RADICULOPATHY

HARVEY P. ROBERTS · 2026 · Case ID: A26040838

MIXED

Summary

The veteran, who served from April 2000 to April 2004, appeals decisions regarding service connection for several conditions. The Board granted service connection for left lower extremity radiculopathy, secondary to a service-connected back disability, based on a January 2025 VA examination and a February 2025 AOJ decision establishing the back condition. The Board denied service connection for a right knee disability, finding the evidence weighed against its service relation or secondary causation to the back condition. The Board noted that while a private examiner opined the knee disability was secondary to an altered gait from the back condition, this opinion lacked probative value due to the absence of a physical examination and inconsistencies with treatment records. The Board also remanded claims for erectile dysfunction, GERD, sleep apnea, and hypertension, to include secondary to service-connected disabilities. These remands were based on pre-decisional errors, including the failure of VA examiners to provide opinions on the relationship between the claimed conditions and service, or to address potential secondary causation to service-connected conditions or TERA. The Board also noted that the private examiner's opinion regarding secondary causation via obesity was not given weight as the underlying right knee disability was denied.

Rationale

Service connection for low back disability established by AOJ; VA examination found radiculopathy related to low back disability; Secondary service connection criteria met

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251204-612628

Full Decision Text

Citation Nr: A26040838
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 251204-612628
DATE: April 30, 2026

ORDER

Entitlement to service connection for left lower extremity radiculopathy, secondary to a service-connected back disability, is granted.

Entitlement to service connection for a right knee disability, to include as secondary to a service-connected disability, is denied.

REMANDED

Entitlement to service connection for erectile dysfunction, to include as secondary to service-connected disability, is remanded.

Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service-connected disability, is remanded.

Entitlement to service connection for sleep apnea, to include as secondary to service-connected disability, is remanded.

Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded.

FINDINGS OF FACT

1. The Veteran's diagnosed left lower extremity radiculopathy is due to the service-connected low back disability.

2. The evidence for the period under review persuasively weighed against finding that a right knee disability began during active service; was otherwise related to an in-service injury or disease; or was secondary to a service-connected low back disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 2000 to April 2004.

This appeal comes before the Board of Veterans' Appeals (Board) from February 2025 and April 2025 decisions of a Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). In the December 4, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, regarding the claims for service connection for right knee, sleep apnea, erectile dysfunction, and left lower extremity radiculopathy, the Board may only consider the evidence of record at the time of the February 2025 AOJ decision on appeal, and any evidence submitted by the Veteran or the Veteran's representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or more than 90 days following the date the Board received the VA Form 10182, the Board did not consider that evidence in this decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

Regarding the claims for service connection for hypertension and GERD, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal, and any evidence submitted by the Veteran or the Veteran's representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or more than 90 days following the date the Board received the VA Form 10182, the Board did not consider that evidence in this decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

Regarding the claims for service connection for left lower extremity radiculopathy, and a right knee disability, if the Veteran wants VA to consider any evidence that was submitted that the Board cannot consider, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify that evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is rem
.R. §§ 20.300, 20.303, 20.801.

However, because the Board is remanding the claims of service connection for GERD, sleep apnea, hypertension, and erectile dysfunction, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. To establish service connection requires evidence of: (1) a current disability; (2) incurrence or aggravation in service of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be established for a disability that is proximately due to, the result of, or aggravated by, service-connected disability. 38 C.F.R. § 3.310.

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service or within an applicable presumptive period, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

The service personnel records indicate that the Veteran is a combat Veteran. In cases where a Veteran asserts service connection for injuries or disease incurred or aggravated in combat, 38 U.S.C. § 1154(b) and its implementing regulation, 38 C.F.R. § 3.304(d), are applicable. That statute and regulation ease the evidentiary burden of a combat Veteran by permitting the use, under certain circumstances, of lay evidence. If the Veteran engaged in combat with the enemy, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). In the case of a combat Veteran not only is the combat injury presumed, but so is the disability due to the combat injury in service. However, to establish service connection, there must be evidence of a current disability and a causal relationship between the current disability and the combat injury. Reeves v. Shinseki, 682 F.3d 988 (Fed. Cir. 2012).

In August 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act (PACT Act) was signed into law. If a Veteran submits a claim for compensation for service connection with evidence of a disability and evidence of participation in a toxic exposure risk activity (TERA) during active service, and that evidence is not sufficient to establish a service connection for the disability, VA shall provide the Veteran with a medical examination and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168. The Veteran, having served in the Persian Gulf during the Gulf War, is presumed to have participated in TERA during service. The PACT Act established additional presumptive diseases for TERA in-service. However, the PACT Act did not establish any of the disabilities claimed in this appeal as new or modified presumptive conditions. 38 C.F.R. § 3.309;
during active service, and that evidence is not sufficient to establish a service connection for the disability, VA shall provide the Veteran with a medical examination and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168. The Veteran, having served in the Persian Gulf during the Gulf War, is presumed to have participated in TERA during service. The PACT Act established additional presumptive diseases for TERA in-service. However, the PACT Act did not establish any of the disabilities claimed in this appeal as new or modified presumptive conditions. 38 C.F.R. § 3.309; 38 U.S.C. § 1116(a)(2). Even if a disease is not listed as presumed, direct service connection must be considered. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

1. Entitlement to service connection for left lower extremity radiculopathy

The Veteran contends that left lower extremity radiculopathy was caused by service-connected disability.

In a January 2025 VA examination report, a VA examiner diagnosed a low back disability and left lower extremity radiculopathy related to the low back disability.

A February 2025 AOJ decision established service connection for a low back disability.

Therefore, the evidence of record for the period under review indicated that left lower extremity radiculopathy was related to a service-connected low back disability. Accordingly, the Board finds that service connection for left lower extremity radiculopathy, secondary to a service-connected back disability, is warranted and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for a right knee disability, to include as secondary to a service-connected low back disability

The Veteran contends that a right knee disability is related to service or to a service-connected disability.

The question for the Board is whether the Veteran had a disability during the period under review that began during service or is at least as likely as not related to an event, injury, or disease during service, or caused or aggravated by service-connected disability.

The service medical records do not contain any notation indicating diagnosis or treatment for a right knee disability.

After service, in an October 2020 private treatment record, the Veteran reported experiencing right knee pain for the previous six months. After an examination, the private examiner diagnosed patellofemoral pain syndrome. The post-service treatment records do not contain any further notation regarding treatment or diagnosis for a right knee disability.

The treatment records for the period under review did not contain any notation indicating that the Veteran walked with an altered gait, to include a limp. In a January 2022 private treatment record, a private examiner indicated that the Veteran's gait was normal. Moreover, the Veteran did not provide any lay evidence suggesting that the Veteran walked with an altered gait.

In November 2024, the Veteran filed a claim for service connection for a right knee disability. The Veteran did not provide any lay statements at any time during the period under review explaining why the Veteran believed that the right knee disability was either related to service, or was secondary to a service-connected disability.

After the issuance of the February 2025 decision from which this appeal arises, but during a period when the evidence can be reviewed by the Board, the Veteran submitted a November 2025 private medical opinion. In that opinion, a private examiner noted having reviewed the claims file, but did not indicate having performed a physical examination of the Veteran. Having noted the right knee disability diagnosed in October 2020, the private examiner opined that the right knee disability was caused by an altered gait caused by the service-connected low back disability.

The Board concludes that, while the Veteran had a diagnosed right knee disability, specifically patellofemoral pain syndrome, during the period under review, the evidence of record persuasively weighed against a finding that the diagnosed right knee disability began during service, or was otherwise related to any event, injury, or disease during service; or was caused or aggravated by service-connected disability. The service medical records contained no notation indicating that the Veteran experienced any right knee disability during service. The Veteran is a combat Veteran and, therefore, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence submitted by the Veteran, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of that service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). However, the Veteran did not submit
persuasively weighed against a finding that the diagnosed right knee disability began during service, or was otherwise related to any event, injury, or disease during service; or was caused or aggravated by service-connected disability. The service medical records contained no notation indicating that the Veteran experienced any right knee disability during service. The Veteran is a combat Veteran and, therefore, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence submitted by the Veteran, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of that service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). However, the Veteran did not submit any evidence indicating that the right knee disability was related to service or any incident of service, to include any incident related to combat. Moreover, the record for the period under review did not contain any clinical evidence suggesting that any right knee disability was related to service or any incident of service. In the October 2020 private treatment record, in which the Veteran was diagnosed as having a right knee disability, the Veteran reported experiencing right knee disability symptoms since approximately April 2020, more than a decade after separation from service. Therefore, the record of evidence weighed against a finding that a diagnosed right knee disability began during service, or was otherwise related to any event, injury, or disease during service.

Moreover, the Board finds that the evidence for the period under review weighed against a finding that a right knee disability was secondary to the low back disability. In a November 2025 private medical opinion, a private examiner reported reviewing the claims file. Having done so, the private examiner opined that the right knee disability was caused by an altered gait caused by the service-connected low back disability. In explaining that opinion, the examiner stated that the low back disability had resulted in biomechanical disturbances that significantly affected the structural foundation of lower body movement. The examiner then stated that medical literature explained how a low back disability could alter an individual's gait, causing progressive date damage to the knee joint. Therefore, the examiner opined that the right knee disability was at least as likely as not a secondary manifestation of the Veteran lumbar spine disability. The examiner then stated that the VA examiners, in performing VA examinations in conjunction with the Veteran's claims for service connection, were at fault for not providing a gait analysis in performing the examinations.

The Board finds that the November 2025 private medical opinion has little probative value in this matter. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In the medical opinion, the private examiner stated that the Veteran's right knee disability was caused by an altered gait caused by a low back disability. The examiner indicated that the VA examiners were at fault for not providing a gait analysis in performing VA examinations. However, the private examiner reported writing the private medical opinion after reviewing the claims file. The private examiner's report did not contain any notation suggesting that the examiner had performed a physical examination, to include the gait analysis suggested by the private examiner. Although the private examiner stated that a low back disability would cause an altered gait, the examiner did not refer to any specific treatment record indicating that the Veteran walked with an altered gait. The examiner also did not provide an explanation as to why the post-service treatment records, to include both private and VA records, contained no notation indicating that the Veteran had an altered gait related to any disability. Moreover, the examiner did not note the January 2022 private treatment record in which a private examiner indicated that the Veteran's gait was normal. Because the private examiner based the opinion on the existence of an altered gait for which there was no basis in the record, the Board finds that the examiner's opinion has little probative value in this matter. Reonal v. Brown, 5 Vet. App. 458 (1993).

The post-service treatment records, to include those from examiners treating the Veteran for musculoskeletal disabilities, did not contain any notation suggesting that the Veteran walked with an altered gait. In a January 2022 private treatment record, a private examiner indicated that the Veteran's gait was normal. Moreover, those same treatment records did not contain any notation suggesting that any right knee disability was caused or aggravated by a low back disability. The Veteran did not provide any lay evidence suggesting that the right knee disability was caused or aggravated by the low back disability. The Veteran did not provide any evidence suggesting that a right knee disability was related to a low back disability, other than the November 2025 private medical opinion which the Board finds has little probative value in this matter. Therefore, the Board finds that the
culoskeletal disabilities, did not contain any notation suggesting that the Veteran walked with an altered gait. In a January 2022 private treatment record, a private examiner indicated that the Veteran's gait was normal. Moreover, those same treatment records did not contain any notation suggesting that any right knee disability was caused or aggravated by a low back disability. The Veteran did not provide any lay evidence suggesting that the right knee disability was caused or aggravated by the low back disability. The Veteran did not provide any evidence suggesting that a right knee disability was related to a low back disability, other than the November 2025 private medical opinion which the Board finds has little probative value in this matter. Therefore, the Board finds that the most probative evidence of record weighed against a finding that a right knee disability was caused or aggravated by a low back disability.

Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service, such as one year for arthritis; or, if they were noted in service, or within an applicable presumptive period, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, patellofemoral pain syndrome is not a form of arthritis. The record did not contain any notation suggesting that the Veteran had a diagnosed right knee disability for which service connection could be granted on a presumptive basis as a chronic disease.

VA conceded that the Veteran participated in a TERA based on the Veteran's exposure to toxic elements during service in the Gulf War. However, the Veteran was not provided a VA TERA examination and medical opinion. During the period under review, the Veteran did not claim that there was any etiological relationship between any right knee disability and toxic exposures during service. The record of evidence for that period, both lay and medical, did not contain any notation suggesting a relationship. Moreover, the Secretary has determined that there is no indication of association between physical disabilities such as the Veteran's right knee disability and toxic exposures during service. Therefore, the evidence weighed against a grant of service connection for a right knee disability based on toxic exposures during service.

By filing this claim, the Board notes that the Veteran expressed a belief that the right knee disability was related to service or was secondary to a low back disability. The Board notes that, if the Veteran can provide evidence suggesting that any knee disability was related to service or any incident during service, to include any incident during combat, or can provide evidence indicating that the right knee disability was caused or aggravated by a service-connected disability, the Veteran may submit that evidence with a supplemental claim in a timely fashion following the issuance of this decision. However, the Board finds that the weight of the evidence weighed against a finding that the Veteran's right knee disability was related to service, or was secondary to a service-connected disability. The Board finds that the evidence is not in approximate balance and that there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim for service connection for a right knee disability must be denied. 38 U.S.C. § 5107.

REASONS FOR REMAND

1. Entitlement to service connection for erectile dysfunction, to include as secondary to a low back disability, is remanded.

In a January 2025 VA examination report, a VA examiner indicated that the Veteran had a low back disability resulting in radiculopathy symptomatology affecting the left lower extremity. Even though the low back disability was shown to have resulted in a neurological disability, the AOJ did not provide the Veteran with an examination to determine whether any erectile dysfunction was related to the Veteran's low back disability. Not providing an examination was a pre-decisional error. Remand is necessary to schedule an examination.

2. Entitlement to service connection for GERD, to include as secondary to service-connected disability, is remanded.

In a March 2025 VA examination report, a VA examiner, having examined the Veteran, diagnosed GERD. During an interview, the Veteran reported that the experiencing GERD symptoms during service. The Veteran specifically indicated experiencing both burning and gas in the chest after eating certain foods during service. In a contemporaneous medical opinion, the VA examiner opined that GERD was not at least as likely as not related to TERA during service, because toxic exposures were not shown to cause
back disability. Not providing an examination was a pre-decisional error. Remand is necessary to schedule an examination.

2. Entitlement to service connection for GERD, to include as secondary to service-connected disability, is remanded.

In a March 2025 VA examination report, a VA examiner, having examined the Veteran, diagnosed GERD. During an interview, the Veteran reported that the experiencing GERD symptoms during service. The Veteran specifically indicated experiencing both burning and gas in the chest after eating certain foods during service. In a contemporaneous medical opinion, the VA examiner opined that GERD was not at least as likely as not related to TERA during service, because toxic exposures were not shown to cause the stomach acid over-production which defined GERD. However, the examiner did not provide any opinion indicating whether the disability was related to the GERD symptoms the Veteran reported experiencing during service. Not providing such an opinion was a pre-decisional error. Remand is necessary to schedule an additional examination.

3. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disability, is remanded.

In an October 2023 VA examination report, a VA examiner diagnosed sleep apnea. During the examination, the Veteran reported being told that the Veteran snored excessively and seemed to gag during sleep in service. In a January 2024 VA medical opinion, another VA examiner, having reviewed the evidence, opined that the disability was not as likely as not related to TERA during service, because toxic exposures were not shown to have any significant effect on the throat muscles whose actions caused sleep apnea. However, the examiner did not provide any opinion indicating whether the disability was related to the snoring and gagging the Veteran reported experiencing during service. In a subsequent December 2024 VA medical opinion, another VA examiner, having performed an examination, opined that sleep apnea was not as likely as not caused by a service-connected psychiatric disability. In explaining that opinion, the VA examiner, exclusively citing medical literature, stated that there was insufficient evidence to establish secondary causation for sleep apnea due to a psychiatric disability. In writing the December 2024 opinion, the VA examiner did not make any reference to any clinical evidence involving the Veteran. The January 2024 VA examiner's not providing an opinion regarding whether sleep apnea was related to snoring and gagging experienced by the Veteran during service was a pre-decisional error. Also, the December 2024 VA examiner's not noting any of the clinical record in the examiner's opinion is also a pre-decisional error. Remand is necessary to schedule an additional examination.

4. Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded.

The service medical records did not contain any diagnosis for hypertension. However, in a March 2025 VA examination report, the Veteran reported having hypertension during service and being given medication for control of hypertension in 2005, approximately a year after separation from service. Although the post-service treatment records did not contain any record initially diagnosing the Veteran with hypertension, in a March 2008 private treatment record, a private examiner indicated that the Veteran was already being treated for hypertension.

In a March 2025 VA examination report, a VA examiner, having examined the Veteran, diagnosed hypertension. The examiner opined that hypertension was not at least as likely as not related to TERA during service. However, the examiner did not provide any opinion indicating whether the disability was related to service, especially in light of the Veteran's reports of treatment soon after service and the private treatment record indicating treatment for already diagnosed hypertension within four years of service separation. Not providing such an opinion was a pre-decisional error. Remand is necessary to schedule an additional examination.

For all disabilities being remanded, in the November 2025 private medical opinion, the private examiner opined that the disabilities were related to obesity caused by right knee and low back disabilities. Indirect secondary service connection can be granted with obesity acting as an intermediate step. Walsh v. Wilkie, 32 Vet. App. 300 (2020); VAOPGCPREC 1 2017 (Jan. 6, 2017). Specifically, service connection can be established (1) if a service-connected disability caused or aggravated obesity, (2) if the obesity was a substantial factor in causing a subsequent disability, and (3) if the subsequent disability would not have occurred but for obesity. In this decision, the Board denied service connection for a right knee disability so the Board finds that obesity related to that disability would not cause the disabilities on appeal. However, because the Veteran claimed that the disabilities being remanded are related to obesity caused by service-connected
an intermediate step. Walsh v. Wilkie, 32 Vet. App. 300 (2020); VAOPGCPREC 1 2017 (Jan. 6, 2017). Specifically, service connection can be established (1) if a service-connected disability caused or aggravated obesity, (2) if the obesity was a substantial factor in causing a subsequent disability, and (3) if the subsequent disability would not have occurred but for obesity. In this decision, the Board denied service connection for a right knee disability so the Board finds that obesity related to that disability would not cause the disabilities on appeal. However, because the Veteran claimed that the disabilities being remanded are related to obesity caused by service-connected disabilities, VA must consider that possibility in this remand.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination to determine the nature and etiology of obesity. The examiner must review the entire claims file, including a copy of this remand. In reviewing the file, the examiner should note the service medical records; the post-service treatment records; the lay evidence; and the November 2025 private medical opinion, indicating that the Veteran had obesity related to a service-connected disability. All indicated tests and studies should be accomplished, with all findings made available to the requesting examiner prior to the completion of the report, and all clinical findings should be reported in detail. A complete rationale for all opinions expressed should be provided. The examiner must consider the lay statements provided by the Veteran regarding symptoms during and since service. The examiner is asked to provide responses to the following:

(a.) Diagnose whether the Veteran had obesity during the pendency of the appeal, dating to May 2023.

(b.) Opine whether it is as likely as not that obesity is due to, the result of, or caused by a service-connected disability or disabilities, to include sinusitis; a psychiatric disability; hemorrhoids; a low back disability; rhinitis; tinnitus; left lower extremity radiculopathy; and a colectomy, to include medication used to treat any service-connected disability and any altered gait caused by service-connected disability.

(c.) Opine whether it is as likely as not that obesity has been aggravated (increased in severity) by service-connected disability, to include medication used to treat any service-connected disability and/or any altered gait caused by a service-connected disability. Aggravation need not be permanent.

2. Schedule the Veteran for an examination to determine the nature and etiology of erectile dysfunction. The examiner must review the entire claims file, including a copy of this remand. In reviewing the file, the examiner should note the service medical records; the post-service treatment records; the lay evidence; and the January 2025 VA examination report, diagnosing left lower radiculopathy related to a low back disability. All indicated tests and studies should be accomplished, with all findings made available to the requesting examiner prior to the completion of the report, and all clinical findings should be reported in detail. A complete rationale for all opinions should be provided. The examiner must consider the lay statements provided by the Veteran regarding symptoms during and since service. The examiner is asked to provide responses to the following:

(a.) Opine whether it is as likely as not that any erectile dysfunction is related to the Veteran's period of active service from April 2000 to April 2004, or any incident of that period of service, to include presumed toxic exposure and any other potential etiology from service mentioned by the Veteran.

(b.) If erectile dysfunction is due to an organic disease of the nervous system is diagnosed, opine whether it is it as likely as not that the disability (1) began during a period of active service from April 2000 to April 2004, (2) manifested within one year after the April 2004 separation from service, or (3) was noted during service with continuity of the same symptomatology since service.

(c.) Opine whether it is as likely as not that erectile dysfunction is due to, the result of, or caused by the service-connected disabilities, to include sinusitis; a psychiatric disability; hemorrhoids; a low back disability; rhinitis; tinnitus; left lower extremity radiculopathy; and a colectomy, to include medication used to treat any service-connected disability.

(d.) Opine whether it is as likely as not that any erectile dysfunction disability has been aggravated (increased in severity) by the service-connected disabilities, to include medication used to treat any service-connected disability. Aggravation need not be permanent.

(e.) If obesity was secondary to the service-connected disabilities, opine whether the Veteran's obesity was a substantial factor in causing erectile dysfunction.

(f.) If the Veteran's obesity was a substantial
, or caused by the service-connected disabilities, to include sinusitis; a psychiatric disability; hemorrhoids; a low back disability; rhinitis; tinnitus; left lower extremity radiculopathy; and a colectomy, to include medication used to treat any service-connected disability.

(e.) If obesity was secondary to the service-connected disabilities, opine whether the Veteran's obesity was a substantial factor in causing erectile dysfunction.

(f.) If the Veteran's obesity was a substantial factor in causing erectile dysfunction, opine whether the Veteran's erectile dysfunction would not have occurred but for the obesity.

3. Schedule the Veteran for an examination to determine the nature and etiology of GERD. The examiner must review the entire claims file, including a copy of this remand. In reviewing the file, the examiner should note the service medical records; the post-service treatment records; the lay evidence; and the March 2025 VA examination report. All indicated tests and studies should be accomplished, with all findings made available to the requesting examiner prior to the completion of the report, and all clinical findings should be reported in detail. A complete rationale for all opinions expressed should be provided. The examiner must consider the lay statements provided by the Veteran regarding symptoms during and since service. The examiner is asked to provide responses to the following:

(a.) Opine whether it is as likely as not that GERD is related to a period of active service from April 2000 to April 2004, or any incident of that period of service, to include presumed toxic exposure and the GERD symptoms reported by the Veteran to have occurred during service.

(b.) Opine whether it is as likely as not that GERD due to, the result of, or caused by a service-connected disability or disabilities, to include sinusitis; a psychiatric disability; hemorrhoids; a low back disability; rhinitis; tinnitus; left lower extremity radiculopathy, and a colectomy, to include medication used to treat any service-connected disability.

(c.) Opine whether it is as likely as not that GERD has been aggravated (increased in severity) by the service-connected disabilities, to include any medication used to treat any service-connected disability. Aggravation need not be permanent.

(d.) If a obesity was secondary to the service-connected disabilities, opine whether the Veteran's obesity was a substantial factor in causing GERD.

(e.) If the Veteran's obesity was a substantial factor in causing GERD, opine whether the Veteran's erectile dysfunction would not have occurred but for the obesity.

4. Schedule the Veteran for a VA examination to determine the nature and etiology of sleep apnea. The examiner must review the entire claims file, including a copy of this remand. In reviewing the file, the examiner should note the service medical records; the post-service treatment records; the lay evidence; and the VA examination reports and medical opinions regarding sleep apnea. All indicated tests and studies should be accomplished, with all findings made available to the requesting examiner prior to the completion of the report, and all clinical findings should be reported in detail. A complete rationale for all opinions expressed should be provided. The examiner must consider the lay statements provided by the Veteran regarding symptoms during and since service. The examiner is asked to provide responses to the following:

(a.) Opine whether it is as likely as not that sleep apnea is related to a period of active service from April 2000 to April 2004, or any incident of that period of service, to include presumed toxic exposure, and the snoring and gagging during sleep during service reported by the Veteran.

(b.) Opine whether it is as likely as not that sleep apnea is due to, the result of, or caused by a service-connected disability or disabilities, to include sinusitis; a psychiatric disability; hemorrhoids; a low back disability; rhinitis; tinnitus; left lower extremity radiculopathy; and a colectomy, to include medication used to treat any service-connected disability.

(c.) Opine whether it is as likely as not that sleep apnea has been aggravated (increased in severity) by the service-connected disabilities, to include any medication used to treat any service-connected disability. Aggravation need not be permanent.

(d.) If obesity was secondary to the service-connected disabilities, opine whether the Veteran's obesity was a substantial factor in causing sleep apnea.

(e.) If the Veteran's obesity was a substantial factor in causing sleep apnea, opine whether the Veteran's erectile dysfunction would not have occurred but for the obesity
back disability; rhinitis; tinnitus; left lower extremity radiculopathy; and a colectomy, to include medication used to treat any service-connected disability.

(d.) If obesity was secondary to the service-connected disabilities, opine whether the Veteran's obesity was a substantial factor in causing sleep apnea.

(e.) If the Veteran's obesity was a substantial factor in causing sleep apnea, opine whether the Veteran's erectile dysfunction would not have occurred but for the obesity.

5. Schedule the Veteran for an examination to determine the nature and etiology of diagnosed hypertension. The examiner must review the entire claims file, including a copy of this remand. In reviewing the file, the examiner should note the service medical records; the post-service treatment records, to include the March 2008 private treatment record in which a private examiner indicated that the Veteran was already being treated for hypertension; the lay evidence, to include the Veteran's statements indicating hypertension symptoms during service and taking medication for the disability in 2005; and the March 2025 VA examination report and medical opinion. All indicated tests and studies should be accomplished, with all findings made available to the requesting examiner prior to the completion of the report, and all clinical findings should be reported in detail. A complete rationale for all opinions expressed should be provided. The examiner must consider the lay statements provided by the Veteran regarding symptoms during and since service. The examiner is asked to provide responses to the following:

(a.) Opine whether it is as likely as not that hypertension is related to a period of active service from April 2000 to April 2004, or any incident of that period of service, to include presumed toxic exposure, and the snoring and gagging during sleep during service reported by the Veteran.

(b.) Opine whether it is it as likely as not that hypertension (1) began during a period of active service from April 2000 to April 2004, (2) manifested within one year after the April 2004 separation from service, or (3) was noted during service with continuity of the same symptomatology since service.

(c.) Opine whether it is as likely as not that hypertension is due to, the result of, or caused by a service-connected disability or disabilities, to include sinusitis; a psychiatric disability; hemorrhoids; a low back disability; rhinitis; tinnitus; left lower extremity radiculopathy; and a colectomy, to include medication used to treat any service-connected disability.

(d.) Opine whether it is as likely as not that hypertension has been aggravated (increased in severity) by the service-connected disabilities, to include any medication used to treat any service-connected disability. Aggravation need not be permanent.

(e.) If obesity was secondary to the service-connected disabilities, opine whether the Veteran's obesity was a substantial factor in causing hypertension.

(f.) If the Veteran's obesity was a substantial factor in causing hypertension, opine whether the Veteran's erectile dysfunction would not have occurred but for the obesity.

Harvey P. Roberts

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T.M. Gillett, 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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