CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

MARJORIE A. AUER · 2026 · Case ID: A26039871

GRANTED

Summary

The Veteran, who served in the Army from August 1974 to July 1975, appeals the initial rating decision concerning multiple claims. The appeal focuses on service connection for a respiratory condition (difficulty breathing), headaches, a cardiovascular condition, left arm, left knee, right knee, left hip, right hip, left wrist, and low back conditions. Additionally, the Veteran claims a stroke condition as secondary to the service-connected cardiovascular condition. The Veteran asserts that these conditions are related to in-service toxic exposures at Fort Ord and Fort Jackson, including contaminated water, other toxins, asbestos, and mustard gas. The Board found that the evidence, when resolving reasonable doubt in the Veteran's favor, supported service connection for all claimed conditions. Specifically, the respiratory, headache, cardiovascular, left arm, bilateral knee, bilateral hip, left wrist, and low back conditions were found to be at least as likely as not related to in-service toxic exposures or a rough terrain vehicle accident. The stroke was found to be secondary to the service-connected cardiovascular condition. All claims for service connection were granted.

Rationale

Resolving reasonable doubt in Veteran's favor; At least as likely as not related to in-service toxic exposures

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250813-575536

Full Decision Text

Citation Nr: A26039871
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250813-575536
DATE: April 29, 2026

ORDER

Entitlement to service connection for a respiratory condition (claimed as difficulty breathing) is granted.

Entitlement to service connection for headaches is granted.

Entitlement to service connection for a cardiovascular condition is granted.

Entitlement to service connection for a left arm condition is granted.

Entitlement to service connection for a left knee condition is granted.

Entitlement to service connection for a right knee condition is granted.

Entitlement to service connection for a left hip condition is granted.

Entitlement to service connection for a right hip condition is granted.

Entitlement to service connection for a left wrist condition is granted.

Entitlement to service connection for a low back condition is granted.

Entitlement to service connection for a stroke condition, as secondary to the service-connected cardiovascular condition, is granted.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his respiratory condition is at least as likely as not related to his in-service toxic exposures.

2. Resolving reasonable doubt in the Veteran's favor, his headaches are at least as likely as not related to his in-service toxic exposures.

3. Resolving reasonable doubt in the Veteran's favor, his cardiovascular condition is at least as likely as not related to his in-service toxic exposures.

4. Resolving reasonable doubt in the Veteran's favor, his left arm condition is at least as likely as not related to a rough terrain vehicle (RTV) in-service accident.

5. Resolving reasonable doubt in the Veteran's favor, his left knee condition is at least as likely as not related to an RTV in-service accident.

6. Resolving reasonable doubt in the Veteran's favor, his right knee condition is at least as likely as not related to an RTV in-service accident.

7. Resolving reasonable doubt in the Veteran's favor, his left hip condition is at least as likely as not related to an RTV in-service accident.

8. Resolving reasonable doubt in the Veteran's favor, his right hip condition is at least as likely as not related to an RTV in-service accident.

9. Resolving reasonable doubt in the Veteran's favor, his left wrist condition is at least as likely as not related to an RTV in-service accident.

10. Resolving reasonable doubt in the Veteran's favor, his low back condition is at least as likely as not related to an RTV in-service accident.

11. The Veteran's stroke condition is due to his now service-connected cardiovascular condition.

CONCLUSIONS OF LAW

1. The criteria for service connection for a respiratory condition (claimed as difficulty breathing) are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for headaches are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a cardiovascular condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a left arm condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for a left knee condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for a right knee condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a left hip condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a right hip condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for service connection for a left wrist condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F
3.102, 3.303.

7. The criteria for service connection for a left hip condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a right hip condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for service connection for a left wrist condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for service connection for a low back condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for service connection for a stroke condition, as secondary to the service-connected cardiovascular condition, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from August 1974 to July 1975.

The rating decision on appeal was issued in January 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. The January 2025 rating decision found that new and relevant evidence had been received to readjudicate the claims on appeal. This is a Favorable Finding by the agency of original jurisdiction (AOJ) and the Board of Veterans' Appeals (Board) will proceed to the address the claims on the merits. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c).

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On November 24, 2025, the Veteran's representative withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the January 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 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).

1. Entitlement to service connection for a respiratory condition.

2. Entitlement to service connection for headaches.

3. Entitlement to service connection for a cardiovascular condition.

The Veteran contends that he has a cardiovascular condition, respiratory condition, and headaches related to his military service. He asserts that he was exposed to contaminated water and other toxins while serving at Fort Ord. The Veteran additionally contends that he was exposed to various toxins while stationed at Fort Jackson, including asbestos, mustard gas, MOS-related toxins, and Shipboard Hazard and Defense (SHAD). See October 2023 Fully Developed Claim. The Veteran additionally recalls watching Agent Orange be used to control vegetation.
1163, 1166-67 (Fed. Cir. 2004).

1. Entitlement to service connection for a respiratory condition.

2. Entitlement to service connection for headaches.

3. Entitlement to service connection for a cardiovascular condition.

The Board concludes that the Veteran has current respiratory condition, headaches, and cardiovascular condition that are related to his in-service toxic exposures. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

In the January 2025 rating decision, the AOJ made a Favorable Finding that the Veteran has a current cardiovascular condition (specifically, a diagnosis of "supraventricular arrhythmia; pericardial effusion"). An October 2025 VA treatment record documents complaints of a headaches, and the August 2025 private medical opinion diagnoses the Veteran with headaches. The Veteran is also competent and credible to report a current headaches condition. Regarding a current respiratory condition, the Veteran's current VA treatment records document a diagnosis of bronchitis. The August 2025 private opinion also diagnosed the Veteran with shortness of breath that may involve "Exertional dyspnea - difficulty breathing with mild activity such as walking or stair climbing." In this regard, a veteran's reports of pain may constitute a current disability to the extent that such results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board finds that the Veteran has established current diagnoses of a cardiovascular condition, headaches, and a respiratory condition.

Regarding an in-service incurrence, the Veteran's service treatment records (STRs) include a February 1975 separation Report of Medical History, wherein he reported having been treated for a heart condition. The Veteran's STRs also include treatment for a January 1974 upper respiratory infection.

Also, the Veteran's claims file includes conflicting toxic exposure risk activity (TERA) memoranda. A September 2023 TERA memorandum found evidence of non-deployment related exposure related to the Veteran's military occupational specialty (MOS) of Army subsistence supplyman and confirmed the Veteran's participation in a TERA. However, without explanation, a March 2024 TERA memorandum found that the Veteran did not participate in a TERA, but did not provide any rationale or discuss the Veteran's lay statements. A February 2026 TERA memorandum determined that the Veteran did not participate in a TERA because there are no presumptive conditions under the PACT Act for the locations claimed by the Veteran. The most recent TERA memorandum in March 2026 found that the Veteran participated in a TERA. The memorandum reasoned that there is evidence of non-deployment related exposure in the Veteran's claims file that is consistent with the circumstances of the Veteran's service. Specifically, the memorandum references that the "Veteran claims he was exposed to contaminated water while he was stationed at Fort Ord, Fort Jackson and Fort Lee; and exposed to asbestos, mustard gas, AO (to control vegetation), contaminated water, and metal fragments. Veteran was stationed at Fort Ord from 11/29/74-7/29/75. There are no presumptive conditions based off PACT for all locations. Fort Ord, Fort Jackson and Fort Lee are not listed on Herbicide Tests and Storage in the U.S." The memorandum then cites to the Veteran's statement received in October 2025. In resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran has participation in a TERA due to chemical exposures. See 38 U.S.C. § 1119.

Thus, the question becomes whether the current disabilities are related to service - specifically, to the TERA. On this question, there are probative opinions in favor of and against the claims.

The evidence in favor of the claims includes an August 2025 private medical opinion.

Following a review of the Veteran's medical records and the medical literature, the August 2025 examiner noted that the Veteran, "asserts that his chronic headaches are at least as likely as not secondary to in-service exposure to herbicides
in October 2025. In resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran has participation in a TERA due to chemical exposures. See 38 U.S.C. § 1119.

Thus, the question becomes whether the current disabilities are related to service - specifically, to the TERA. On this question, there are probative opinions in favor of and against the claims.

The evidence in favor of the claims includes an August 2025 private medical opinion.

Following a review of the Veteran's medical records and the medical literature, the August 2025 examiner noted that the Veteran, "asserts that his chronic headaches are at least as likely as not secondary to in-service exposure to herbicides and contaminated water at Fort Ord, California and Fort Jackson, South Carolina." The examiner opined that the Veteran's "confirmed presence at Fort Ord and Fort Jackson - both EPA designated Superfund sites with documented contamination by herbicides and volatile organic compounds (VOCs) - it is medically reasonable to conclude that his herbicides and VOCs provide a biologically plausible mechanism linking his service-related exposures to his ongoing neurological symptoms (Kavuncuolu & Koan, 2019; Wallace, 2001; Wilcox, 2011; Slezak, 2000)." The examiner provided extensive rationale for the opinion.

The August 2025 private examiner also opined that, "Given the credible lay evidence, the known toxic profile of these locations, and [the Veteran's] persistent respiratory symptoms since service, the condition of breathing difficulty warrants presumptive or direct service connection under 38 C.F.R. §§ 3.303 and 3.307-3.309, applying the benefit of the doubt doctrine under 38 U.S.C. § 5107(b). [The Veteran's] chronic shortness of breath is at least as likely as not the result of inhalational exposure to contaminated waterborne vapors, metal particulates, and likely combustion-related pollutants during his service at Fort Ord and Fort Jackson - both EPA-listed Superfund sites. Exposure to airborne fuel residues, oxidized metals, and other combustion byproducts initiates a cascade of respiratory events that can culminate in persistent dyspnea. At the molecular level, such inhalants introduce a complex mixture of gaseous irritants and particulate matter into the alveoli, triggering oxidative stress and inflammatory responses - key mediators of toxicant induced respiratory dysfunction (Shvedova et al., 2013; Oeder et al., 2015; Akopian et al., 2016)."

The August 2025 private examiner also opined that, "based on [the Veteran's] documented history of exposure to environmental toxins - including fuel fumes, exhaust emissions, contaminated water, and Agent Orange - during his service at Fort Ord and Fort Jackson, it is at least as likely as not that these exposures contributed substantially to the development of his current heart conditions, including supraventricular arrhythmia and cardiomyopathy. The toxicants he encountered are known to provoke chronic autonomic imbalance, myocardial inflammation, oxidative stress, and molecular disruption of cardiac structure and function. These mechanisms are consistent with the clinical trajectory and symptoms reported by [the Veteran], including shortness of breath, chest discomfort, and cardiac rhythm disturbances. Given the well-documented contamination of Fort Ord (a designated EPA Superfund site) and corroborative scientific evidence linking toxic exposure to cardiac pathology, a direct causal relationship is medically plausible and legally supportable under VA standards for service connection."

The evidence against the claims includes June 2024 VA examinations and opinions. However, the Board finds the medical opinions to be inadequate for adjudication purposes. With regard to the Veteran's cardiovascular condition, the examiner's opinion relied upon the absence of a cardiovascular condition during service and only considered the Veteran's contended herbicide exposure, despite the lack of development done by the AOJ on this matter. The examiner further failed to provide adequate rationale in support of the cardiovascular opinion

provided.

The Veteran has not been accorded a VA examination or medical opinion regarding the etiology of his headaches and respiratory condition. However, based on the current lay and medical evidence of record, the Board finds that a remand to obtain a VA examination or opinion for these claims is not necessary.

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current cardiovascular condition, respiratory condition, and headaches are related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a cardiovascular condition, respiratory condition, and headaches is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claims are granted.

4. Entitlement to service connection for a left arm condition.

5. Entitlement
condition. However, based on the current lay and medical evidence of record, the Board finds that a remand to obtain a VA examination or opinion for these claims is not necessary.

4. Entitlement to service connection for a left arm condition.

5. Entitlement to service connection for a left knee condition.

6. Entitlement to service connection for a right knee condition.

7. Entitlement to service connection for a left hip condition.

8. Entitlement to service connection for a right hip condition.

9. Entitlement to service connection for a left wrist condition.

10. Entitlement to service connection for a low back condition.

The Veteran asserts that his current left arm, knees, hips, left wrist, and low back conditions are related to his military service. He contends that in November 1974 while stationed at Fort Lee, Virginia, he fell out of the back of an RTV and was nearly run over by another RTV. He reports that he was taken to the Fort Lee hospital, seen by a doctor, and told to "take it easy and return to duty." He states that the fall is the cause of his left arm, knees, hips, left wrist, and low back problems. See August 2025 Statement in Support of Claim.

The Board concludes that the Veteran has current disabilities that are related to an RTV in-service accident. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

In the January 2025 rating decision, the AOJ made Favorable Findings regarding current bilateral knee and low back diagnoses. Regarding a current left arm diagnosis, an August 2025 private examiner found that the Veteran has chronic left arm pain that causes functional limitations of weakness and interference with sleep as well as discomfort and distress. The Veteran was further noted to experience tension when lifting, reaching, or bracing with his left arm. Regarding current hip diagnoses, the Veteran was found to have bilateral hip pain that has been persistent and severe enough to result in functional limitations of daily living. See August 2025 Private Examination. The August 2025 private examination finds that "subsequent medical evaluations confirm a fracture of the left wrist and persistent pain localized to the same area, consistent with chronic post-traumatic residuals." The private examiner found that the Veteran currently has "ongoing pain, reduced range of motion, and functional limitation in the same wrist (i.e., left)." In this regard, the Board notes that a veteran's reports of pain may constitute a current disability to the extent that such results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran has established current diagnoses related to his left arm, knees, hips, left wrist, and low back conditions.

Regarding an in-service incurrence, the Veteran's STRs do not contain any complaints of or treatment for the left arm, knees, hips, left wrist, and low back. The Veteran's reported RTV accident or treatment following such is not documented in his STRs. However, the Veteran has repeatedly referenced this RTV event, and two buddy statements are of record from April 2010 attesting to the Veteran's nightmares about nearly being hit by an RTV. See November 2002 Correspondence, August 2003 VA Treatment Record, May 2004 Posttraumatic Stress Disorder Questionnaire, January 2008 VA Treatment Record, April 2010 Statement in Support of Claim, May 2010 Statement in Support of Claim for PTSD, August 2010 Statement in Support of Claim, and August 2025 Statement in Support of Claim. The Board finds the Veteran's testimony regarding the circumstances of his service to be competent and credible, especially because his STRs document a "painful neck" and "sharp pain in his right flank" following a "blow" in January 1975. The details of the "blow" are not described in the STRs. However, based on the lay and medical evidence of record, the Board finds that the RTV accident occurred in service.

Thus, the question becomes whether the current disabilities are related to service. On this question, there is only a probative opinion in favor
2010 Statement in Support of Claim for PTSD, August 2010 Statement in Support of Claim, and August 2025 Statement in Support of Claim. The Board finds the Veteran's testimony regarding the circumstances of his service to be competent and credible, especially because his STRs document a "painful neck" and "sharp pain in his right flank" following a "blow" in January 1975. The details of the "blow" are not described in the STRs. However, based on the lay and medical evidence of record, the Board finds that the RTV accident occurred in service.

Thus, the question becomes whether the current disabilities are related to service. On this question, there is only a probative opinion in favor of the claims.

The evidence in favor of the claims includes a private examination dated in August 2025. Following a review of the Veteran's medical records, the private examiner opined that the Veteran's left arm condition is at least as likely as not related to his service. The examiner recorded the Veteran's reports of an RTV accident

during service and stated that "the event is well-documented in both VA and

private medical records." The examiner reasoned that "[t]his injury occurred during his time in service and is part of a broader history of combat-related musculoskeletal trauma."

The August 2025 examiner opined that the Veteran's bilateral knee condition is at least as likely as not related to his service. The examiner explained the nature of chronic knee degenerative arthritis secondary to acute trauma and noted that the Veteran's in-service RTV accident plausibly initiated bilateral knee damage. The examiner included reference to medical literature and related some of the research back to the Veteran's specific case and the development of his arthritis over time. The examiner explained that the Veteran's fall initiated a cascade of mechanical

disruption, inflammatory activation, and long-term biomechanical overloading

which are hallmarks of post-traumatic osteoarthritis progression and that the

development of severe bilateral joint degeneration aligns precisely with established

scientific understanding of trauma-induced joint deterioration. The examiner

concluded that, given the consistency of the Veteran's medical history, imaging

findings, and the scientifically established mechanisms of disease, it is at least as

likely as not that the Veteran's current bilateral knee condition is related to his in-

service fall.

The August 2025 examiner opined that the Veteran's bilateral hip condition is at least as likely as not related to his service. The examiner indicated that the

Veteran's treatment records demonstrate a chronic and progressive bilateral hip

condition and that there is a continuity of symptoms from the time of the reported

injury through the present. The examiner explained that chronic hip strain

secondary to acute trauma is a multifactorial condition in which an initial injury,

such as the Veteran's in-service fall from an RTV, initiates a cascade of

biochemical and biophysical changes in the soft tissues of the hip. The examiner indicated that the mechanical injury sustained during the in-service incident likely

disrupted the muscles, tendons, and ligaments surrounding the hip, resulting in

micro tears, hemorrhage, and localized inflammation that initiated long-term tissue

dysfunction. The examiner noted that even seemingly minor injuries can initiate

maladaptive healing and predispose the joint to chronic strain and altered

biomechanics. The examiner remarked that the progression from acute trauma to

chronic hip strain in the Veteran's case is supported by the repeated medical

documentation of severe hip pain in more recent years and reflects the structural

and neurophysiological consequences of the unresolved injury. The examiner described the development of the Veteran's bilateral hip condition over time following the initial injury and included numerous references to relevant medical literature in finding that the Veteran's chronic bilateral hip condition is the direct result of his in-service RTV accident and that it is at least as likely as not that it is related to his service.

The August 2025 examiner opined that the Veteran's left wrist condition is at least as likely as not related to his service. The examiner noted that the in-service fall was a high-impact incident involving axial loading and torsional stress to the upper extremity, which plausibly caused undetected osseoligamentous damage. The examiner explained that these types of injuries are well-established in the literature as precursors to biomechanical instability and degenerative changes that may evolve over time into symptomatic pathology. The examiner remarked that the delayed fracture post-service likely reflects cumulative joint degradation from unresolved in-service trauma rather than an isolated post-service incident. The examiner concluded that the Veteran's ongoing pain, reduced range of motion, and functional limitation in the same wrist are consistent with a chronic post-traumatic trajectory initiated during active duty. The examiner referenced medical literature as further support for the opinion.

The August 2025 examiner determined that the Veteran's
axial loading and torsional stress to the upper extremity, which plausibly caused undetected osseoligamentous damage. The examiner explained that these types of injuries are well-established in the literature as precursors to biomechanical instability and degenerative changes that may evolve over time into symptomatic pathology. The examiner remarked that the delayed fracture post-service likely reflects cumulative joint degradation from unresolved in-service trauma rather than an isolated post-service incident. The examiner concluded that the Veteran's ongoing pain, reduced range of motion, and functional limitation in the same wrist are consistent with a chronic post-traumatic trajectory initiated during active duty. The examiner referenced medical literature as further support for the opinion.

The August 2025 examiner determined that the Veteran's low back condition is at least as likely as not related to his service. The examiner explained that the Veteran's chronic low back strain is a downstream consequence of his in-service fall, which produced an abrupt mechanical injury to lumbar ligaments, paraspinal muscles, and possibly the intervertebral discs. The examiner explained that the initial protective inflammatory response likely became low-grade and persistent and that this state promotes stiffness, reduced shock absorption, and vulnerability to flare-ups, which is consistent with the Veteran's lateral clinical course. The examiner further remarked that the RTV incident was described as physically and psychologically traumatic and the record documents ongoing psychosocial stressors. The examiner explained that such psychological load is known to heighten central responsiveness to pain, lower thresholds, and impair recovery, factors that help explain the durability and severity of symptoms in the Veteran's case. The examiner concluded that the Veteran's in-service fall from an RTV, the persistent high-intensity lumbar pain recorded across years of VA care, and the well-described mechanisms by which a single traumatic event precipitates chronic lumbar strain, mechanical disruption, maladaptive inflammatory remodeling, peripheral and central sensitization, impaired descending inhibition, and psychosocial amplification, it is at least as likely as not that his current low back condition is the direct sequela of that service injury.

The Veteran has not been accorded a VA examination or medical opinion regarding the etiology of these conditions. However, based on the current lay and medical evidence of record, the Board finds that a remand to obtain a VA examination or opinion for these claims is not necessary.

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current left arm, knees, hips, left wrist, and low back conditions are related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for left arm, knees, hips, left wrist, and low back conditions is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claims are granted.

11. Entitlement to service connection for a stroke condition, as secondary to the service-connected cardiovascular condition.

The Veteran's representative contends that the Veteran's "ischemic stroke was caused by or a consequence of his supraventricular tachycardia and underlying cardiac pathology" (citing a private medical opinion as support). See December 2025 Third Party Correspondence.

Service connection may be established on a secondary basis for a disability which

is proximately due to or the result of a service-connected disease or injury; or any

increase in severity of a nonservice-connected disease or injury which is

proximately due to or the result of a service-connected disease or injury, and not

due to the natural progress of the nonservice-connected disease or injury. 38 U.S.C.

§§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310(a)-(b). Secondary service connection

requires evidence of (1) a current disability, (2) a service-connected disability, and

(3) a nexus, or link, between the service-connected disability and the current

disability. Wallin v. West, 11 Vet. App. 509, 512 (1998).

The AOJ made a Favorable Finding in the January 2025 rating decision that the Veteran has a current diagnosis of "ischemic vertebrobasilar artery brain stem stroke x2."

In the January 2025 rating decision, the AOJ also made a Favorable Finding that the claimed condition of two strokes is secondary to the heart condition.

As a result of this Board decision, the Veteran is now service connected for a cardiovascular condition.

Thus, upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current stroke condition is due to his now service-connected cardiovascular condition. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a stroke condition is warranted. 38 U.S
the January 2025 rating decision that the Veteran has a current diagnosis of "ischemic vertebrobasilar artery brain stem stroke x2."

In the January 2025 rating decision, the AOJ also made a Favorable Finding that the claimed condition of two strokes is secondary to the heart condition.

As a result of this Board decision, the Veteran is now service connected for a cardiovascular condition.

Thus, upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current stroke condition is due to his now service-connected cardiovascular condition. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a stroke condition is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted.

MARJORIE A. AUER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. M. Watkins, 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