his claim.

In May 2023, the Veteran filed a claim for service connection for GERD.

A December 2023 VA TERA Memorandum indicates that he was positive for in-service TERA.

During the Veteran's February 2024 VA examination for esophageal conditions, the VA examiner indicated he was positive for GERD, with a diagnosis dating to 2024.

In an August 2024 addendum VA medical opinion, the VA examiner opined that his claimed condition was less likely than not caused by the TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner noted that the Veteran was positive for exposure to Gulf War Oil Fires. In their rationale, they noted that according to VA Public Health, "Health effects of exposure to oil well fires. Particles from oil well fires may cause skin irritation, runny nose, cough, shortness of breath; eye, nose, and throat irritation; and aggravation of sinus and asthma conditions. Most of the irritation is temporary and resolves once the exposure is gone. Research does not show evidence of long-term health problems from exposure to oil well fires at this time." The examiner then concluded that the claimed GERD was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The Veteran has consistently asserted that his GERD is due to in-service TERA. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). His lay contentions are thus of markedly lower probative value than, and are outweighed by, the August 2024 VA examination opinion and medical evidence of record.

The Board finds that the evidence of record is persuasively against the Veteran's claim. There is no evidence of GERD during service or until many years post service. No medical opinion supports his claim, and the August 2024 addendum VA medical opinion indicates that his GERD is less likely than not caused by his conceded in-service TERA. Based on these facts, the Board finds that the criteria for service connection have not been met.

Accordingly, entitlement to service connection for GERD is denied.

3
asively against the Veteran's claim. There is no evidence of GERD during service or until many years post service. No medical opinion supports his claim, and the August 2024 addendum VA medical opinion indicates that his GERD is less likely than not caused by his conceded in-service TERA. Based on these facts, the Board finds that the criteria for service connection have not been met.

Accordingly, entitlement to service connection for GERD is denied.

3. Entitlement to a compensable disability rating for allergic rhinitis

The Veteran seeks a compensable rating for his service-connected rhinitis for the entirety of the appeal period.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.

The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7.

The rating for allergic rhinitis is assigned pursuant to 38 C.F.R. § 4.97, Diagnostic Code 6522. Under Diagnostic Code 6522, allergic rhinitis will be rated as 10 percent disabling when it is manifested by a greater than fifty percent obstruction of both nasal passages or complete obstruction of one nasal passage, without polyps. A 30 percent disability rating is the maximum available rating and is warranted when polyps are present.

As for sinusitis, the rating is assigned pursuant to 38 C.F.R. § 4.97, Diagnostic Code 6510. The Board notes that sinusitis is to be evaluated under the general rating formula for sinusitis pursuant to Diagnostic Codes 6510-6514. Under the general rating formula, a noncompensable evaluation contemplates sinusitis detected by X-ray only. A 10 percent disability evaluation is warranted for sinusitis that results in one or two incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent disability evaluation is warranted for sinusitis that results in three or more incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A maximum 50 percent disability evaluation is warranted following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness or affected sinus, and purulent discharge or crusting after repeated surgeries.

A note following Diagnostic Codes 6510 through 6514 defines an incapacitating episode of sinusitis as one that requires bed rest and treatment by a physician.

The Veteran's chronic sinusitis is separately service connected; therefore, the Board will not further consider DC 6510 at this time. See November 2025 codesheet.

In this case, on May 23, 2023, the Veteran filed a claim for service connection for rhinitis. This represents the beginning of the period on appeal for this issue.

During the Veteran's June
radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness or affected sinus, and purulent discharge or crusting after repeated surgeries.

A note following Diagnostic Codes 6510 through 6514 defines an incapacitating episode of sinusitis as one that requires bed rest and treatment by a physician.

The Veteran's chronic sinusitis is separately service connected; therefore, the Board will not further consider DC 6510 at this time. See November 2025 codesheet.

In this case, on May 23, 2023, the Veteran filed a claim for service connection for rhinitis. This represents the beginning of the period on appeal for this issue.

During the Veteran's June 2024 VA examination for rhinitis and related conditions, the VA examiner found that he was positive for chronic sinusitis and allergic rhinitis. The examiner found no evidence of any characteristics that define the compensable ratings under DC 6522, to include obstruction of the nasal passage, hypertrophy of the nasal turbinates, or nasal polyps. He took over-the-counter medication to treat his symptoms.

The Board has reviewed the Veteran's private and VA treatment records. Although the Veteran is treated for allergic rhinitis, he is negative for symptoms consistent with a compensable disability rating.

The Veteran has consistently asserted that his rhinitis is more severe than is reflected by his current evaluation. While the Veteran is competent to observe his rhinitis symptoms, he does not have the training or credentials to determine the current nature, extent, and severity of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluation concerning his rhinitis symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

The Board finds that the evidence of record is persuasively against concluding that the Veteran's rhinitis has resulted in greater than fifty percent obstruction of both nasal passages, complete obstruction of one nasal passage, or the development of nasal polyps. Consequently, the criteria for a compensable disability rating under DC 6522 have not been met. In reaching this determination, the Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130 (2025). Here, there is no specific indication of symptom improvements due to medication, and the Board therefore finds no basis for an increased rating due to beneficial medication effects.

Accordingly, entitlement to a compensable disability rating for allergic rhinitis is denied.

Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Notably, the evidence and contentions of record as of the rating decision on appeal do not suggest that the question of entitlement to a total disability rating based on individual unemployability due to a service-connected disability has been raised in this case. Rice v. Shinseki, 22 Vet. App. 447 (2009).

REASONS FOR REMAND

1. Entitlement to service connection for tinnitus is remanded.

The Veteran asserts that he experiences tinnitus that began during or as a result of his active service.

May 2023 VA treatment records reflect a positive diagnosis for tinnitus.

During the Veteran's November 2024 VA examination for hearing loss and tinnitus, the Veteran reported that his tinnitus began during service and had worsened over time. The VA examiner indicated that the Veteran did not report tinnitus; therefore, they did not provide an etiology opinion for the claimed condition. They did not provide an explanation for this conclusion that reconciled the negative diagnosis provided by the examiner with the May 2023 VA treatment records.

The Board finds the November 2024 VA examination inadequate for adjudication purposes, as it did not provide an adequate explanation for the negative diagnosis, given the positive medical and lay evidence of tinnitus. The Board finds that the AOJ committed a pre-decisional duty-to-assist error by failing to obtain an adequate VA examination and medical opinion prior to adjudicating the issue on appeal.

Accordingly, this claim must be remanded for additional development.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of the Veteran's claim tinnitus. The examiner should address the following matters:

(a)
with the May 2023 VA treatment records.

Accordingly, this claim must be remanded for additional development.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of the Veteran's claim tinnitus. The examiner should address the following matters:

(a) Does the Veteran have a positive diagnosis for tinnitus during the period on appeal (from July 25, 2024 onward)? If the examiner finds that the Veteran is negative for tinnitus, they should provide an explanation for that conclusion that reconciles the finding with the Veteran's lay reports as well as the May 2023 VA treatment records reflecting that he is positive for tinnitus.

(b) If the Veteran is positive for tinnitus, is it at least as likely as not (at least an approximate balance of the evidence) that the claimed condition was caused by an injury, disease, or event of service or that it manifested during active service or within one year after discharge from service?

A rationale is required for all opinions in the report.

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Hixon, Evan

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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