ALLERGIC REACTIONS TO INSECT STINGS

Summary

The Veteran served from August 1972 to August 1979. He appeals the denial of service connection for Hymenoptera-related anaphylaxis, claiming it resulted from severe bee stings experienced during service. The Veteran clarified that his appeal does not concern his COPD or bronchitis. The Board reviewed the procedural history, noting the claim was initially decided under the legacy system, then opted into the modernized review system. A Board hearing was held in April 2025, and the decision considers evidence of record up to the March 2021 Statement of the Case (SOC). The primary issue is entitlement to direct service connection for Hymenoptera-related anaphylaxis. The Board considered a January 2021 VA examination that diagnosed the condition, satisfying the first element. The March 2021 SOC discussed a VA addendum opinion that contradicted the initial opinion, but the Board found the evidence regarding medical nexus to be in equipoise. Applying the benefit of the doubt, the Board found the Veteran satisfied all three elements for service connection. Therefore, service connection for Hymenoptera-related anaphylaxis is granted.

Rationale

Satisfied existence of current disability (January 2021 VA exam diagnosis); Satisfied in-service incurrence (bee sting event in service, credible witness letters); Satisfied nexus (equipoise resolved in Veteran's favor)

Full Decision Text

Citation Nr: A26040305
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210331-151284
DATE: April 29, 2026

ORDER

Entitlement to service connection for Hymenoptera-related anaphylaxis is granted.

FINDING OF FACT

The Veteran's Hymenoptera-related anaphylaxis onset in and has continued since his active service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for Hymenoptera-related anaphylaxis have been met.  38?U.S.C. §?5108; 38?C.F.R. §§?3.159, 3.303. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from August 1972 to August 1979.

Procedural History

A rating decision was issued under the legacy system in February 2018, and the Veteran submitted a timely notice of disagreement.  In March 2021, the agency of original jurisdiction (AOJ) issued a statement of the case (SOC).  The Veteran opted the claim into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a March 2021 VA Form 10182, Decision Review Request: Board Appeal, identifying the March 2021 SOC.  Therefore, the March 2021 SOC is the decision on appeal.  

In the March 31, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held on April 15, 2025; a transcript is associated with the claims file.  Therefore, the Board may only consider the evidence of record at the time of the March 2021 SOC, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. §?20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the March 2021 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted and 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 claim, considering the new evidence in addition to the evidence previously considered.  Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Issue: Entitlement to service connection for Hymenoptera-related anaphylaxis

Service Connection - Direct

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service.  38?U.S.C. §§?1110, 1131; 38?C.F.R. §?3.303(a).  Service connection may be granted for any disease diagnosed after discharge when all the evidence establishes that the disease was incurred in service.  38?C.F.R. §?3.303(d). 

The United States Court of Appeals for the Federal Circuit has held that a three-element test must be satisfied to establish entitlement to service connection.  Specifically, the evidence must show (1) the existence of 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 disease or injury incurred or aggravated during service (the "nexus" requirement).  Walker v. Shinseki, 708 F.3d. 1331, 1333 (Fed. Cir. 2013) (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) ((quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004)).  

Merits - Direct

In April 2017, the Veteran claimed service connection for "allergies pain/condition to include bee stings."  In April 2025, the following testimony occurred before the undersigned:

"Veteran's Representative: Thank you.  Thank you, Judge.  Okay. [Veteran], just to clarify the issue, your main concern and contention is that the
 (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) ((quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004)).  

Merits - Direct

In April 2017, the Veteran claimed service connection for "allergies pain/condition to include bee stings."  In April 2025, the following testimony occurred before the undersigned:

"Veteran's Representative: Thank you.  Thank you, Judge.  Okay. [Veteran], just to clarify the issue, your main concern and contention is that the severe bee stings you suffered in service has resulted in, or did result in anaphylaxis, and that has, and that is what your concern and contention is; is that correct?

Veteran: Correct.

Veteran's Representative: You're not claiming that your COPD or bronchitis are related to service, to any incident in service, including the bee stings; is that correct?

Veteran: That's correct.  I'm not (INAUDIBLE)."

Based on this, the Board has analyzed the claim as styled above.

In January 2021, a VA examiner diagnosed the Veteran with hymenoptera-related anaphylaxis.  This satisfies the first element of his direct service connection claim.  

In the March 2021 SOC, the AOJ stated: "The examiner states that the evidence of record, your testimony, and the examination provide sufficient evidence to support your history of anaphylaxis to bees with respiratory distress condition.  The examiner states that your enlistment examination in 1984 was silent for anaphylaxis or allergy to bees.  You report bee sting event in the military and that you have been told those records have been lost.  However, you have two signed letters of witnesses who say you get stung multiple times and need to be medevacked out of the field.  These letters are specific and credible.  The examiner states that bee stings can and do cause anaphylaxis and can cause subsequent anaphylaxis afterwards after initial sensitization. The examiner states that your medical record document current bee allergy.  There is evidence that the condition started in military service and continues to this day.  Therefore, your history of anaphylaxis to bees with respiratory distress condition is at least as likely as not incurred by or caused by the bee stings during service."  This excerpt suffices to satisfy the second element of his direct service connection claim.  

This excerpt also bears on the third element of his direct service connection claim.  The Board recognizes that the AOJ obtained a March 2021 addendum opinion which contradicts the January 2021 opinion.  However, when weighed against each other, the Board finds the evidence regarding medical nexus is, at worst, in equipoise.  Consequently, the Board resolves doubt in the Veteran's favor by finding he has satisfied the third element of his direct service connection claim.  

Because the Veteran has satisfied all three elements of his direct service connection claim, the Board grants the appeal.  

 

Tiffany Dawson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Sopko, 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.