MALIGNANT NEOPLASMS OF THE DIGESTIVE SYSTEM

J. NICHOLS · 2026 · Case ID: A26040843

GRANTED

Summary

The Veteran served from January 1969 to December 1972. The Veteran appeals the denial of service connection for thyroid cancer and hypertension, and seeks service connection for hypothyroidism, migraine headaches, and cervical spine degenerative disc disease. The Board granted service connection for residuals of papillary carcinoma, thyroid, status post total thyroidectomy, finding the evidence persuasively in favor of a service connection, resolving doubt in the Veteran's favor due to approximate balance of evidence regarding herbicide exposure. Service connection for hypothyroidism was granted as secondary to the granted thyroid cancer, resolving doubt in the Veteran's favor. Service connection for migraine headaches was granted, finding the evidence persuasively in favor of a separate migraine disorder related to service, resolving doubt in the Veteran's favor. Service connection for degenerative disc disease of the cervical spine was granted, finding the evidence persuasively in favor of a service connection related to the Veteran's in-service fall and road marches, resolving doubt in the Veteran's favor. An initial rating of 10 percent for hypertension was granted, as the evidence supported this rating but not a higher one, with doubt resolved in the Veteran's favor for the 10 percent rating.

Rationale

Evidence persuasively in favor of service connection; Approximate balance of evidence regarding herbicide exposure; Benefit of the doubt resolved in Veteran's favor

Special Benefit

NO SPECIAL BENEFIT

Docket No.

230822-371461

Full Decision Text

Citation Nr: A26040843
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 230822-371461
DATE: April 30, 2026

ORDER

Service connection for residuals of papillary carcinoma, thyroid, status post total thyroidectomy is granted.

Service connection for hypothyroidism is granted.

Service connection for migraine headaches including migraine variants, is granted.

Service connection for degenerative disc disease of the cervical spine is granted.

An initial rating of 10 percent, but no higher, for hypertension, is granted.

FINDINGS OF FACT

1. The evidence is persuasively in favor of a finding that the Veteran's residuals of papillary carcinoma, thyroid, status post total thyroidectomy is related to service.

2. The evidence is persuasively in favor of a finding that the Veteran's hypothyroidism is related to service.

3. The evidence is persuasively in favor of a finding that the Veteran's migraine headache disorder, including migraine variants, is related to service.

4. The evidence is persuasively in favor of a finding that the Veteran's degenerative disc disease of the cervical spine is related to service.

5. Resolving doubt in favor of the Veteran, the Veteran's hypertension manifested in systolic pressure predominantly 160 or more, but not diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

CONCLUSIONS OF LAW

1. The criteria for service connection for residuals of papillary carcinoma, thyroid, status post total thyroidectomy, are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309.

2. The criteria for service connection for hypothyroidism, are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310.

3. The criteria for service connection for migraine headaches including migraine variants, are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

4. The criteria for service connection for degenerative disc disease of the cervical spine are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309.

5. The criteria for an initial 10 percent rating, but no higher, for hypertension are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.104, Diagnostic Code (DC) 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from January 1969 to December 1972.

In the August 22, 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 18, 2025.

Therefore, the Board may only consider the evidence of record at the time of the July 2023 (service connection for hypothyroid, migraine headaches, cervical spine, and initial rating for hypertension) and August 2023 (service connection for thyroid cancer) agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or
as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted 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.

Service Connection

Service connection may be granted 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. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain enumerated diseases shall be service connected if the requirements of 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e).

Effective August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) added additional diseases presumed to be related to herbicide agent exposure. See PACT Act, Pub. L. No 117-168, to be codified at 38 U.S.C. § 1116.

A veteran, who during active military, naval, or air service, served in the Republic of Vietnam, or certain water and air spaces, during the period from January 9, 1962 to May 7, 1975, shall be presumed to have been exposed during such service to certain herbicide agents, to include the commonly referred herbicide agent, Agent Orange, absent affirmative evidence to establish that the veteran was not exposed. See 38 U.S.C. § 1116 (f); 38 C.F.R. §§ 3.307 (a)(6)(iii). As noted in June 2023 TERA Memorandum, the RO has concluded that the Veteran was exposed to herbicide agents during his active-duty service based upon his sea service in waters associated with the Republic of Vietnam. Accordingly, the Veteran is presumed to have been exposed to herbicide agents during his active-duty service.

Where a veteran served 90 days or more of active service, and certain chronic diseases, such as malignant tumors, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id.

The determination as
.F.R. §§ 3.307, 3.309(a).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303 (a).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

1. Entitlement to service connection for residuals of papillary carcinoma, thyroid, status post total thyroidectomy.

There is no dispute that the Veteran was diagnosed with papillary carcinoma of the thyroid in April 2009. See e.g. May 2021 letter from Dr. X.C. Dr. X.C. was the Veteran's treating physician and confirmed that the Veteran had a diagnosis of thyroid cancer and underwent a total thyroidectomy in 2009.

The Veteran asserts that his thyroid cancer was due to toxic exposures in service, including radiation and herbicide agents. As discussed above, the June 2023 TERA memorandum indicated that the Veteran was exposed to herbicide agents. Notably, thyroid cancer is not one of the enumerated diseases presumed to be associated with exposure to herbicide agents.

Additionally, the Board acknowledges that thyroid cancer shall be service-connected if it becomes manifest in a radiation-exposed veteran as defined in 38 C.F.R. § 3.309 (d)(3), provided the rebuttable presumption provisions of section 3.307 are satisfied. In this case, however, radiation exposure has not been conceded by VA. In this regard, the AOJ inquired with the Naval Dosimetry Center as to the Veteran's radiation exposure and was advised that there were no records indicating that the Veteran was exposed to ionizing radiation. The AOJ informed the Veteran of the same in the April 2020 rating decision which cited the December 2009 letter from the Naval Dosimetry Center.

As noted above, certain chronic illnesses, including malignant tumors, are presumed to be service connected if they become manifest to a compensable degree within one year of service separation and the Veteran served for at least 90 days. In this case, however, the Veteran's thyroid cancer was not diagnosed until April 2009, approximately 37 years after service separation. Thus, the cancer was not manifest to a compensable degree within one year of service separation and service connection is not warranted on this basis.

Even though the Veteran's thyroid cancer does not appear to be warranted on a presumptive basis, the provisions for presumptive service connection do not preclude a claimant from establishing service connection with proof of actual direct causation, on the basis that the exposure led to the development of the claimed disability after service. See Combee v. Brown, 34 F.3d 1039, 1042-44 (Fed. Cir. 1994).

Turning to the relevant evidence, there are medical opinions in favor of, and against, the claim.

Weighing in favor of the claim are private opinions from Dr. C.B., Dr. P.B., and Dr. P.A.

Dr. C.B. submitted a letter in August 2022 in favor of the claim. Dr. C.B. explained that the Veteran was exposed to herbicide agents and water toxins during service that were known to cause thyroid cancer. Dr. C.B. provided medical literature to support the opinion.

In Dr. P.B.'s opinion received in July 2023, Dr. P.B. noted that he reviewed the Veteran's operative report, surgical pathology report of thyroidectomy, history and physical of the Veteran, as well as laboratory reports. Dr. P.B. explained that the Veteran was preparing for surgery for something else when the thyroid lump was found and it was determined that the Veteran had papillary thyroid cancer. Dr. P.B. noted that the Veteran was exposed to herbicide agents during service which
favor of the claim. Dr. C.B. explained that the Veteran was exposed to herbicide agents and water toxins during service that were known to cause thyroid cancer. Dr. C.B. provided medical literature to support the opinion.

In Dr. P.B.'s opinion received in July 2023, Dr. P.B. noted that he reviewed the Veteran's operative report, surgical pathology report of thyroidectomy, history and physical of the Veteran, as well as laboratory reports. Dr. P.B. explained that the Veteran was preparing for surgery for something else when the thyroid lump was found and it was determined that the Veteran had papillary thyroid cancer. Dr. P.B. noted that the Veteran was exposed to herbicide agents during service which were likely causes for papillary thyroid cancer. Dr. P.B. explained that papillary carcinoma was a slow-growing cancer that may take many years to become clinically apparent. Dr. P.B. also indicated that the Veteran was exposed to radiation during service and that it was reasonable to consider that the Veteran's thyroid cancer grew out of the exposure.

Dr. P.A. submitted a letter in support of the Veteran's claim that was received in December 2025. Dr. P.A. noted that he had reviewed the Veteran's medical records and extensively reviewed pertinent literature. Dr. P.A. opined that it was very likely that the Veteran's thyroid condition was a direct result of his service exposures. Dr. P.A. explained that the herbicide agents to which the Veteran was exposed were classified as significant carcinogens by the International Agency for Research on Cancer. Dr. P.A. also confirmed that it was well-established in medical literature that there could be a long latency period between exposure to carcinogens and the development of cancer. Dr. P.A. concluded that it was very likely that the Veteran's thyroid cancer was related to the Veteran's exposures during service.

Weighing against the claim is the January 2023 VA opinion.

The January 2023 VA examiner opined that the Veteran's thyroid cancer was less likely than not due to Agent Orange exposure in service. The examiner noted that the Veteran had risk factors of being of older age and being overweight at the time of the diagnosis in 2009. The VA examiner also explained that papillary thyroid cancer is one of the most common cancers and that most people who develop the cancer have not had Agent Orange exposure. The examiner also determined that there was insufficient evidence for Agent Orange as a cause of papillary thyroid cancer. The examiner cited medical literature to support the opinion that there was insufficient evidence.

Based on the foregoing evidence, the Board concludes that, on balance, the evidence is at least in approximate balance as to whether the Veteran's thyroid cancer was caused or aggravated by his presumed exposure to herbicide agents.

In this regard, the private clinicians addressed medical research regarding thyroid cancer caused by herbicide agents. The January 2023 VA examiner cited medical literature indicating that there was insufficient evidence to support a relationship between the Veteran's thyroid cancer and herbicide agent exposures.

Weighing the evidence in favor of and against the claim, the Board finds that the evidence is in approximate balance that the Veteran's thyroid cancer was related to herbicide agent exposure during service.

Accordingly, resolving all reasonable doubt in the Veteran's favor, the appeal as to entitlement to service connection for the residuals of thyroid cancer is granted. 38 U.S.C. § 5107 (b); Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021).

2. Entitlement to service connection for hypothyroidism.

There is no dispute that the Veteran has a diagnosis of hypothyroidism. See e.g. March 2022 VA medical opinion.

Under the PACT act, Congress added hypothyroidism to the list of disease associated with herbicide agent exposure. As discussed above, there is no dispute that the Veteran was exposed to herbicide agents.

Although hypothyroidism is presumptively associated with exposure to herbicide agents, the presumption may be rebutted if there is evidence of an intercurrent cause. In this case, there is no dispute that the Veteran had an intercurrent cause of thyroid cancer which required removal of his thyroid in 2009.

The Veteran was provided with a VA telehealth examination in April 2021. At that time, the Veteran reported that he was treated for his thyroid cancer with a thyroidectomy in 2009 followed by radioactive iodine ablation and had been on medication ever since for residual hypothyroidism due to the treatments. The examiner reviewed the Veteran's medical records which confirmed the Veteran's reported history. The examiner noted that as a result of treatment for the papillary thyroid carcinoma (thyroid gland removal and radioactive iodine ablation), the Veteran became hypothyroid. The examiner explained that the Veteran
this case, there is no dispute that the Veteran had an intercurrent cause of thyroid cancer which required removal of his thyroid in 2009.

The Veteran was provided with a VA telehealth examination in April 2021. At that time, the Veteran reported that he was treated for his thyroid cancer with a thyroidectomy in 2009 followed by radioactive iodine ablation and had been on medication ever since for residual hypothyroidism due to the treatments. The examiner reviewed the Veteran's medical records which confirmed the Veteran's reported history. The examiner noted that as a result of treatment for the papillary thyroid carcinoma (thyroid gland removal and radioactive iodine ablation), the Veteran became hypothyroid. The examiner explained that the Veteran's hypothyroidism was secondarily caused by having his thyroid gland removed and ablated. The examiner noted that the Veteran did not have a primary hypothyroidism condition.

A VA addendum opinion was obtained in March 2022 to address whether the Veteran's hypothyroidism was due to the Veteran's due to the thyroidectomy that was completed because of the Veteran's thyroid cancer. The March 2022 VA clinician opined that the Veteran's hypothyroidism was "less likely than not incurred in or caused by any presumptive hypothyroidism during service." The examiner explained that the Veteran had a normal thyroid function in 2008 prior to thyroidectomy with a TSH of 2.42 in December 2008. The VA examiner went on to note that the Veteran's hypothyroidism is a result of the Veteran's thyroidectomy.

Dr. C.B.'s August 2022 also related the Veteran's hypothyroid to the Veteran's thyroidectomy, noting that since the thyroidectomy, the Veteran had to be on medication for hypothyroidism, experienced mental fog, mental and physical fatigue, did not sleep well, experienced decreased memory, unstable weight, and heat and cold intolerance. Dr. C.B. opined that based on sound medical principles, it was at least 90 percent level of probability that the Veteran's hypothyroidism (and thyroid cancer) was due to the Veteran's toxic exposures during service.

As the Board has herein granted service connection for the Veteran's thyroid cancer, the Board finds service connection is warranted for the Veteran's hypothyroidism as secondary to the thyroid cancer. Again, there is no dispute that the April 2009 thyroidectomy which caused the Veteran's hypothyroidism, was incurred as a result of the Veteran's thyroid cancer.

Accordingly, resolving all reasonable doubt in the Veteran's favor, the appeal as to entitlement to service connection for hypothyroidism is granted. 38 U.S.C. § 5107 (b); Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021).

3. Entitlement to service connection for migraine headaches including migraine variants.

In this case, there is no dispute that the Veteran experienced a significant fall in service. See October 1972 service treatment record. Service connection is already in effect for occipital headaches related to the fall. The Veteran asserts that he has a separate migraine headache disability also related to the fall. There is some dispute as to whether the Veteran has a separate migraine headache disability, to include migraine variants.

The Veteran was provided with VA examinations in March 2021 and August 2022, and a VA opinion was obtained in September 2022.

During the March 2021 VA examination, the examiner noted a diagnosis of occipital neuralgia. The examiner was offered the opportunity to indicate additional headache diagnoses including migraine and migraine variants, tension, and cluster, but did not indicate an additional type of headache. The examiner explained that during service, the Veteran fell into a ditch and broke his jaw in five places and shattered 12 teeth. The examiner noted that the Veteran had some neck pain afterwards and started having headaches. The examiner noted that the Veteran's headaches would begin in the right occipital region and sometimes spread to the midline but never cross over to the left side.

During the August 2022 VA examination, the VA examiner noted a diagnosis of headaches due to occipital neuralgia and did not indicate a diagnosis of migraine headaches. The examiner noted that the headaches began after the Veteran's facial bones fracture in 1972 and surgical repairs. The examiner noted the Veteran's report that his headaches were located mostly on the right side of the head, occipital radiating to the neck. The examiner also noted the Veteran's report that during headaches, tinnitus was worse and the Veteran could not concentrate. The examiner also noted symptoms of nausea and sensitivity to light.

An August 2022 private disability benefits questionnaire authored by Dr. C.B. noted diagnoses of two types of headaches - migraines and tension
During the August 2022 VA examination, the VA examiner noted a diagnosis of headaches due to occipital neuralgia and did not indicate a diagnosis of migraine headaches. The examiner noted that the headaches began after the Veteran's facial bones fracture in 1972 and surgical repairs. The examiner noted the Veteran's report that his headaches were located mostly on the right side of the head, occipital radiating to the neck. The examiner also noted the Veteran's report that during headaches, tinnitus was worse and the Veteran could not concentrate. The examiner also noted symptoms of nausea and sensitivity to light.

An August 2022 private disability benefits questionnaire authored by Dr. C.B. noted diagnoses of two types of headaches - migraines and tension headaches. Dr. C.B. indicated that at least one of the types of headaches was due to the Veteran's cervical spine injury during service. Dr. C.B. cited the fall in service. Dr. C.B. was offered the opportunity to indicate whether the Veteran experienced prostrating attacks for migraine headaches and/or non-migraine headaches. Dr. C.B. noted that the Veteran experienced prostrating attacks of both migraine headache pain and non-migraine headache pain.

In September 2022, a VA addendum opinion regarding the Veteran's correct diagnosis was rendered. The September 2022 VA examiner reviewed the records and determined that the Veteran's history noted in prior examinations was consistent with occipital neuralgia. The September 2022 VA examiner determined that although Dr. C.B. diagnosed migraine and tension headaches in the August 2022 private DBQ, the diagnoses were likely rendered in error because the medical records did not indicate evidence of those diagnoses.

During the December 2025 hearing before the Board, Dr. C.B. explained that the Veteran has two types of headaches that both resulted from the fall in service. See Transcript page 7. In a December 2025 letter, Dr. C.B. provided further explanation that the Veteran has two types of headache disorders: migraines due to the traumatic brain injury in service when the Veteran fell in October 1972; and occipital headaches which are secondary to the Veteran's neck injury incurred in the same fall. Dr. C.B. cited medical literature to support the finding of multiple types of headaches. Additionally, Dr. C.B. noted the Veteran's reports of continuity of migraine symptoms since the fall in service.

The Board places a high probative value on Dr. C.B.'s December 2025 report. The Board places a limited probative value on the VA examination reports that did not distinguish between the two types of headaches.

Weighing the evidence in favor of and against the claim, the Board finds that the evidence is persuasively in favor of a finding that the Veteran has a separate migraine headache disorder related to service.

Accordingly, resolving all reasonable doubt in the Veteran's favor, the appeal as to entitlement to service connection for a migraine headache disorder is granted. 38 U.S.C. § 5107 (b); Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021).

4. Entitlement to service connection for neck pain.

In this case, there is no dispute that the Veteran has cervical spine disabilities including degenerative arthritis, degenerative disc disease, intervertebral disc syndrome, and spinal stenosis. See e.g. January 2023 VA examination report. The Veteran asserts that his current disabilities are due to service, to include the fall in service. See Transcript page 16.

In a June 2022 disability benefits questionnaire, Dr. C.B. noted the Veteran's current cervical spine disabilities.

Dr. C.B. also submitted a separate statement dated in August 2022 detailing the Veteran's in-service fall in which the Veteran fractured his mandible in five places. Dr. C.B. noted that the Veteran likely injured his cervical spine at the time of the fall. Dr. C.B.'s finding was based on the Veteran's report that he remembered neck pain or whiplash and hand numbness following the accident. Dr. C.B. also noted that the Veteran's hand numbness had gotten intermittently worse over the years. Dr. C.B. also opined that training road march activities also likely injured the Veteran's spine. Dr. C.B. cited a medical journal article pertaining to injuries associated with strenuous road marching. Overall, Dr. C.B. opined that considering every possible medical principle, to at least 90 percent level of probability, the Veteran's cervical spine problems were due to the Veteran's fall in service or road marches during service. Dr. C.B. cited the Veteran's service treatment records, statements regarding continuity of symptoms, and the Veteran's post-service treatment records. The Board places a high probative value on the
. Dr. C.B. also noted that the Veteran's hand numbness had gotten intermittently worse over the years. Dr. C.B. also opined that training road march activities also likely injured the Veteran's spine. Dr. C.B. cited a medical journal article pertaining to injuries associated with strenuous road marching. Overall, Dr. C.B. opined that considering every possible medical principle, to at least 90 percent level of probability, the Veteran's cervical spine problems were due to the Veteran's fall in service or road marches during service. Dr. C.B. cited the Veteran's service treatment records, statements regarding continuity of symptoms, and the Veteran's post-service treatment records. The Board places a high probative value on the opinion as Dr. C.B. offered detailed explanation for the opinion offered.

As noted above, the Veteran was provided with a VA examination in January 2023. At that time, the Veteran reported that his neck condition started in 1972 when he fell and broke his mandible in five places. He reported that his (cervical spine) symptoms at the time were neck pain and neck movement pain. Although the VA examiner diagnosed current cervical spine disabilities, and considered that the Veteran incurred a fall in service wherein the Veteran hit his head, the January 2023 VA examiner opined that it was less likely than not that the Veteran's cervical spine disorders were related to service-connected traumatic brain injury (TBI). The examiner reasoned that there was no known medical literature showing a direct correlation between vertigo, loss of sense of smell and taste, and cervical spine disabilities. Rather, the examiner determined that the Veteran's degenerative arthritis and degenerative disc diseases were a result of normal wear and tear on the body, and were typical findings for someone of the Veteran's age.

The Board places only a limited probative value on the January 2023 VA opinion and finds that the January 2023 VA examiner should have addressed whether the Veteran's neck disabilities were due to service (to include the fall in service in which the TBI was incurred), not whether the neck disabilities were secondary to the service-connected TBI itself.

In a July 2023 letter, Dr. P.B. explained that the Veteran's fall in 1972, in which the Veteran fractured his jaw and incurred a traumatic brain injury, was more than likely the cause of the Veteran's current ongoing neck pain. Dr. P.B. opined that the Veteran's diagnoses of degenerative disc disease and degenerative arthritis, spinal stenosis were related to the posttraumatic closed head injury.

During the December 2025 hearing before the Board, the Veteran offered sworn testimony that he experienced neck aches since service. Transcript page 7.

In a December 2025 letter, Dr. C.B. further explained that the Veteran's fall in service caused a whiplash of the Veteran's neck resulting in degeneration advanced for the Veteran's age. Dr. C.B. also reasoned that because the Veteran's currently service-connected occipital headaches are service connected due to the Veteran's neck injury incurred during the fall in October 1972, it naturally follows that neck disability arising from the neck injury should also be service-connected.

The Board places a high probative value on the Veteran's statements that he has experienced neck pain since service. Given that the Veteran has a diagnosis of degenerative disc disease in the cervical spine, and continuity of neck symptoms since service, as well as medical opinions in favor of the claim, the Board finds that the evidence is persuasively in favor of a finding that the Veteran's neck disorder is related to service.

Accordingly, resolving all reasonable doubt in the Veteran's favor, the appeal as to entitlement to service connection for degenerative disc disease of the cervical spine is granted. 38 U.S.C. § 5107 (b); Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021).

Initial Rating

Entitlement to a compensable initial rating for hypertension.

Service connection for hypertension was granted in an April 2023 rating decision and assigned a noncompensable rating effective August 10, 2022. Later in April 2023, the Veteran requested higher level review of the decision. In a May 2023 higher level review decision continued the noncompensable rating. In June 2023, the Veteran submitted a supplemental claim for higher rating for hypertension with an accompanying private disability benefits questionnaire (DBQ) pertinent to hypertension. In July 2023, the AOJ once again continued the noncompensable rating. The present appeal arises from disagreement with the July 2023 rating decision. As additional relevant evidence was received within one year of the April 2023 rating decision which granted service connection, the April 2023 rating decision did not become final
assigned a noncompensable rating effective August 10, 2022. Later in April 2023, the Veteran requested higher level review of the decision. In a May 2023 higher level review decision continued the noncompensable rating. In June 2023, the Veteran submitted a supplemental claim for higher rating for hypertension with an accompanying private disability benefits questionnaire (DBQ) pertinent to hypertension. In July 2023, the AOJ once again continued the noncompensable rating. The present appeal arises from disagreement with the July 2023 rating decision. As additional relevant evidence was received within one year of the April 2023 rating decision which granted service connection, the April 2023 rating decision did not become final, and the initial rating is presently on appeal.

During the pendency of the appeal, the Veteran filed a supplemental claim for a higher rating for hypertension in July 2025 and the AOJ granted an increased rating to 10 percent for hypertension, effective August 28, 2025.

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. See 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In this case, the Veteran was assigned a noncompensable rating under DC 7101 for his hypertension, for the period prior to August 28, 2025, and 10 percent thereafter. 38 C.F.R. § 4.104.

Under DC 7101 rating criteria, a 10 percent rating for hypertension is warranted for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control; a 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more; a 40 percent rating is warranted for diastolic pressure predominantly 120 or more; and a maximum 60 percent rating is warranted for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines "predominant" as "being most frequent or common." See merriam-webster.com, last visited April 21, 2026.

Under Diagnostic Code 7101, "a history of diastolic pressure predominantly 100 or more [that] requires continuous medication for control" refers to blood pressure readings taken before a veteran began medication to control hypertension, and therefore requires analyzing blood pressure readings prior to the appeal period. See Wilson v. McDonough, 35 Vet. App. 75 (2021).

The Veteran was provided with a VA examination in March 2023. The VA examiner noted that since the Veteran was diagnosed with hypertension in 2008, his clinicians had to increase his medication significantly to control his blood pressure. The examiner noted that the Veteran was taking four medications to control blood pressure. On the day of the examination, the Veteran had blood pressure readings of 152/87, 147/87, and 144/92.

VA treatment records note a history of blood pressure readings of 175/102 in February 2008, 171/94 in September 2020, 160/98 in July 2021, and 174/82 in January 2023. The Board notes that a July 2022 VA treatment record regarding an exercise stress test noted a maximum blood pressure of 202/69 during the stress test.

After reviewing the record, the Board resolves doubt and finds that the Veteran's hypertension manifested with systolic pressure predominantly 160 or more for the entire period on appeal. However, none of the VA treatment records, March 2023 VA examination or private DBQ indicate a diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more,
readings of 175/102 in February 2008, 171/94 in September 2020, 160/98 in July 2021, and 174/82 in January 2023. The Board notes that a July 2022 VA treatment record regarding an exercise stress test noted a maximum blood pressure of 202/69 during the stress test.

After reviewing the record, the Board resolves doubt and finds that the Veteran's hypertension manifested with systolic pressure predominantly 160 or more for the entire period on appeal. However, none of the VA treatment records, March 2023 VA examination or private DBQ indicate a diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more, at any point pertinent to the appeal. In this regard, none of the readings indicated a diastolic pressure over 110 and only one reading indicated systolic pressure of 200 or more, and that was during a stress test. One reading does not meet the definition of "predominant" as it was not repeated and therefore could not be described as frequent or common.

Based on the foregoing, the Board finds that the evidence supports an initial 10 percent disability rating but no higher.

In light of the above, the Board finds that the evidence of record persuasively weighs in favor of a finding that the Veteran meets the criteria for an initial 10 percent disability rating for hypertension, but no higher. Accordingly, the benefit of the doubt rule has been applied where necessary but does not apply to a rating greater than 10 percent. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-782 (Fed. Cir. 2021).

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D. Ebaugh, 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.

Analyze in VA Law Explorer