RHEUMATOID ARTHRITIS

A. C. MACKENZIE · 2026 · Case ID: A26040421

MIXED

Summary

The Veteran served from December 1995 to October 1998, with service in the Southwest Asia theater of operations, which included conceded participation in a Toxic Exposure Risk Activity (TERA). The Veteran sought service connection for rheumatoid arthritis, Sjogren's syndrome, and hypertension. The Board found that the evidence was at least in equipoise regarding the Veteran's claim for service connection for rheumatoid arthritis, noting that while a VA examiner provided a negative opinion, the examiner also acknowledged medical literature linking TERA exposure to rheumatoid arthritis. The Board found this sufficient to grant service connection. For Sjogren's syndrome, claimed as secondary to rheumatoid arthritis, the Board found the evidence in equipoise, granting service connection. The claim for hypertension was remanded due to deficiencies in the VA examinations, which failed to adequately address the nexus between the Veteran's conceded TERA participation and the development of hypertension, despite acknowledging medical literature suggesting a link. The Board found the examinations contradictory and insufficient, necessitating further development.

Rationale

Evidence in equipoise regarding TERA contribution; Conceded TERA participation; Diagnosed rheumatoid arthritis dating from at least 2009

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250603-550483

Full Decision Text

Citation Nr: A26040421
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250603-550483
DATE: April 29, 2026

ORDER

Entitlement to service connection for rheumatoid arthritis is granted.

Entitlement to service connection for Sjogren's syndrome is granted.

REMANDED

Entitlement to service connection for hypertension is remanded.

FINDINGS OF FACT

1. The evidence is at least in equipoise as to the question of whether the diagnosed rheumatoid arthritis is directly attributable to the Veteran's conceded participation in a toxic exposure risk activity (TERA) while in service.

2. The evidence is at least in equipoise as to the question of whether there is a causal link between the now service-connected rheumatoid arthritis and the development of Sjogren's syndrome.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for rheumatoid arthritis have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303.

2. The criteria for entitlement to service connection for Sjogren's syndrome as proximately caused by rheumatoid arthritis have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.303; 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1995 to October 1998.

These matters arise out of the Veteran's July 2023 request to reopen previously denied claims of service connection for the above-listed conditions. In a December 2023 rating decision, the regional office elected to reopen the claims of service connection for rheumatoid arthritis as well as Sjogren's syndrome but ultimately confirmed the denial of service connection for both conditions. Thereafter, in a February 2024 rating decision, the regional office similarly elected to reopen the claim of service connection for hypertension but ultimately confirmed the denial.

In a June 2024 correspondence, the Veteran requested higher-level review of the denial of service connection for all three claimed disabilities. The regional office in an August 2024 rating decision found that VA had a duty to further assist the Veteran in support of his claims, and so indicated that the Veteran would be scheduled for examinations in support of his claims. Following the administration of that development, the regional office issued an April 2025 rating decision confirming the denial of service connection for all three claimed disabilities.

The Veteran effectuated his appeal via submission of a June 2025 notice of disagreement on VA Form 10182. As he elected the direct review option, the Board's consideration is limited to that evidence that was of record at the time of the underlying April 2025 rating decision. With this in mind, the Board is cognizant that VA medical records, to specifically include an April 2026 eye examination, have been added to the claims file outside this evidentiary review window which may not be considered in the present appeal.

The Board notes that each of these claims was previously adjudicated in final decisions. The Veteran submitted a?supplemental claim in July 2023 seeking to reopen the previously denied claims of service connection. ?Under the AMA, the evidence required to readjudicate a previously denied claim must only be "new?and?relevant," and favorable findings by the regional office in that regard are generally binding on the Board. The Board notes that the regional office made a favorable finding that new and relevant evidence had been received pertaining to each of the claimed disabilities and, therefore, readjudicated the merits of the claims. The Board is bound by those favorable findings.?38 C.F.R. § 3.104(c).

Service Connection

Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Secondary service connection is permitted based on aggravation. Compensation is payable for the degree of aggravation of a nonservice-connected disability caused by a service-connected disability. Id.; Allen v. Brown, 7
in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

1. Rheumatoid Arthritis

The Veteran seeks entitlement to service connection for rheumatoid arthritis, which he contends is directly attributable to his exposure to toxic environmental agents while in service.

The overarching question for the Board, therefore, is whether the Veteran has currently diagnosable rheumatoid arthritis that began during service or is at least as likely as not related to an in-service injury, event, or disease. To that end, the Board takes notice of factual findings in the underlying April 2025 rating decision that the Veteran has diagnosable rheumatoid arthritis and also that he has a confirmed TERA through his period of service in the Southwest Asia theater of operations. The Board confirms that these findings are corroborated through its own review of the record, to specifically include a November 2023 autoimmune disease examination.

Thus, the only remaining question is whether the conceded in-service participation in a TERA contributed to the Veteran's development of the rheumatoid arthritis. After consideration of the record, the Board concludes that the evidence is at least in equipoise as to whether this TERA participation contributed to the development of the disability, and so service connection is warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d).

As noted, the Veteran was afforded a November 2023 VA autoimmune disease examination, wherein it was confirmed that he diagnosable rheumatoid arthritis dating from at least as early as 2009. In an associated November 2023 medical opinion report, the chosen examiner found that it was less likely than not that the condition is attributable to the Veteran's TERA participation. In support thereof, the examiner detailed the pathophysiological processes of the development of the condition. She did not refer to any medical literature or any other objective medical evidence to substantiate her determination that TERA participation does not contribute to the development of rheumatoid arthritis.

In recognition of the deficiencies in the November 2023 examination, the regional office directed that a new opinion be secured regarding the likely etiology of the rheumatoid arthritis. In the resulting November 2024 medical opinion report, the examiner confirmed that it is less likely than not that the Veteran's TERA participation contributed to his development of rheumatoid arthritis. However, as a rationale, the examiner referred to medical literature that suggested that burn pit exposure is associated with autoantibody expression, which is a known risk factor for the development of rheumatoid arthritis. Indeed, the examiner acknowledged that this study indicates that there is a link between burn pit exposure and rheumatoid arthritis. Nevertheless, the examiner still set forth a negative opinion, and offered no explanation as to why she dismissed the relevancy of this noted medical literature.

Typically, an examination with such contradictory conclusions would warrant remand for clarification. However, the Board instead finds that the November 2024 examination provides sufficient probative value for the purposes of substantiating the Veteran's claim. That is, the November 2024 examiner acknowledges the very nexus which underlies the service connection query at issue before the Board. Therefore, rather than remand this matter in order to secure an addendum opinion, the Board instead finds that the evidence is at least in equipoise as to the question of whether the claimed rheumatoid arthritis is attributable to the Veteran's in-service TERA participation. Accordingly, the Board finds that service connection is warranted on a direct basis and the claim is granted in full. 38 C.F.R. § 3.303.

2. Sjogren's Syndrome

The Veteran seeks entitlement to service connection for Sjogren's syndrome as secondary to the now-service connected rheumatoid arthritis.

At the outset, the Board notes that the regional office in the underlying April 2025 rating decision made a factual finding that the Veteran has a diagnosis of Sjogren's syndrome, as set forth in the November 2023 autoimmune disease VA examination. Therefore, the first threshold element,
the claimed rheumatoid arthritis is attributable to the Veteran's in-service TERA participation. Accordingly, the Board finds that service connection is warranted on a direct basis and the claim is granted in full. 38 C.F.R. § 3.303.

2. Sjogren's Syndrome

The Veteran seeks entitlement to service connection for Sjogren's syndrome as secondary to the now-service connected rheumatoid arthritis.

Accordingly, the question that remains for the Board is whether it is at least as likely as not that the condition is proximately caused by or aggravated permanently by the service-connected rheumatoid arthritis. To that end, the Board also takes notices of the factual finding of the regional office in the April 2025 rating decision that Sjogren's syndrome is secondary to the rheumatoid arthritis, as set forth in a November 2023 medical opinion report.

The Board's review of the record shows that in the November 2023 autoimmune disease examination, it was confirmed that the Veteran has diagnosable Sjogren's syndrome dating from at least as early as 2009. Furthermore, in the associated November 2023 medical opinion report, the examiner detailed the pathophysiological processes leading to the development of rheumatoid arthritis, and specifically noted that dry eyes and a dry mouth are known symptoms of rheumatoid arthritis and that together these symptoms are often characterized as Sjogren's syndrome. The examiner did not offer an opinion specifically addressing the likely etiology of the condition.

Under these circumstances, the Board concludes that the evidence is at least in equipoise as to the question of whether the claimed Sjogren's syndrome is caused secondary to the now-service connected rheumatoid arthritis.

Accordingly, the Board finds that service connection is warranted on a secondary causation basis for Sjogren's syndrome. The claim is thus granted in full. 38 C.F.R. §§ 3.303, 3.310.

REASONS FOR REMAND

1. Entitlement to service connection for hypertension is remanded.

The Veteran seeks entitlement to service connection for hypertension, which he contends is directly attributable to his exposure to toxic environmental agents while in service. In a December 2024 opinion report, the chosen VA examiner acknowledged the Veteran's participation in a toxic exposure risk activity (TERA) via his period of service in the Southwest Asia theater of operations; nevertheless, the examiner found that it was less likely than not that this TERA participation contributed to the development of hypertension following service. In setting forth this opinion, the examiner noted that medical studies indicate that there is an association between the prevalence of hypertension and certain toxic exposures; however, the examiner still found that there was no nexus between the TERA participation and the Veteran's hypertension. The examiner did not offer an explanation as to why they discounted the acknowledged association that may establish entitlement to service connection.

As stated above, the regional office in the August 2024 rating decision found that the prior examination provided to the Veteran in support of his claim of service connection for hypertension was deficient, and indicated that it would secure a new medical opinion regarding the likely etiology of the condition. Internal memoranda show that the objective query for the newly requested examination centers on the question of whether the Veteran's conceded participation in a TERA contributed to his development of hypertension.

In the resulting November opinion report, the chosen examiner found that it is less likely than not that the hypertension is attributable service. As support thereof, the examiner merely stated there is not enough evidence to substantiate a claim of hypertension; there is no discussion of the Veteran's medical history, to include his conceded participation in a TERA.

Under these circumstances, the Board finds that remand is necessary to correct a failure of the duty to assist in affording the Veteran a deficient examination in support of his hypertension claim. Specifically, the regional office directed itself to secure an opinion regarding the likelihood that the Veteran's participation in a TERA contributed to his development of hypertension, and the resulting examination failed to do so.

The matter is REMANDED for the following action:

Provide the claims file to?a qualified examiner?in order to?elicit an etiology opinion concerning the?claimed hypertension.??The claims file, to include a copy of this remand, must be made available to the chosen examiner, who must?indicate?that they reviewed the file prior to preparing any?opinion?report.??

The examiner is asked
correct a failure of the duty to assist in affording the Veteran a deficient examination in support of his hypertension claim. Specifically, the regional office directed itself to secure an opinion regarding the likelihood that the Veteran's participation in a TERA contributed to his development of hypertension, and the resulting examination failed to do so.

The matter is REMANDED for the following action:

The examiner is asked to consider whether it is?at least as likely as not?(at least an approximate balance of positive and negative evidence) that diagnosable hypertension had its onset in service or is otherwise the result of a disease or injury in active service.

In setting forth this opinion, the examiner must address whether there is a nexus between hypertension and the total potential toxic exposure through all applicable deployments, including the synergistic, combined effect of each identified substance, chemical, and airborne hazard as described in 38 U.S.C. § 1119(b)(2). The examiner should review the claims file, including the TERA Memorandum, and address whether the diagnosed hypertension is related to the Veteran's active service, to include presumed exposure to burn pits and other toxins (BPOT).

The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a thorough rationale for any opinion expressed. A thorough rationale is not simply a restatement of the evidence but includes the application of medical analysis and a discussion of the significance of the relevant evidence, as well as relevant medical literature and/or studies. The lay contentions of the Veteran must also be considered in full.

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Christopher M. Collins, 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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