SKIN CONDITIONS

CYNTHIA M. BRUCE · 2026 · Case ID: A26040327

MIXED

Summary

The veteran, who served in the Navy from September 1985 to May 1988 and February 1989 to February 1991, including service in the Persian Gulf, appeals the denial of service connection for mumps residuals, lumbar spine disability, left hip disability, left knee disability, and left leg injury. The Board denied these claims, finding the evidence unpersuasive. For mumps residuals, the Board found the veteran's lay testimony lacked credibility when weighed against contemporaneous service treatment records that were negative for mumps and contained affirmative denials of relevant symptoms. A private medical opinion supporting the claim was not assigned weight due to its reliance on non-credible lay reports and inaccurate factual premises. For the musculoskeletal claims, the Board noted a favorable finding of an in-service low back complaint but found no probative evidence of the claimed fall or subsequent injuries to the back, hip, knee, or leg. The Board also found the veteran's affirmative denials of symptoms in service treatment records and at separation contradicted his current allegations, rendering his lay testimony non-credible. A negative VA medical nexus opinion for the lumbar spine was found adequate. Private medical opinions supporting these claims were not assigned weight due to reliance on non-credible allegations and inaccurate factual premises. Service connection for Chronic Obstructive Pulmonary Disease (COPD) was granted, based on a favorable finding of a COPD diagnosis and presumptive service connection under the PACT Act due to Persian Gulf service and alleged asbestos exposure. A private medical opinion from Dr. RP was found adequate to support direct service connection for COPD. The claim for migraine headaches was remanded for a VA TERA medical opinion to assess the nexus to asbestos and petroleum vapor exposure, as the prior VA opinion was inadequate under the PACT Act, and private opinions were not fully probative.

Rationale

Contemporaneous service treatment records negative for mumps; Veteran's affirmative denials of symptoms in service records; Lay testimony deemed non-credible against service records; Private medical opinion lacked probative value due to reliance on non-credible reports

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210728-175179

Full Decision Text

Citation Nr: A26040327
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210728-175179
DATE: April 29, 2026

ORDER

Entitlement to service connection for mumps residuals is denied.

Entitlement to service connection for a lumbar spine disability is denied.

Entitlement to service connection for a left hip disability is denied.

Entitlement to service connection for a left knee disability is denied.

Entitlement to service connection for a left leg injury is denied.

Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is granted.

REMANDED

Entitlement to service connection for migraine headaches is remanded.

FINDINGS OF FACT

1. The evidence fails to probatively demonstrate that the Veteran experienced a mumps infection during service, and as such, he does not have any mumps-related residuals.

2. The evidence fails to probatively establish that the Veteran's current lumbar spine disability, assessed as bulging discs and degenerative disc disease, was incurred in or is otherwise etiologically or presumptively related to the Veteran's active duty service.

3. The record contains no probative evidence that the Veteran suffered an event, injury, or illness related to the left hip during his active duty service.

4. The record contains no probative evidence that the Veteran suffered an event, injury, or illness related to the left knee during his active duty service, and the Veteran's current left knee condition did not manifest to a compensable degree within one year of service separation.

5. The record contains no probative evidence that the Veteran suffered an event, injury, or illness related to the left leg during his active duty service.

6. The evidence probatively establishes that the Veteran's COPD is presumptively linked to his in-service exposure to environmental hazards during his Persian Gulf War service and directly linked to his in-service exposure to asbestos.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for mumps residuals have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for entitlement to service connection for a left leg injury have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for COPD have been met. 38 U.S.C. §§ 1110, 1119, 1120, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.320.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1985 to May 1988 and from February 1989 to February 1991.

On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). The law creates a new framework for veterans dissatisfied with the United States Department of Veterans Affairs' (VA) decision on their claims to seek review, and this decision has been written consistent with the new AMA framework.

In the July 28, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Board of Veterans' Appeals' (Board) Hearing docket. A Board hearing was held on April 8, 2025,
. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). The law creates a new framework for veterans dissatisfied with the United States Department of Veterans Affairs' (VA) decision on their claims to seek review, and this decision has been written consistent with the new AMA framework.

In the July 28, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Board of Veterans' Appeals' (Board) Hearing docket. A Board hearing was held on April 8, 2025, before a Veterans Law Judge other than the undersigned. See Frantzis v. McDonough, 35 Vet. App. 354 (2022). A copy of the hearing transcript is substantially complete and has been associated with the electronic claims file.

The Board may only consider the evidence of record at the time of the June 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his attorney 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 June 2021 rating decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board cannot consider it in this decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

As to the matters adjudicated below, 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 claim[s], 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 claim seeking entitlement to service connection migraine headaches, any evidence the Board could not consider will be considered by the AOJ in the lower-level adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection will be granted if it is shown that a veteran has a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a preexisting injury or disease contracted in the line of duty, in the active military, naval, air, or space service. 38?U.S.C. §§?1110, 1131; 38?C.F.R. §?3.303.

Generally, to establish service connection, a veteran must show: (1) a current disability; (2) an in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). All elements must be satisfied before service connection may be achieved.

Additionally, service connection may be achieved if any applicable presumptive service connection regulations apply to the Veteran's circumstances or when a claimed disability is shown to be proximately due to, the result of, or aggravated by a service-connected disability.

1. Entitlement to service connection for mumps residuals is denied.

The Veteran seeks entitlement to service connection for mumps residuals. At the April 2025 Board hearing, the Veteran testified that he got mumps during his active duty service and it manifested as painful and itchy skin lesions/scars that never dissipated. He stated they were located all over the body, to include on his back, nose, other parts of the face, and his chest.

The Veteran is competent to report his symptoms and past experiences, as this is within the realm of his personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, the Board cannot find the Veteran's hearing testimony to be credible when weighed against the contemporaneous in-service treatment records, which are wholly negative for a mumps infection or any residual skin effects.

In medical history questionnaires completed by the Veteran in February
active duty service and it manifested as painful and itchy skin lesions/scars that never dissipated. He stated they were located all over the body, to include on his back, nose, other parts of the face, and his chest.

In medical history questionnaires completed by the Veteran in February 1989 and July 1990, the Veteran affirmatively denied a history of ulcers or hives. The Veteran was seen for viral upper respiratory infections in April 1989 and November 1990, but these illnesses were never diagnosed as mumps by the evaluating clinicians, and there was no evidence of painful or swollen salivary glands.

In a health record from July 1989, the Veteran affirmatively denied chronic or frequent sore throat; skin conditions such as rashes, sores, or boils; prolonged periods of feeling tired; and the presence of a contagious disease in the last 12 months.

In November 1990, the Veteran was seen for a routine physical, and he denied any medical complaints; he denied any cough or hemoptysis; he denied any symptoms suggestive of pulmonary tuberculosis; and he denied any skin lesions or discoloration. Physical examination of the head was normal, the throat appeared benign, and an oral examination showed leukoplakia but no masses or lesions; and the integument had no masses, lesions, or color changes.

At the January 1991 service separation examination, the physical examination did not identify any skin disabilities and examination of the head, nose, mouth, and throat were clinically normal. References to an active or resolved mumps infection or any mumps-related residuals were not included in the summary and defects section of the examination report. In the accompanying Report of Medical History completed by the Veteran, he stated that he was in "great" health and affirmatively denied the history or presence of ear, nose, or throat trouble and skin diseases. The Report of Medical History contained no reference to mumps, and the Veteran responded "no" to the question of whether he "ever had any illness or injury other than those already noted." This response amounts to an affirmative denial of an in-service mumps infection.

Overall, the Veteran's service treatment records contain no evidence of mumps or related residuals, and he did not list mumps as an illness experienced during service in the January 1991 Report of Medical History completed at service separation and affirmatively denied any other illnesses than those listed in the form. When weighing the competing lay reports, the Board places far greater weight on the Veteran's contemporaneous in-service reports than those issued decades later solely in the context of seeking VA service-connected compensation benefits. The contemporaneous reports were recorded far closer to the events in question and have a much lower susceptibility of bias or memory distortion. The in-service records, and the Veteran's affirmative denials therein, have rendered the Veteran's Board hearing testimony noncredible. Thus, the Board concludes there is no probative evidence that the Veteran experienced mumps or residual skin issues during his active duty service.

In support of the appeal, the Veteran submitted a March 2025 private medical opinion from Dr. RP, which opined that the Veteran suffered from "long-term complications from mumps with skin manifestations, including hypertrophic and keloid scar, itching (pruritus), and risk of infection, primarily affecting the face, back, and shoulders." Despite claiming to have reviewed the evidence of record, including the service treatment records, Dr. RP's report did not contain a single citation to evidence of an in-service mumps infection in the Veteran's service treatment records. She explained that mumps is a systemic viral infection caused by the paramyxovirus, primarily affecting the salivary glands, and stated that the Veteran's "current symptoms of painful scarring, skin irritation, and potential systemic effects align with documented post-viral complications." Not once did she cite contemporaneous in-service evidence of a mumps infection. This is because no such evidence exists. Although unstated, the Board assumes that Dr. RP's medical opinion was predicated on the Veteran's lay reports of an in-service mumps infection; but these lay reports have been determined to lack credibility under the current evidentiary record. Thus, Dr. RP's medical opinion was based on an inaccurate factual premise, and no evidentiary weight has been assigned to it in this appeal. See Reonal v
primarily affecting the salivary glands, and stated that the Veteran's "current symptoms of painful scarring, skin irritation, and potential systemic effects align with documented post-viral complications." Not once did she cite contemporaneous in-service evidence of a mumps infection. This is because no such evidence exists. Although unstated, the Board assumes that Dr. RP's medical opinion was predicated on the Veteran's lay reports of an in-service mumps infection; but these lay reports have been determined to lack credibility under the current evidentiary record. Thus, Dr. RP's medical opinion was based on an inaccurate factual premise, and no evidentiary weight has been assigned to it in this appeal. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993).

The Board acknowledges that the Veteran was not afforded a VA examination in relation to this claim prior to issuance of the June 2021 rating decision. The Board finds that the AOJ's inaction did not result in a predecisional duty to assist error, as the record before the AOJ contained no evidence establishing that the Veteran suffered an event, injury, or disease in service. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The service treatment records were negative for mumps and contained the Veteran's affirmative denial of relevant symptoms and illnesses other than those listed at service separation (which did not include mumps). The requisite elements for obtaining a VA examination under 38 U.S.C. § 5103A(d) were not satisfied during the predecisional period.

Likewise, VA had no duty to obtain a VA examination under 38 U.S.C. § 1168(a) based on the Veteran's in-service toxic exposure risk activities (TERAs). The provisions of 38 U.S.C. § 1168(b) state that a TERA examination is not warranted "if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the [TERA] for which the veteran submitted evidence." The Secretary has determined a TERA examination is not warranted for disabilities "with an etiology not associated with toxic exposure," and as explained by Dr. RP, mumps is a viral infection caused by the paramyxovirus, unrelated to any toxic exposures. See VBA Letter 20-24-06, Updated Guidance on Processing Claims Involving the PACT Act, 89 Fed. Reg. 51,224 (June 17, 2024).

The evidence is not in approximate balance and persuasively weighs against the Veteran's claim. As such, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776, 780-82 (2021). The appeal seeking entitlement to service connection for mumps residuals is denied.

2. Entitlement to service connection for a lumbar spine disability is denied.

3. Entitlement to service connection for a left hip disability is denied.

4. Entitlement to service connection for a left knee disability is denied.

5. Entitlement to service connection for a left leg injury is denied.

The Veteran seeks entitlement to service connection for a lumbar spine disability, a left hip disability, a left knee disability, and a left leg injury, all claimed as the result of the same incident during service, discussed infra.

In the June 2021 rating decision, the AOJ issued a favorable finding that the Veteran has been diagnosed with bulging discs in the lumbar spine. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). The March 2025 report of Dr. RP also contains diagnoses of left knee degenerative joint disease and patellofemoral syndrome, left hip and leg strains, and degenerative disc disease at the lumbosacral region of the spine. Consequently, the current disability element of the Veteran's service connection claims has been met.

The June 2021 AOJ rating decision also contained a binding favorable finding that the Veteran's service treatment records from November 1989 show an assessment of acute low back pain. 38 C.F.R. § 3.104(c). However, the Veteran's service treatment records are negative for further low back complaints or any injuries to the left hip, left knee, or left leg. Likewise, the service department records do not contain any evidence of the Veteran's allegation of falling down a stairwell in July 1990 while carrying cases of soda, injuring his
enerative disc disease at the lumbosacral region of the spine. Consequently, the current disability element of the Veteran's service connection claims has been met.

In the April 2021 VA Form 21-526EZ, the Veteran indicated that he fell down a ladder well while carrying Pepsi boxes during his active duty service resulting in injury. The Veteran provided additional clarity at the April 2025 Board hearing. He explained that he was a service shipman and his job duties included refilling vending machines. In July 1990, while his ship was in the Indian Ocean on its way to the Persian Gulf, it ran into bad weather and choppy waters. While he was descending a flight of stairs, the ship pitched upwards, causing him to fall while carrying two cases of soda. He injured his lower back, his left hip, his left knee, and his left leg/ankle. He stated that he was taken to medical, but they did not have the equipment or facilities to manage his injury, and he was transferred via helicopter to the U.S.S. Independence for treatment. His ankle was reset and a splint was applied to the left leg. He testified that he never fully recovered and his injuries have remained symptomatic since the claimed injury.

This level of detail regarding the Veteran's claimed in-service injuries was not of record at the time of issuance of the June 2021 AOJ rating decision. At the June 2021 VA examination, the Veteran merely reported "falling while in service (1990) and injuring his back, after which time has had ongoing problems." The AOJ was not aware of the allegations that the Veteran experienced such severe injuries that he required a helicopter transfer for treatment. Consequently, the AOJ did not engage in development in an effort to verify this allegation, and since the details were not of record at the time, the failure to do so cannot constitute a predecisional duty to assist error.

The Board further observes that the Veteran told the June 2021 VA examiner that he treated with a chiropractor and physical therapist for back complaints in 2009, 2011, 2015, yet he did not identify the providers or otherwise authorize VA to obtain the records from these providers on his behalf. In the April 2021 VA Form 21-526EZ, the Veteran indicated that he wanted his claims processed under the fully developed claim (FDC) program, and he certified that he received the notice attached to the application titled, Notice to Veteran/Service Member of Evidence Necessary to Substantiate a Claim for Veterans Disability Compensation and Related Compensation Benefits.

Under this framework, a claim is submitted in a "fully developed" status, limiting the need for further development of the claim by VA. When filing an FDC, a veteran is to submit all evidence relevant and pertinent to the claim other than service treatment records and treatment records from VA medical centers, which will be obtained by VA. Despite the fact that the Veteran filed his claims under the FDC program, VA's Adjudication Procedures Manual (M21-1) states that claims should be excluded from this program when "the claim requires development for evidence from private healthcare providers." See M21-1, Part X, Subpart i, 2.B.2.a. (last accessed April 21, 2026). Nonetheless, when the Veteran submitted his FDC, he certified that he received the notice attached to the application which plainly instructed that a completed and signed VA Form 21-4142 was needed for VA to obtain private treatment records on his behalf. The Veteran did not submit this form prior to issuance of the June 2021 AOJ rating decision, and thus, there was no predecisional duty to assist error in the AOJ's failure to procure the private chiropractor and physical therapy records identified at the VA examination.

The Board must assess the credibility and weight of all the evidence to determine its probative value, accounting for the evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Washington v. Nicholson, 19 Vet. App. 362, 367 (
that a completed and signed VA Form 21-4142 was needed for VA to obtain private treatment records on his behalf. The Veteran did not submit this form prior to issuance of the June 2021 AOJ rating decision, and thus, there was no predecisional duty to assist error in the AOJ's failure to procure the private chiropractor and physical therapy records identified at the VA examination.

The Board has considered the Veteran's Board hearing testimony. While his reports are competent because they are based on his own recollection and lay observable accounts, the Board does not find such accounts to be credible under the current evidentiary record. See Layno, 6 Vet. App. at 469-71. As noted above, the Veteran's service department records are silent regarding the Veteran's claimed fall, related injuries to the low back, left hip, left knee, and left leg, and being helicoptered to the U.S.S. Independence for further treatment. To be clear, the Board's credibility finding is not based exclusively on the absence of evidence in the service treatment records; instead, the Board affords significant evidentiary weight to the Veteran's affirmative denials of relevant symptoms, which contradict his present-day allegations.

The Veteran was seen for a dental visit in July 1990, near the time of the claimed fall, and he completed a medical questionnaire regarding relevant facts. He affirmatively denied the presence or history of arthritis or painful joints. The Veteran was seen by providers on the U.S.S. England in November 1990, after the claimed in-service accident, for an annual physical examination. He denied any medical complaints.

The Veteran appeared at the January 1991 service separation examination, approximately 6 months after the claimed in-service injury, and a physical examination of the lower extremities and spine were clinically normal. The evaluator did not identify any lower back, left hip, left knee, or left leg issues in the summary of defects and diagnosis section of the examination report. In a Report of Medical History completed the same day, the Veteran described his health as "great" and he affirmatively denied cramps in the legs; arthritis, rheumatism, or bursitis; bone, joint, or other deformity; lameness; recurrent back pain; trick or "locked knee;" or foot trouble. The Report of Medical History contained no reference to a fall down stairs just 6 months prior in July 1990; related trauma to the lower back, left hip, left knee, or left leg; or transfer to the U.S.S. Independence for treatment. In the Report of Medical History, the Veteran was asked, "have you ever been a patient in any type of hospital, and he marked "yes," but clarified he was referencing a visit to MR Hospital in 1972 for treatment of a broken right arm. He did not identify treatment at the infirmary aboard the U.S.S. Independence in relation to the claimed July 1990 fall. The Veteran was also asked whether he had ever had any illness or injury other than those already noted on the report, and he responded "no." As the Report of Medical History contained no references to the July 1990 claimed accident, the Board interprets this response as an affirmative denial that the injury occurred.

In assessing the probity of the Veteran's lay reports, the Board affords far greater weight to the Veteran's contemporaneous accounts than the contrary reports issued decades later solely in the course of pursuing VA service-connected compensation. See generally Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran); Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (pecuniary interest may affect the credibility of testimony). As noted supra, contemporaneous accounts are inherently more reliable as they are not impacted by memory decay, hindsight bias, or external influences, such as the pursuit of financial gain.

Based on the analysis above, the Board concludes that the record (within the evidentiary window parameters) weighs substantially against the Veteran's lay account of a July 1990 injury to the low back, left hip, left knee, and left leg after falling down stairs while
1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran); Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (pecuniary interest may affect the credibility of testimony). As noted supra, contemporaneous accounts are inherently more reliable as they are not impacted by memory decay, hindsight bias, or external influences, such as the pursuit of financial gain.

Based on the analysis above, the Board concludes that the record (within the evidentiary window parameters) weighs substantially against the Veteran's lay account of a July 1990 injury to the low back, left hip, left knee, and left leg after falling down stairs while carrying cases of soda, with continuity of symptoms thereafter. These accounts are outweighed by the contemporaneous in-service records documented after the date of the claimed injury, where the Veteran affirmatively denied pertinent symptoms and events. Consequently, the Board concludes that the in-service incurrence element of a service connection claim has not been met in relation to the claims based on a left hip, left knee, and left leg disabilities. Having found the evidence regarding an in-service injury to be unpersuasive and unfounded, there is no basis upon which the medical nexus element could be achieved for these claims.

Regarding the lower back, the record contains a negative medical nexus opinion issued by a VA examiner in June 2021. The VA examiner concluded it was less likely than not that the Veteran's bulging discs in the lumbar spine were related to service because the isolated instance of low back pain in service in November 1989 resolved without documented residuals or recurrence. The examiner explained that at the time of separation in 1991, no back pain was noted, and there was no objective evidence of back pain developing within the year following active duty service. The VA examiner emphasized the Veteran's lay reports on the date of the examination, where he asserted that he had initial diagnosis and treatment for "bulging discs" in or around 2003, more than 10 years after service separation.

The Board finds the VA medical opinion to be based on an accurate assessment of the record, and it was supported by cogent explanatory rationale. There was no need for the examiner to address the Veteran's lay reports of continuous symptoms, as such reports have been determined to lack credibility. The Board finds the June 2021 VA medical opinion to be adequate to resolve the medical nexus element of a service connection claim.

The Board notes that the Veteran has submitted two favorable medical nexus reports linking his lower back, left hip, left knee, and left leg disabilities to his active duty service. The first report was issued in March 2023 by Dr. JPL, and the second report was issued by Dr. RP in March 2025. Both physicians have linked the Veteran's disabilities to his claimed in-service fall down stairs in July 1990. Dr. JPL further alleged that the Veteran had combat status during his Persian Gulf War service, despite any credible contention from the Veteran that he injured his lower back, left hip, left knee, or left leg during combat action.

Under 38 U.S.C. § 1154(b), VA has created a presumption regarding in-service incurrence or aggravation of a disability claimed to be the result of combat service. When a veteran has engaged in combat with the enemy during active duty service, VA must accept satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat, if such evidence is "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C. § 1154(b); see also 38 C.F.R. § 3.304(d). VA General Counsel has held that "[t]he ordinary meaning of the phrase 'engaged in combat with the enemy,' as used in 38 U.S.C. § 1154(b), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality." VAOGCPREC. No. 12-99, 65 Fed. Reg. 6256-58 (Feb. 8, 2000).

The Veteran's DD Forms 214 do not reference combat action and do not contain reference to decorations, medals, badges, citations, or campaign ribbons suggestive of combat service. The Veteran's DD Forms 214 lists the Veteran's military occupational specialty (MOS) as barber/ship serviceman, and this MOS is not consistent with combat duties. The Board has fully reviewed the record (within the evidentiary window parameters) and has been unable to locate evidence from the Veteran or his service department records that demonstrate that he participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality during his active duty service. The Veteran's MOS is not consistent with the circumstances, conditions or hardships of combat service. The Veteran's service personnel records contain no persuasive evidence that the Veteran had combat service and actively engaged in combat with the enemy. Thus, the combat presumption is not for application, and the Veteran may not meet the in-service incurrence element of his service connection claims using lay evidence alone. Moreover, to the extent Dr. JPL based his medical report on the assumption that the Veteran engaged in combat during service, the medical report is not probative in this appeal.

Dr. JPL opined that the Veteran met the criteria for Gulf War Syndrome under the provisions of 38 C.F.R. § 3.317; but in doing so ignored that the Veteran's musculoskeletal claims were attributed to known clinical diagnoses by history, physical examination, or laboratory tests, and thus, they are not qualifying chronic disabilities subject to presumptive service connection consideration under 38 C.F.R. § 3.317(a)(1).

A full review of Dr JPL's medical report shows that it is conglomeration of boilerplate references to VA regulations, Title 38 statutes, and court cases from the United States Court of Appeals for Veterans Claims, with very little analysis regarding the Veteran's specific medical history based on factual and well-supported evidence in the file. The report's extensive use of dense technical language and prose masks the absence of a reasoned medical analysis based on accurate facts in the record.

In the medical opinion, Dr. JPL noted the single report of "acute low back pain" in the service treatment records but ignored that this report was dated in November 1989. Dr. JPL then conflated this notation with the Veteran's non-credible reports of suffering a fall injury while carrying cases of soda from July 1990 (mistakenly cited as June 1990), requiring a medical evacuation by helicopter for more advanced treatment on the U.S.S. Independence. However, this summary is inaccurate, and even if it were, Dr. JPL relied exclusively on the Veteran's lay reports of the claimed injury, which have been determined to lack credibility under the current evidentiary record.

Dr. JPL disregarded the complete lack of reference to left hip, left knee, and left leg injuries in the service treatment records, as well as any references to the claimed July 1990 accident from falling down stairs while carrying cases of soda. Furthermore, Dr. JPL's medical report disregarded the Veteran's affirmative denial of the presence or history of relevant symptoms and events at service separation. Dr. JPL's assessment that the Veteran's single report of acute back pain in service was evidence of "insidious inception and chronic development" is inconsistent with the Veteran's own denial of recurrent back pain in the January 1991 Report of Medical History.

Dr. JPL's conclusion that the Veteran's low back, left hip, left knee, and left leg disabilities are etiologically related to the claimed 1990 injury, toxic exposures, and repetitive heavy lifting performed by the Veteran in service are not based on a thorough and accurate assessment of the claims file and ignore contradictory evidence in the service treatment records, where the Veteran affirmatively denied such injuries. The conclusion that toxic exposures led to mechanical injuries to the musculoskeletal system was unaccompanied by a cogent rationale. Likewise, to the extent that Dr. JPL opined that any of the Veteran's claimed disabilities caused or exacerbated other claimed disabilities due to overcompensation or "the synergistic effect of injury to the joints," such a medical opinion is not supported by a rational explanation. Service connection has not been awarded for any of the claimed disabilities such that they can serve as a primary disability under a secondary service connection theory of entitlement. It appears that Dr. JPL's medical opinion was based primarily on the Veteran's lay reports, without any meaningful consideration of the service treatment records, which do not support the Veteran's accounts. Dr. JPL relied on noncredible information to formulate his medical nexus opinion, and as
cogent rationale. Likewise, to the extent that Dr. JPL opined that any of the Veteran's claimed disabilities caused or exacerbated other claimed disabilities due to overcompensation or "the synergistic effect of injury to the joints," such a medical opinion is not supported by a rational explanation. Service connection has not been awarded for any of the claimed disabilities such that they can serve as a primary disability under a secondary service connection theory of entitlement. It appears that Dr. JPL's medical opinion was based primarily on the Veteran's lay reports, without any meaningful consideration of the service treatment records, which do not support the Veteran's accounts. Dr. JPL relied on noncredible information to formulate his medical nexus opinion, and as a result, the report's probative value has been so diminished that it is entitled to no evidentiary weight in this appeal.

The Board has fully reviewed the March 2025 medical opinion from Dr. RP, and it is plagued by many of the same evidentiary issues that rendered Dr. JPL's medical opinion non-probative in this appeal. Dr. RP's medical opinion is based on the faulty premise that the Veteran's claimed July 1990 fall down stairs while carry cases of soda and being medically evacuated to a carrier for treatment is accurate and supported by the evidence of record. Dr. RP claims to have reviewed the Veteran's service treatment records, yet her medical opinion ignores that the Veteran's service treatment records do not support the Veteran's account of his in-service injury. Dr. RP did not account for the contemporaneous in-service evidence where the Veteran affirmatively denied relevant symptoms and treatment, which is inconsistent with his present-day allegations.

Instead of recognizing that the Veteran's current reports are not credible when viewed against the Veteran's affirmative denials in the service treatment record, Dr. RP then speculated that the Veteran suffered a "significant injury [in the fall] such as a severe sprain, tendon and ligament damage, muscular damage, or a possible fracture...[and] these injuries altered his gait, leading to secondary hip and back conditions." None of these assertions align with an accurate review of the service treatment records, and the assumption that the Veteran experienced an altered gait as a result of these speculative injuries has no objective support in the service treatment records or the post-service records. Dr. RP then cited general literature regarding the prevalence of musculoskeletal injuries experienced by service members and the nature of soft tissue and overuse-related injuries, but none of the principles addressed in these articles are relevant if the in-service injury did not occur.

Dr. RP's medical opinion was based primarily on the Veteran's non-credible lay reports of an in-service injury and related "biomechanical and compensatory changes." Because this medical opinion rests on an inaccurate factual premise and it fails to address highly relevant evidence in the service treatment records, it is not thorough, and it holds no probative value or evidentiary weight in this appeal.

The AOJ did not obtain a VA examination related to the left hip, left knee, or left leg prior to issuing the June 2021 rating decision. The Board finds no error in this decision, as the service treatment records did not show an event, injury or disease in service or during any presumptive period, and there was no indication that the Veteran's disability may be associated with his active duty service beyond his allegations of in-service injury and continuity of symptoms, which have been deemed non-credible. The elements triggering VA's duty to assist in obtaining a VA examination related to these claims were not met during the predecisional period. See McLendon, 20 Vet. App. at 83. Additionally, the provisions of 38 U.S.C. § 1168(a) do not apply when the claims are based on allegations of physical trauma. VBA Letter 20-24-06 at. p. 12; 38 U.S.C. § 1168(b).

Lastly, the Board has considered the principles of chronic disease presumptive service connection for the Veteran's low back and left knee disabilities, as the degenerative conditions cited by Dr. RP are arguably defined as "arthritis," which is one of the listed conditions subject to presumptive service connection consideration under 38 C.F.R. §§ 3.303(b), 3.307(a)(3), and 3.309(a). There is no persuasive evidence that the Veteran's low back and left knee disabilities manifested to a compensable degree within one year of service separation. Likewise, the record does not show chronic complaints in service. The service treatment records show a single report of acute low back pain in November 1989 without recurrence, and no evidence of left knee complaints. The Veteran's allegations of an in-service injury to the back and left knee from
as the degenerative conditions cited by Dr. RP are arguably defined as "arthritis," which is one of the listed conditions subject to presumptive service connection consideration under 38 C.F.R. §§ 3.303(b), 3.307(a)(3), and 3.309(a). There is no persuasive evidence that the Veteran's low back and left knee disabilities manifested to a compensable degree within one year of service separation. Likewise, the record does not show chronic complaints in service. The service treatment records show a single report of acute low back pain in November 1989 without recurrence, and no evidence of left knee complaints. The Veteran's allegations of an in-service injury to the back and left knee from July 1990 with continuous symptoms to the present have been determined to lack credibility. The elements needed to support chronic disease presumptive service connection have not been met under the current evidentiary record.

The evidence is not in approximate balance and persuasively weighs against the Veteran's claims. As such, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776, 780-82 (2021). The appeals seeking entitlement to service connection for low back, left hip, left knee, and left leg disabilities are denied.

6. Entitlement to service connection for COPD is granted.

The Veteran seeks entitlement to service connection for COPD alleging that it is etiologically related to the environmental exposures he experienced during service, to include claimed asbestos exposure on the U.S.S. Fife and U.S.S. England, as well as the toxic environmental exposures inherent to his verified service in the Persian Gulf on or after August 2, 1990.

In the June 2021 rating decision, the AOJ issued a favorable finding of a diagnosis of COPD, and the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). The current disability element of the Veteran's claim has been met.

Regarding the in-service element of a service connection claim, the Board notes that the record establishes that the Veteran served in the Southwest Asia theater of operations on or after August 2, 1990. In the April 2024 rating decision, the AOJ issued a favorable finding that the Veteran was deployed to the Persian Gulf, and the Board is bound by this finding. 38 C.F.R. § 3.104(c). Thus, the Veteran is presumed to have been exposed to substances, chemicals, and airborne hazards during his Persian Gulf War service. 38 U.S.C. § 1119. Moreover, VA will presume exposure to fine particulate matter for Persian Gulf War Veterans deployed in the Southwest Asia theater of operations, regardless of length of deployment. 38 C.F.R. § 3.320(a)(4), (a)(5).

The Veteran has also alleged in-service exposure to asbestos. At the April 2025 Board hearing, he asserted that his in-service job duties involved painting and removing asbestos-containing drywall from the U.S.S. Fife and the U.S.S. England while both ships were dry docked. VA's Adjudication Procedures Manual, known as the M21-1, contains a table describing the probability of asbestos exposure by Navy MOS. The table lists each Naval MOS code and states whether each MOS has a minimal, probable, or highly probable degree of asbestos exposure. The Board finds that reliance on the M21-1, Part VIII, Subpart iii, 7.C.1.b. (last accessed April 21, 2026) and the table listing the probability of asbestos exposure by Navy MOS is required for adjudication purposes. See VAOPGCPREC 4-2000 (Apr. 13, 2000), 65 Fed. Reg. 33422 (2000); Overton v. Wilkie, 30 Vet. App. 257, 259, 264 (2018). According to the M21-1, the duties of a ship serviceman result in "minimal" exposure to asbestos. Consequently, the Board concedes that the Veteran experienced at least a "minimal" degree of asbestos exposure as a result of his in-service duties. Based on the above, the Board concludes that the Veteran experienced multiple TERAs during his service, despite the absence of COPD or chronic respiratory complaints (aside from 2 acute episodes of viral upper respiratory infections) in the service treatment records.

Effective August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act
, 30 Vet. App. 257, 259, 264 (2018). According to the M21-1, the duties of a ship serviceman result in "minimal" exposure to asbestos. Consequently, the Board concedes that the Veteran experienced at least a "minimal" degree of asbestos exposure as a result of his in-service duties. Based on the above, the Board concludes that the Veteran experienced multiple TERAs during his service, despite the absence of COPD or chronic respiratory complaints (aside from 2 acute episodes of viral upper respiratory infections) in the service treatment records.

Effective August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) was signed into law, and it established a presumption for several respiratory illnesses and cancers, including COPD, as due to in-service exposure to burn pits and other toxins. See The PACT Act, Pub. L. 117-168 (August 10, 2022). In the newly created 38 U.S.C. § 1120, it is established that any of the enumerated diseases in section (b)(2) of the statute, including COPD, that become manifested in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service as a result of exposure to burn pits and other toxins, notwithstanding the lack of evidence showing such a disease during the veteran's period of active service. 38 U.S.C. § 1120(a), (b)(4). As relevant to this appeal, a covered veteran for the purposes of applying this presumption is any veteran who served on or after August 2, 1990, while assigned to a duty station in the countries listed in 38 U.S.C. § 1119(c)(1)(A). See also 38 U.S.C. § 1120(c). The Veteran's verified Persian Gulf service fits within these requirements, and he is a covered veteran for the purposes of applying 38 U.S.C. §§ 1119 and 1120.

As the Veteran has been diagnosed with COPD during the period on review, and his service records demonstrate sea service in the Persian Gulf on or after August 2, 1990, the Veteran's COPD is presumed to have developed as a result of in-service exposure to burn pits and other toxins. Consequently, entitlement to service connection for COPD on a presumptive basis is granted under the PACT Act, as codified in 38 U.S.C. §§ 1119 and 1120.

The Veteran's claim also succeeds on a direct service connection basis. While the June 2021 VA examiner issued a negative nexus medical opinion, the conclusion was based on the lack of a chronic respiratory disability in service, without consideration of the Veteran's in-service TERAs. As such, this VA medical opinion is afforded no evidentiary weight in this appeal.

The Veteran has submitted private favorable medical opinions from Drs. JLP and RP. The medical report of Dr. JLP summarily stated that the Veteran's COPD developed due to "exposure to toxic solvents/chemicals/fuels/asbestos in-service" without a supporting rationale. This medical opinion was wholly conclusory and was not accompanied by reasoned medical analysis. See Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) ("[A] mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion."); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (stating that the probative value of a medical opinion comes from the "factually accurate, fully articulated, sound reasoning for the conclusion..."). Dr. JLP's medical opinion is assigned no evidentiary weight in this appeal.

Unlike Dr. JLP's medical opinion, the opinion of Dr. RP contains an adequate explanatory rationale for why the Veteran's in-service exposure to asbestos resulted in the development of COPD. Dr. RP explained that inhaling microscopic asbestos fibers damages alveoli, leading to progressive lung fibrosis and impaired respiratory function, and cited medical literature showing that asbestos exposure from handling insulating material was directly linked to an increased risk of COPD. The Board finds this private medical opinion to be adequate to resolve the Veteran's appeal on a direct service connection basis.

Based on the forgoing analysis, the Veteran's appeal seeking entitlement to service connection for COPD is granted.

REASONS FOR REMAND

Pursuant to 38 C.F.R. § 20.802(a), the Board's authority
RP contains an adequate explanatory rationale for why the Veteran's in-service exposure to asbestos resulted in the development of COPD. Dr. RP explained that inhaling microscopic asbestos fibers damages alveoli, leading to progressive lung fibrosis and impaired respiratory function, and cited medical literature showing that asbestos exposure from handling insulating material was directly linked to an increased risk of COPD. The Board finds this private medical opinion to be adequate to resolve the Veteran's appeal on a direct service connection basis.

Based on the forgoing analysis, the Veteran's appeal seeking entitlement to service connection for COPD is granted.

REASONS FOR REMAND

Pursuant to 38 C.F.R. § 20.802(a), the Board's authority to remand a claim is limited to instances requiring (1) correction of an error on the part of the AOJ to satisfy its duties under 38 U.S.C. § 5103A, if the error occurred prior to the date of the AOJ decision on appeal, or (2) the correction of any other error by the AOJ in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim.

1. Entitlement to service connection for migraine headaches is remanded.

The Veteran seeks entitlement to service connection for migraine headaches claimed as incurred during service and continuing to the present. The record has also reasonably raised the contention that his headaches may be the result of his in-service TERAs. The AOJ has conceded that the Veteran was exposed to environmental hazards while serving in the Persian Gulf, to include petroleum vapors containing benzene. See August 2024 rating decision. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c).

The Veteran's service treatment records are negative for a chronic headache condition. In April 1989, the Veteran complained of a 2-day history of headaches, nausea, and vomiting in the context of a diagnosis of a viral upper respiratory infection with motion sickness. The service treatment records contain no further references to headaches, and in the Report of Medical History completed by the Veteran in January 1991 at service separation, he affirmatively denied the presence or history of frequent or severe headache.

In June 2021, a VA examiner issued a negative medical nexus opinion. The examiner explained that the service treatment records documented an isolated report of headaches in association with an upper respiratory infection with motion sickness, which resolved without further mention thereafter. The examiner highlighted the Veteran's affirmative denial of frequent or severe headaches at service separation and the lack of evidence of a headache condition within a year of service separation. These factors weighed against a medical nexus between the Veteran's current headaches and the onset of the condition in service.

After receipt of this VA medical nexus opinion, the PACT Act was enacted in August 2022. This law created 38 U.S.C. § 1168(a), which requires the procurement of a medical nexus examination where there is "evidence of a disability and evidence of participation in a toxic exposure risk activity [TERA]" during the Veteran's active duty service. Under 38 U.S.C. § 1168(b), a TERA examination is not required "if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the [TERA] for which the veteran submitted evidence." The VA Secretary, through an appropriate designee, has issued guidance listing the six situations where a TERA examination is not required, and the Veteran's claim does not fit under any of these exemptions. See VBA Letter 20-24-06 at pp. 12-14. Accordingly, a remand for a VA TERA medical opinion is authorized under 38 C.F.R. § 20.802(a) for a correction of an error in failing to satisfy the statutory duty under 38 U.S.C. § 1168(a), and correction of this error has a reasonable possibility of aiding in substantiating the Veteran's claim.

The Veteran has submitted favorable medical nexus opinions by Drs. JPL and RP, but neither of which are sufficient to resolve the claim at this point. Dr. JPL stated that the Veteran has experienced headaches since his active duty service in the Persian Gulf, which is a contention that is unsupported by the contemporaneous service treatment records. Dr. JPL then opined that the Veteran's migraines were linked to his psychiatric conditions, but the Veteran is not yet service connected for any psychiatric conditions. See pending appeal under docket number 240729-459551. For these reasons, Dr. JPL's medical opinion is not probative in this appeal.

Dr. RP's opinion also stated that the Veteran's headaches began in service and have continued to the
by Drs. JPL and RP, but neither of which are sufficient to resolve the claim at this point. Dr. JPL stated that the Veteran has experienced headaches since his active duty service in the Persian Gulf, which is a contention that is unsupported by the contemporaneous service treatment records. Dr. JPL then opined that the Veteran's migraines were linked to his psychiatric conditions, but the Veteran is not yet service connected for any psychiatric conditions. See pending appeal under docket number 240729-459551. For these reasons, Dr. JPL's medical opinion is not probative in this appeal.

Dr. RP's opinion also stated that the Veteran's headaches began in service and have continued to the present, a contention which is not supported by the contemporaneous service treatment records and is refuted by the Veteran's denial of frequent headaches at service separation. Dr. RP then stated that Gulf War veterans are at a significantly higher risk of developing migraines and explained that the Veteran's exposure to trichloroethylene (TCE) and perchloroethylene (PCE) was a significant contributing factor to the Veteran's headaches. However, the record does not establish that the Veteran was ever exposed to TCE or PCE during his active duty service. TCE is a solvent used for cleaning metal parts and PCE is used for dry cleaning and metal degreasing. See Centers for Disease Control website regarding chemicals involved in the Camp Lejeune water contamination, https://www.atsdr.cdc.gov/camp-lejeune/about/chemicals-involved.html, last visited April 21, 2026. There is no evidence of record that the Veteran would have been exposed to agents used to clean and degrease metal during his active duty service, and such exposure is inconsistent with this MOS. The fact that Dr. RP's favorable medical opinion cited and relied on two false premises (headaches since service and exposure to TCE and PCE) severely undermines the credibility of her opinion and raises a question regarding her familiarity with the record and the Veteran's unique medical and service experiences, despite her claim of having reviewed the file. For these reasons, Dr. RP's medical opinion lacks the probative value needed to resolve the appeal.

The matter is REMANDED for the following action:

1. Obtain a VA TERA medical opinion from an appropriate VA examiner addressing the Veteran's COPD. Following a complete review of the electronic claims file, including a copy of this REMAND, the VA examiner is requested to address the following inquiry:

(a.) Is it at least as likely as not that there is a nexus between the Veteran's migraine headaches and his TERAs of in-service exposure to asbestos and petroleum vapors containing benzene.

The VA examiner must consider the total potential exposure through all applicable military deployments of the Veteran and the combined effect of all TERAs of the Veteran.

2. The AOJ is requested to ensure that the VA medical opinion is supported by a complete explanatory rationale based on the VA examiner's medical expertise and clinical experience; established medical principles; and citations to the record, as appropriate.

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Galante, 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.

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