CUSHING'S SYNDROME

Summary

The veteran, who served in the U.S. Army from November 1956 to October 1959, including a brief period at Fort McClellan as a medical laboratory helper and x-ray technician trainee, appeals the denial of service connection for Cushing's disease and a pituitary tumor. The veteran claims these conditions are related to toxic exposure risk activities (TERA) during service, specifically mentioning potential exposures at Fort McClellan near the Monsanto chemical plant, including ionizing radiation, radioactive compounds, mustard gas, nerve agents, and airborne PCBs. The Board reviewed the evidence, including a VA endocrine conditions examination and a TERA opinion from April 2024, and a subsequent VA examination in June 2025. The April 2024 TERA examiner noted a potential link between ionizing radiation and pituitary tumors but ultimately concluded that Cushing's disease and pituitary tumors are not caused by the indicated toxic exposures, citing that their causes are unknown or linked to other factors like genetics or long-term steroid use. The June 2025 VA examiner reviewed the Veteran's TERA and records, finding no causal association between the claimed exposures and Cushing's disease or pituitary tumors, concluding the conditions were less likely than not caused by TERA. The Board found the evidence against the veteran's claim, giving greater weight to the VA examiners' opinions which provided reasoned medical explanations. The Board denied service connection for both conditions.

Rationale

No causal or etiologic relationship to service/TERA established; VA examiners concluded conditions not caused by toxic exposures; Board found evidence against claim, favoring VA examiner opinions

Full Decision Text

Citation Nr: A26040299
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 260404-648196
DATE: April 29, 2026

ORDER

Service connection for Cushing's disease is denied.

Service connection for pituitary tumor is denied.

FINDINGS OF FACT

1. The Veteran's Cushing's disease is not causally or etiologically related to any disease, injury, or incident in service, to include toxic exposure risk activities (TERA).

2. The Veteran's pituitary tumor is not causally or etiologically related to any disease, injury, or incident in service, to include TERA.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for Cushing's disease have not been met.  38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.311.

2. The criteria for entitlement to service connection for pituitary tumor have not been met.  38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.311.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from November 1956 to October 1959.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office.

In the April 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the June 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

The Board notes that in the April 2026 Notice of Disagreement, the Veteran also indicated that she was also appealing the issues of exophthalmos disorder, diabetes, headaches, hypertensive disorder, polyneuropathy, and hypertension.  As the time frame to appeal those issues has expired as they were decided over one year ago, the Veteran should file a VA Form 20-0995, Decision Review Request: Supplemental Claim if she has new and relevant evidence to submit for those claims.

Service Connection - Cushing's Disease and Pituitary Tumor

The Veteran asserts that her Cushing's disease and pituitary tumor are the result of her military service and service connection is warranted.

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury.  See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

A layperson is generally incapable of opining on matters requiring medical knowledge.  Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff'd sub nom., Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998).  However, lay evidence can be competent and sufficient to establish a1 diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (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.  See Jandreau v. Nicholson, 492 F.
 186 (1997), aff'd sub nom., Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998).  However, lay evidence can be competent and sufficient to establish a1 diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (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.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

In essence, lay testimony is competent when it pertains to the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection."  Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2).  A determination as to whether medical evidence is needed to demonstrate that a Veteran presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran's present condition (e.g., whether the Veteran's present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation).  See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007).

Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C. § 1154(a).  See Davidson, supra. 

When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. If the evidence is not in approximate balance or nearly equal, the claim is to be denied.  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The Veteran served at Fort McClellan from approximately November 1956 to January 1957 as a medical laboratory helper.  The Veteran's military personal record shows the Veteran attended x-ray technician school.

The Board notes that in February 2024, a VA Advisory Opinion was issued regarding the Veteran's radiation exposure pursuant to 38 C.F.R. § 3.311(c).

In April 2024, the Veteran was afforded a VA endocrine conditions examination. The VA examiner noted a diagnosis of benign neoplasm and Cushing's Disease.  The Veteran reported onset in 1993 with a diagnosis of Cushing's disease and a pituitary tumor.  Status post resection of pituitary tumor in 1993.  The Veteran reported that despite resection, she still had the tumor and it was monitored periodically; the tumor size had not changed.  The Veteran had pituitary macroadenoma status post resection in 1993.  The VA examiner noted no functional impact.

In a separate April 2024 TERA opinion, the VA examiner noted that "Cushing disease is a form of Cushing syndrome.  Cushing disease occurs when a benign tumor in the pituitary gland causes the pituitary gland to produce too much ACTH, the hormone responsible for cortisol production.  Too much ACTH in the body causes the adrenal glands to produce cortisol in high levels.  Cushing disease can also occur with diffuse growth of the pituitary gland, also called pituitary hyperplasia.  Pituitary hyperplasia can lead to the release of too much ACTH, which then leads to over-production of cortisol by the adrenal glands."  The April 2024 VA examiner concluded that for "Cushing's Disease there is medical or scientific evidence available that notes a relationship between the development of the condition(s) at issue and the TERA."  The examiner reasoned that "the risk of developing pituitary tumors after exposure to ionizing radiation is increased."

Additionally, the April 2024 TERA examiner also opined that the claimed conditions were less likely than not caused by the indicated toxic exposure risk activity(ies), 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
 to the release of too much ACTH, which then leads to over-production of cortisol by the adrenal glands."  The April 2024 VA examiner concluded that for "Cushing's Disease there is medical or scientific evidence available that notes a relationship between the development of the condition(s) at issue and the TERA."  The examiner reasoned that "the risk of developing pituitary tumors after exposure to ionizing radiation is increased."

Additionally, the April 2024 TERA examiner also opined that the claimed conditions were less likely than not caused by the indicated toxic exposure risk activity(ies), 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.  Regarding Cushing's disease, the VA examiner reasoned: "The most common cause of Cushing's syndrome is the long-term, high-dose use of the cortisol-like glucocorticoids.  Other people develop endogenous Cushing's syndrome because their bodies make too much cortisol.  Several types of tumors can cause the body to make excess cortisol. Cushing's syndrome is not caused by the indicated toxic exposures."  Regarding the pituitary tumor, the VA examiner reasoned: "The causes of pituitary tumors are unknown. Some tumors are caused by hereditary disorders such as multiple endocrine neoplasia I (MEN I).  Pituitary tumors have not been linked to the indicated toxic exposures."

In June 2025 a VA examiner provided negative opinions for the Veteran's claims after a review of the Veteran's records.  The examiner noted that the Veteran's TERA and records note her duty station at Fort McClellan in Anniston, Alabama and near the Monsanto chemical plant from November 1956 to January 1957.  Per the Veteran's TERA her potential military exposures include the following: ionizing Radiation, radioactive compounds including cesium-137 and cobalt 60, mustard gas, nerve agents, and airborne polychlorinated biphenyls (PCBs).  Per information on the Veteran's Administration public site, servicemen and persons stationed at Fort McClellan Army base and near the Monsanto chemical plant between 1929 and 1971 potentially may also have had exposure to fog oil and hexachloroethane smoke.  Based upon the Information on Hazardous Chemicals and Occupational Diseases the examiner found that that there was no causal association of pituitary adenomas or Cushing's disease due to pituitary adenomas due to exposure to ionizing radiation, radioactive compounds including cesium-137 and cobalt 60, mustard gas, nerve agents, fog oil, hexachloroethane or airborne PCBs.  The examiner concluded that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), 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.

Based on the foregoing, the Board finds that the evidence is not in approximate balance or nearly equal and is against the Veteran's claim of service connection for a Cushing's disease and pituitary tumor.  While the evidence of record shows that the Veteran is diagnosed with Cushing's disease and pituitary tumor, the most persuasive evidence demonstrates they are not related to her service.  In this regard, the Board places greater probative weight on the VA examiners' opinions as the examiners set out clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).  

The Board has considered the Veteran's contentions that her symptoms and diagnosis are related to TERA.  Lay witnesses are competent to provide testimony or statements relating to symptoms or facts that they have observed and are within the realm of their personal knowledge but are not competent to establish that which would require specialized knowledge or training, such as medical expertise.  See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994).  

In the instant case, the Board finds that questions regarding the potential relationship between the Veteran's service and disabilities to be complex in nature.  See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions).  Thus, while the Veteran is competent to describe the manifestations of her Cushing's disease and pituitary tumor, the Board must accord her lay statements regarding the etiology of her disabilities little probative
. App. 465, 469-70 (1994).  

In the instant case, the Board finds that questions regarding the potential relationship between the Veteran's service and disabilities to be complex in nature.  See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions).  Thus, while the Veteran is competent to describe the manifestations of her Cushing's disease and pituitary tumor, the Board must accord her lay statements regarding the etiology of her disabilities little probative value. 

Based on the foregoing, the Board finds that the Veteran's Cushing's disease and pituitary tumor are not shown to be due to the Veteran's service.  In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine.  However, there is not an approximate balance of positive and negative evidence regarding the merits of the issues, and the benefit of the doubt shall not be given to the Veteran.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  When the evidence is not in approximate balance or nearly equal, the claims are to be denied.  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

Christopher Seppanen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Gandhi, Rahil

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.