Case A26040725

M. SORISIO · 2026 · Case ID: A26040725

GRANTED

Summary

The Veteran served from April 1975 to March 1983 and March 1985 to April 1993. The Veteran appealed the denial of service connection for asbestosis and cardiovascular disease secondary to PTSD. The Veteran withdrew claims related to a right third finger disability and a left thumb disability at a hearing, which were dismissed by the Board. For the asbestosis claim, the Board found the evidence in approximate balance between a private opinion finding the condition related to service and a VA opinion finding it less likely than not, ultimately resolving doubt in the Veteran's favor to grant service connection. The Board assigned substantial weight to the private opinion, which linked the asbestosis to in-service asbestos exposure. For the cardiovascular disease claim, the Board found the evidence favored a grant of secondary service connection to PTSD, assigning substantial weight to a private cardiologist's opinion. The cardiologist explained that PTSD can alter neurohormones and neurotransmitters, impacting heart and vascular function, thus predisposing individuals to heart disease. The Board concluded that the cardiovascular disease was at least as likely as not caused by the Veteran's service-connected PTSD, granting service connection on a secondary basis.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210210-140784

Full Decision Text

Citation Nr: A26040725
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210210-140784
DATE: April 30, 2026

ORDER

A rating in excess of 10 percent for a right third finger disability is dismissed.

An effective date prior to April 18, 2018, for the award of service connection for a right third finger disability is dismissed.

A rating in excess of 10 percent for a left thumb disability is dismissed.

An effective date before April 18, 2018, for the award of service connection for a left thumb disability is dismissed.

Service connection for a lung condition, diagnosed as asbestosis, is granted.

Service connection for cardiovascular disease as secondary to service-connected posttraumatic stress disorder (PTSD), is granted.

FINDINGS OF FACT

1. At the January 2025 Board hearing, prior to the promulgation of a decision in the appeal, the Veteran withdrew his appeal seeking a rating in excess of 10 percent for a right third finger disability, an effective date prior to April 18, 2018, for the award of service connection for a right third finger disability, a rating in excess of 10 percent for a left thumb disability, and an effective date before April 18, 2018, for the award of service connection for a left thumb disability.

2. Resolving reasonable doubt in the Veteran's favor, the Veteran has a lung condition that has been diagnosed as asbestosis that is at least as likely as not related to in-service exposure to asbestos.

3. Resolving reasonable doubt in the Veteran's favor, the Veteran's cardiovascular disease is at least as likely as not caused by the Veteran's service-connected PTSD.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of the appeal seeking a rating in excess of 10 percent for a right third finger disability, an effective date prior to April 18, 2018, for the award of service connection for a right third finger disability, a rating in excess of 10 percent for a left thumb disability, and an effective date before April 18, 2018, for the award of service connection for a left thumb disability by the Veteran and his attorney have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for service connection for a lung condition, diagnosed as asbestosis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1975 to March 1983 and March 1985 to April 1993.

In the February 10, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 28, 2025.

Therefore, the Board may only consider the evidence of record at the time of the January 2021 statement of the case (SOC) concerning the asbestosis claim and the February 2021 SOC concerning the cardiovascular disability claim, as well as any evidence submitted by the Veteran or his attorney at the hearing. At the Board hearing, the Veteran's attorney waived the right to submit evidence within the 90-day window after the Board hearing. 38 C.F.R. §?20.302(a). If evidence was submitted during the period after the AOJ issued the January 2021 SOC concerning the asbestosis claim and the February 2021 SOC concerning the cardiovascular disability claim and prior to the Board 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 asbestosis claim and the cardiovascular disability 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.

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the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

A. Withdrawn Claims

The Board may dismiss any appeal which fails to identify the specific determination with which the claimant disagrees. 38 U.S.C. § 7105(d). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the Veteran or his attorney. Id.

An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the appellant. Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018); DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011).

At the Board hearing on January 2025, the Veteran, in the presence of his attorney, orally withdrew the issues seeking a rating in excess of 10 percent for a right third finger disability, an effective date prior to April 18, 2018, for the award of service connection for a right third finger disability, a rating in excess of 10 percent for a left thumb disability, and an effective date before April 18, 2018, for the award of service connection for a left thumb disability.

All of the aforementioned requirements have been met. Accordingly, the Board does not have jurisdiction to review the appeal of these issues, and they are dismissed.

B. Service Connection

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

Entitlement to direct service connection requires evidence of three elements: (1) the existence of 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. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013).

Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, including cardiovascular-renal disease (such as organic heart disease), to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.

In some cases, when a disease listed in 38 C.F.R. § 3.309(a) is noted during service, but not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.
presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, (2) that there is an already service-connected disability, and (3) that there is "but for" causation or aggravation of the disability for which service connection is sought by a service-connected disability. See Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and holding "but for" causation or aggravation is enough to show entitlement to secondary service connection).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

a. Lung Condition

In the January 2021 SOC, the AOJ determined that the Veteran was exposed to asbestos during service and the Board is bound by this favorable finding. 38 C.F.R. §§ 3.104(c), 20.801(a).

In November 2019, the Veteran submitted a private nexus opinion completed in September 2019 by Dr. MS. Dr. MS reviewed the Veteran's entire claims file, including his service treatment records and treatment records since service separation. Dr. MS noted that the Veteran was exposed to asbestos during service and that the Veteran exhibited symptoms of asbestosis, such as shortness of breath difficulty in exercising, and daily clinical fatigue. Dr. MS indicated that the Veteran had an X-ray done in September 2015 which indicated the Veteran did not have active pulmonary disease. Dr. MS indicated that with asbestosis, the active disease may not show up for decades after exposure. Dr. MS stated that the Veteran was starting to "develop some signs and symptoms of asbestosis, but it is in the early phase[.]" Dr. MS noted the Veteran reported having difficulty breathing, being unable to run, and having trouble cutting the lawn because of his breathing difficulties. Dr. MS indicated that asbestosis was a difficult diagnosis to clearly delineate, that the Veteran was having clinical symptoms, but on radiological studies had yet to show diagnostic evidence. Dr. MS found with reasonable medical certainty that the Veteran currently had asbestosis. Dr. MS opined that the Veteran's asbestosis was the result of the Veteran's exposure to asbestos during service.

The Veteran was afforded a VA examination in July 2020 and the examiner diagnosed asbestosis. The examiner noted the Veteran was examined in person and that they reviewed the Veteran's claims file. Pulmonary function testing was not completed due to the COVID-19 pandemic. In a November 2020 opinion, the examiner noted that the Veteran was diagnosed with exposure to asbestos and treated while on active duty and that the current diagnosis of asbestosis was at least as likely as not a progression of the same condition diagnosed while the Veteran was in military service. The Board finds this opinion to be inadequate and places little weight of probative value on it as it appears to be based on inaccurate factual premises. In this regard, although the Veteran's service treatment records reflect that he was in an asbestos medical surveillance program due to his job duties, they do not reflect that he was diagnosed with an asbestos condition during service. Additionally, regarding the diagnosis of asbestos, the examiner did not clearly explain upon what the diagnosis was based, including any testing completed or consideration of the Veteran's symptoms.

In January 2021 a VA examiner provided an addendum opinion. The examiner indicated that January 2021 pulmonary function test results showed a predominantly restrictive pattern with a paradoxically above-normal diffusing capacity and that the reduced FEV1 at 69 percent of predicted likely correlated best with the Veteran's exercise limitation. The examiner indicated that the restrictive pattern shown on
In this regard, although the Veteran's service treatment records reflect that he was in an asbestos medical surveillance program due to his job duties, they do not reflect that he was diagnosed with an asbestos condition during service. Additionally, regarding the diagnosis of asbestos, the examiner did not clearly explain upon what the diagnosis was based, including any testing completed or consideration of the Veteran's symptoms.

In January 2021 a VA examiner provided an addendum opinion. The examiner indicated that January 2021 pulmonary function test results showed a predominantly restrictive pattern with a paradoxically above-normal diffusing capacity and that the reduced FEV1 at 69 percent of predicted likely correlated best with the Veteran's exercise limitation. The examiner indicated that the restrictive pattern shown on pulmonary function testing was compatible with the diagnosis of asbestosis, but it was not specific for asbestosis and did not establish such a diagnosis. The examiner stated that the Veteran did not have a diagnosis of asbestosis based on a lack of interstitial pulmonary fibrosis on chest imaging.

The Board concludes that the evidence is in approximate balance on whether the Veteran has a lung condition, that has been diagnosed as asbestosis, that is at least as likely as not related to his in-service asbestos exposure. In reaching this conclusion, the Board assigns equal weight of probative value to the November 2019 private opinion and the January 2021 VA examiner's opinion which provide conflicting conclusions regarding whether the Veteran has asbestosis. Both opinions reflect full consideration of the record and address the lack of evidence of asbestosis on clinical testing, but they reach different conclusions based on this evidence regarding whether the Veteran has asbestosis. Additionally, the January 2021 opinion indicates that the Veteran's pulmonary function testing is compatible with asbestosis, even though it is not specific for asbestosis and would not establish a diagnosis. As both opinions are entitled to equal weight of probative value, the Board resolves any reasonable doubt in the Veteran's favor and concludes that he has a current diagnosis of asbestosis. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Regarding whether the Veteran's asbestosis is related to his asbestos exposure during service, the Board places great weight of probative value on the opinion of Dr. MS. Dr. MS reviewed the Veteran's medical records and concluded that it was at least as likely as not that the Veteran's asbestosis was caused by the Veteran's exposure to asbestos in service. The opinion is based on a thorough review of the medical evidence, is well-reasoned, and is supported by medical evidence and the Veteran's service treatment records regarding his exposures. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). For these reasons, the Board affords substantial weight of probative value to the November 2019 private opinion that the Veteran's asbestosis was caused by the Veteran's in-service exposure to asbestos.

In sum, the Board concludes that the evidence is in at least approximate balance on whether the Veteran has a current diagnosis of asbestosis that is at least as likely as not related to his in-service asbestos exposure. As such, service connection for asbestosis is granted.

b. Cardiovascular Disease

The Veteran is claiming service connection for a cardiovascular disease based on it being secondary to his service-connected PTSD.

In August 2020, the Veteran submitted a private opinion from Dr. JK, a cardiologist. Dr. JK diagnosed the Veteran with left ventricular hypertrophy. The Veteran was afforded a VA examination in November 2020 and the examiner diagnosed left ventricular hypertrophy. In January 2021, a VA examiner diagnosed non-specific T wave abnormality. The examiner noted that the Veteran exhibited cardiac arrhythmia. In January 2021, a VA examiner stated that the nature and etiology of the Veteran's heart disease was undefined. The examiner noted that the Veteran did not meet the criteria for ischemic coronary artery disease but that a "diagnosis of left ventricular diastolic failure seems secure." Thus, there is evidence of a cardiovascular disability. Moreover, the Veteran is service connected for PTSD. Therefore, the first two elements of secondary service connection are met. What remains to be established is whether the Veteran's PTSD caused or aggravated his cardiovascular disability.

In August 2020, the Veteran submitted a private opinion from Dr. JK, a cardiologist. Dr. JK opined that it is at least as likely as not that the Veteran's left ventricular hypertrophy was caused by the Veteran's service-connected PTSD. Dr. JK explained that individuals with an acquired psychiatric disability are at high risk for developing heart disease and becoming predisposed to developing heart disease. Dr. JK explained that individuals with depression exhibit hypertrophic vascular wall growth with an increase in medial cross-sectional area and resulting in small artery structure and function. Dr. JK added that depression is related to abnormal function and reception of neurotransmitters and hormones (such as serotonin, dopamine, and norepinephrine) that impact functioning of the central nervous system and can ultimately result in altered vascular structure. Dr. JK stated that PTSD can increase the risk of developing cardiovascular disease by altering neurohormones, which impact heart, vasculature, and platelet function.

The Board concludes that the evidence favors a finding that the Veteran's cardiovascular disability is at least as likely as not caused by his service-connected PTSD. In reaching this conclusion, the Board assigns substantial weight of probative value to Dr. JK's opinion that the Veteran's cardiovascular disability was the result of the Veteran's service-connected PTSD because the opinion is based on a thorough review of the medical evidence, is well-reasoned, and supported by medical evidence. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Dr. JK explained that PTSD can impact an individual on a cellular level by resulting in increased heart cell growth, which causes smaller artery structure and inhibits artery function. Dr. JK also stated that depression alters the body's biochemistry by disturbing the body's neurotransmitters and hormones resulting in changes to the vascular structure. For these reasons, the Board assigns substantial weight of probative value to Dr. JK's opinion that the Veteran's cardiovascular disability is the result of the Veteran's service-connected PTSD.

The Board recognizes the various opinions concerning direct service connection. However, as the Board concludes that service connection for a cardiovascular disability is warranted based on it being caused by the Veteran's service-connected PTSD, the Board finds it does not need to address further the theory of direct service connection or the opinions on that theory of entitlement.

In sum, the Board concludes that the evidence is in approximate balance on whether the Veteran's cardiovascular disability is at least as likely as not caused by his service-connected PTSD. As such, service connection is granted.

M. SORISIO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Patel, S., Associate 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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