SINUSITIS

ANTHONY C. SCIRÉ, JR · 2026 · Case ID: A26040926

GRANTED

Summary

The Veteran served in the U.S. Air Force from June 1976 to September 1981 and in the U.S. Army from December 1990 to April 1991, including service in the Southwest Asia Theater of Operations, with additional Army Reserve and National Guard service. The Veteran appealed the May 2021 rating decision that denied service connection for sinusitis, rhinitis, bilateral plantar fasciitis, cervical spine disability (including strain, degenerative arthritis, and IVDS), right and left upper extremity nerve disabilities (including cervical spine nerve impingement), lumbar spine disability (including lumbosacral strain, degenerative arthritis, and IVDS), right and left lower extremity nerve disabilities (including sciatic nerve impingement), and migraine headaches. The Board reviewed evidence of record up to the July 2, 2025, virtual hearing. The Board found that the Veteran's current sinusitis, rhinitis, bilateral plantar fasciitis, cervical spine disability, lumbar spine disability, right and left upper extremity nerve disabilities, and right and left lower extremity nerve disabilities were caused by active duty, including a repelling accident during training. Migraine headaches were found to be related to active duty, environmental exposures in Southwest Asia, and/or service-connected cervical spine and nerve disabilities. Resolving reasonable doubt in the Veteran's favor for all conditions, the Board granted service connection for all claimed conditions. The Board cited relevant statutes and regulations, including 38 U.S.C. §§ 1110, 1131, and 38 C.F.R. §§ 3.303, 3.304, and 3.310, for its findings.

Rationale

Direct service connection established; Caused by active duty, mold/sensitizer exposure; Benefit of doubt resolved in Veteran's favor

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210603-164202

Full Decision Text

Citation Nr: A26040926
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210603-164202
DATE: April 30, 2026

ORDER

Entitlement to service connection for sinusitis, on a direct basis, is granted.

Entitlement to service connection for rhinitis is granted.

Entitlement to service connection for bilateral plantar fasciitis is granted.

Entitlement to service connection for a cervical spine disability, to include cervical strain, degenerative arthritis, and intervertebral disc syndrome (IVDS), is granted.

Entitlement to service connection for a right upper extremity nerve disability, to include right cervical spine nerve impingement, is granted.

Entitlement to service connection for a left upper extremity nerve disability, to include left cervical spine nerve impingement, is granted.

Entitlement to service connection for a lumbar spine disability, to include lumbosacral strain with degenerative arthritis and IVDS, is granted.

Entitlement to service connection for a right lower extremity nerve disability, to include right sciatic L4, L5, and S1 spinal nerve impingement, is granted.

Entitlement to service connection for a left lower extremity nerve disability, to include left sciatic L4, L5, and S1 spinal nerve impingement, is granted.

Entitlement to service connection for migraine headaches is granted.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his current sinusitis is directly caused by his active duty, to include in-service exposure to mold and other sensitizers.

2. Resolving reasonable doubt in the Veteran's favor, his current rhinitis is caused by his active duty.

3. Resolving reasonable doubt in the Veteran's favor, his current bilateral plantar fasciitis is caused by his active duty.

4. Resolving reasonable doubt in the Veteran's favor, his current cervical spine disability is caused by his active duty and/or was incurred in line of duty during active duty for training (ACDUTRA) or inactive duty for training (INACDUTRA) service, including a repelling accident.

5. Resolving reasonable doubt in the Veteran's favor, his right upper extremity nerve disability is caused by his cervical spine disability.

6. Resolving reasonable doubt in the Veteran's favor, his left upper extremity nerve disability is caused by his cervical spine disability.

7. Resolving reasonable doubt in the Veteran's favor, his current lumbar spine disability is caused by his active duty and/or was incurred in line of duty during ACDUTRA or INACDUTRA service, including a repelling accident.

8. Resolving reasonable doubt in the Veteran's favor, his right lower extremity nerve disability is caused by his lumbar spine disability.

9. Resolving reasonable doubt in the Veteran's favor, his left lower extremity nerve disability is caused by his lumbar spine disability.

10. Resolving reasonable doubt in the Veteran's favor, his current migraine headaches are caused by or otherwise related to his active duty, to include as due to environmental exposures during his service in the Southwest Asia Theater of Operations, and/or are caused by his service connected sinusitis, cervical spine, and bilateral cervical spine nerve impingement.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for sinusitis, on a direct basis, have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. The criteria for entitlement to service connection for rhinitis have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for entitlement to service connection for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

4. The criteria for entitlement to service connection for a cervical spine disability have been met. 38 U.S.C. §§ 101, 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303, 3.304, 3.307, 3.309.

5. The criteria for
met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for entitlement to service connection for a right upper extremity nerve disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

6. The criteria for entitlement to service connection for a left upper extremity nerve disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

7. The criteria for entitlement to service connection for a lumbar spine disability have been met. 38 U.S.C. §§ 101, 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303, 3.304, 3.307, 3.309.

8. The criteria for entitlement to service connection for a right lower extremity nerve disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

9. The criteria for entitlement to service connection for a left lower extremity nerve disability have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

10. The criteria for entitlement to service connection for migraine headaches have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty in the U.S. Air Force from June 1976 to September 1981 and in the U.S. Army from December 1990 to April 1991, to include service in the Southwest Asia Theater of Operations. He had additional periods of ACDUTRA and/or INACDUTRA service in the Army Reserve and Army National Guard from September 1981 to April 1992.

This appeal comes before the Board from a May 2021 rating decision, in which the Agency of Original Jurisdiction (AO) denied the claims of entitlement to service connection for sinusitis, rhinitis, bilateral plantar fasciitis, a cervical spine disability, bilateral cervical spinal nerve impingement, a lumbar spine disability, bilateral sciatic L4, L5, S1 spinal nerve impingement, and migraine headaches. The Veteran appealed the denial of these service connection claims in the May 2021 rating decision to the Board.

On a June 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket under the Appeals Modernization Act (AMA). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a virtual Board hearing on July 2, 2025. Therefore, the Board will consider the evidence of record at the time of the May 2021 rating
ar fasciitis, a cervical spine disability, bilateral cervical spinal nerve impingement, a lumbar spine disability, bilateral sciatic L4, L5, S1 spinal nerve impingement, and migraine headaches. The Veteran appealed the denial of these service connection claims in the May 2021 rating decision to the Board.

On a June 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket under the Appeals Modernization Act (AMA). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a virtual Board hearing on July 2, 2025. Therefore, the Board will consider the evidence of record at the time of the May 2021 rating decision on appeal and any evidence submitted by the Veteran and the representative as of the day of the hearing and within 90 days following the hearing, which was September 30, 2025. 38 C.F.R. § 20.302(a).

Service Connection, Generally

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

Where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, certain nerve disabilities, and migraines 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).

Additionally, pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Active military, naval, or air service includes active duty, any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, and any period of and/or INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 U.S.C. § 101(21)-(24); 38 C.F.R. § 3.6. Service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing ACDUTRA in the Reserves, or from injury incurred or aggravated while performing INACDUTRA in the Reserves. Members of the Army National Guard of the United States and Air National Guard of the United States are included as Reserves.

ACDUTRA also includes full-time duty performed by members of the National Guard of any State, under 32 U.S.C. §§ 316, 502, 503, 504, or 505 or the prior corresponding provisions of law. 38 C.F.R. § 3.6(c)(3). This is considered federalized National Guard status.

INACD
3.6. Service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing ACDUTRA in the Reserves, or from injury incurred or aggravated while performing INACDUTRA in the Reserves. Members of the Army National Guard of the United States and Air National Guard of the United States are included as Reserves.

INACDUTRA also includes duty (other than full-time duty) performed by members of the National Guard of any State, under 32 U.S.C. §§ 316, 502, 503, 504, or 505 or the prior corresponding provisions of law. 38 C.F.R. § 3.6(d)(4). This is also considered federalized National Guard status.

ACDUTRA and INACDUTRA also includes any period of federalized National Guard service during which a member who is authorized or required by competent authority assumes an obligation to perform ACDUTRA or INACDUTRA and, who is disabled from an injury incurred while proceeding directly to, or returning directly from such ACDUTRA or INACDUTRA. 38 U.S.C. § 3.6(e).

The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. 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.

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

1. Entitlement to service connection for sinusitis, on a direct basis, is granted.

2. Entitlement to service connection for rhinitis is granted.

The Veteran contends that his current sinusitis and rhinitis symptoms are caused by his active duty. For example, he testified during the July 2025 Board hearing that his sinusitis and rhinitis symptoms started during his service in Operation Desert Storm.

At the outset, the Board notes that while the appeal for entitlement to service connection for sinusitis was pending on the current docket, the Veteran filed a supplemental claim for service connection for the same issue. See February 2024 VA Form 20-0995, Decision Review Request: Supplemental Claim. In a June 2024 rating decision, the AOJ granted entitlement to service connection for sinusitis pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act). The effective date of the award of service connection was assigned as February 23, 2023, which was one year prior to the date of February 2024 VA Form 20-0995.

Although service connection for sinusitis is already in effect, case law has clarified that an appeal is moot only if the Board's granting of the claim would not lead to any effectual relief whatsoever to the Veteran, such as preserving the possibility of an earlier effective date or ancillary benefits. Green v. McDonough, 37 Vet. App. 127, 136-48 (2024); Bailey v. Wilkie, 33 Vet. App. 188, 204 (2021); see also Warren v. McDonald, 28 Vet. App. 214, 221 (2016) (holding that a subsequent AOJ decision cannot divest the Board of jurisdiction over the prior appeal; therefore, an AOJ grant of service connection cannot finally decide the claim of service connection already on appeal to the Board). The Board observes that the Veteran's claim for service connection for sinusitis has been continuously pursued since October 14,
Veteran, such as preserving the possibility of an earlier effective date or ancillary benefits. Green v. McDonough, 37 Vet. App. 127, 136-48 (2024); Bailey v. Wilkie, 33 Vet. App. 188, 204 (2021); see also Warren v. McDonald, 28 Vet. App. 214, 221 (2016) (holding that a subsequent AOJ decision cannot divest the Board of jurisdiction over the prior appeal; therefore, an AOJ grant of service connection cannot finally decide the claim of service connection already on appeal to the Board). The Board observes that the Veteran's claim for service connection for sinusitis has been continuously pursued since October 14, 2020. See October 2020 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. Thus, a grant of service connection in the present appeal could lead to an earlier effective date for sinusitis. Accordingly, the Board finds it has not been divested of jurisdiction over this appeal, and the issue of entitlement to service connection for sinusitis, on a direct basis, must be addressed.

The Veteran contends that his current sinusitis and rhinitis began during active duty. For example, he asserted in the October 2020 VA Form 21-526EZ that his sinusitis and rhinitis were due to his period of service from 1976 to 1978 and that he treated the symptoms by himself at that time. Additionally, he asserted during the July 2025 Board hearing that his current sinusitis and rhinitis began during his service in the Southwest Asia Theater of Operations during Operation Desert Storm. He asserted that his rhinitis and sinusitis were triggered by numerous environmental factors and exposures. He stated that his sinusitis symptoms become so bad that they drain into his lungs and cause pneumonia.

Regarding the existence of a present disability, the record reflects that the Veteran was diagnosed with sinusitis and rhinitis during the appeal. Specifically, in an August 2020 private medical evaluation report, Dr. J. W. E. diagnosed the Veteran with sinusitis and rhinitis. Moreover, the AOJ has made favorable findings in the May 2021 rating decision on appeal that the Veteran was diagnosed with current sinusitis and rhinitis disabilities based on Dr. J. W. E.'s August 2020 private medical evaluation. The Board is bound by such favorable findings absent clear and unmistakable error, which the Board does not find to be present in this case. See 38 C.F.R. §§ 3.104(c), 20.801(a). Thus, the record establishes that the Veteran has current sinusitis and rhinitis disabilities.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records do not document any complaints of sinusitis or rhinitis during his periods of active duty, Army National Guard, or Army Reserve service apart from a September 1982 Report of Medical Examination that showed that the Veteran had a history of seasonal hay fever that was treated with antihistamines. However, as discussed in the August 2020 private medical evaluation report by Dr. J. W. E., the Veteran was exposed to mold and other sensitizers while stationed in Germany during his first period of active duty. Furthermore, the record establishes that the Veteran was exposed to certain environmental hazards due to his active-duty service during Operation Desert Storm. Thus, the second element of service connection is met for each claim.

In regard to the nexus element of service connection, i.e., a causal relationship between the Veteran's current sinusitis and rhinitis and his active duty, the claims file contains the medical opinions from one medical provider on the subject. Specifically, in an August 2020 private opinion, Dr. J. W. E. indicated that he had reviewed the Veteran's pertinent records, including his service treatment and post-service VA and private treatment records, as well as interviewed and performed an in-person evaluation of the Veteran prior to formulating his medical opinions. The doctor noted that while the Veteran was stationed in Germany, he began having itchy eyes and drainage from his nose. He had acute infections in his maxillary sinuses and some infections in the ethmoid sinuses. He was treated with medication and antibiotics. He was treated with antibiotics intermittently since that time. The doctor noted that since service, the Veteran had continued to have fullness in the ethmoid sinuses and maxillary sinuses and drainage from his nose. The doctor noted that the Veteran would wake up in the morning with drainage in the back of his throat and have a cough. He had difficulty breathing. He reported a history of smoking when he was 20 years old, but he quit smoking while in Germany. He quit smoking because he was having trouble with
Veteran was stationed in Germany, he began having itchy eyes and drainage from his nose. He had acute infections in his maxillary sinuses and some infections in the ethmoid sinuses. He was treated with medication and antibiotics. He was treated with antibiotics intermittently since that time. The doctor noted that since service, the Veteran had continued to have fullness in the ethmoid sinuses and maxillary sinuses and drainage from his nose. The doctor noted that the Veteran would wake up in the morning with drainage in the back of his throat and have a cough. He had difficulty breathing. He reported a history of smoking when he was 20 years old, but he quit smoking while in Germany. He quit smoking because he was having trouble with his eyes and his sinuses; however, his quitting smoking did not change his upper respiratory symptomatology.

Dr. J. W. E. opined that it was more likely than not that the Veteran was exposed to mold and other sensitizers while in Germany, which caused an acute inflammatory process in the upper respiratory membranes of his nose, throat, and sinuses, which caused acute sinusitis. The doctor also opined that it was more likely than not that the Veteran's repetitive acute sinusitis episodes caused thickening of the mucous membranes of his sinusitis causing chronic sinusitis. The doctor further discussed the Veteran's obstructive sleep apnea, but also opined that it was more likely than not that the chronic drainage from his nose and sinuses had caused an increased hypertrophied lymphoid follicles of the posterior pharynx and that it was more likely than not that his abnormal laminar flow through his nose due to his rhinitis had contributed to his obstructive sleep apnea.

Given this evidence, the Board finds that after resolving reasonable doubt in the Veteran's favor, his current sinusitis and rhinitis are directly caused by his active duty. Although there is some evidence against the claims, the Board finds the August 2020 medical opinions by Dr. J. W. E. place the evidentiary record in relative equipoise. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (holding "if the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt"). The Board attaches significant probative value to this doctor's opinions, which were fully articulated and furnished reasoned analyses. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion).

The Board finds it significant that the Veteran's claims file does not contain any medical opinions that indicate or show that the current sinusitis and rhinitis were not caused by his active duty, to include his in-service exposure to mold and other sensitizers while in Germany.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, grants of service connection for sinusitis and rhinitis are warranted. See Lynch, 21 F.4th at 781; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990) ("[T]he 'benefit of the doubt' standard is similar to the rule deeply embedded in sandlot baseball folklore that 'the tie goes to the runner'.... [I]f... the play is close, i.e., 'there is an approximate balance of positive and negative evidence,' the veteran prevails by operation of [statute].").

The Board reiterates that the record shows that entitlement to service connection for sinusitis on a presumptive basis pursuant to the PACT Act has been granted since February 23, 2023. However, the Board emphasizes that its decision above shows that entitlement to service connection for sinusitis is also warranted on a direct basis.

3. Entitlement to service connection for bilateral plantar fasciitis is granted.

The Veteran contends that his current bilateral plantar fasciitis is caused by his active duty. For example, he asserted in the October 2020 VA Form 21-526EZ that this disability onset during the period of active duty from 1976 to 1981 and that he treated his bilateral plantar fasciitis by himself. The Veteran also testified during the July 2025 Board hearing that his current bilateral foot pain was due to in-service walking on the flight line due to his military occupational specialty (MOS) duties as a Military Police. He reported that he stood guard at gates on concrete for several hours per day in boots and patent leather shoes, which were uncomfortable. He reported that after service, he began having bilateral foot pain and "pin[s] and needles" in his feet
is caused by his active duty. For example, he asserted in the October 2020 VA Form 21-526EZ that this disability onset during the period of active duty from 1976 to 1981 and that he treated his bilateral plantar fasciitis by himself. The Veteran also testified during the July 2025 Board hearing that his current bilateral foot pain was due to in-service walking on the flight line due to his military occupational specialty (MOS) duties as a Military Police. He reported that he stood guard at gates on concrete for several hours per day in boots and patent leather shoes, which were uncomfortable. He reported that after service, he began having bilateral foot pain and "pin[s] and needles" in his feet that went up to his thighs. He stated that the sensation felt like burning in his feet.

Regarding the existence of a present disability, the record reflects that the Veteran has current bilateral plantar fasciitis. For example, a May 2011 private nerve conduction study showed that the Veteran complained of severe pain in his bilateral feet. He was diagnosed with plantar fasciitis in the right foot on a May 2011 magnetic resonance imaging (MRI) scan. Additionally, a February 2020 VA examination for fibromyalgia showed that the Veteran complained of bilateral foot pain with sitting for 10 to 15 minutes. He was also diagnosed with bilateral plantar fasciitis by Dr. J. W. E. in an August 2020 private medical evaluation report. Moreover, the May 2021 rating decision on appeal shows that the AOJ has made a favorable finding that the Veteran was diagnosed with this disability. Thus, the record establishes that the Veteran has a current disability.

In regard to the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that the Veteran's service treatment records, including evaluations from February 1976, September 1982, April 1989, and April 1991, do not document complaints of or treatment for bilateral plantar fasciitis. Nonetheless, the record shows that the Veteran has credibly reported that his current bilateral foot pain onset during his period of active duty in the Air Force, i.e., period of service ending in September 1981, due to the rigors of service, including wearing boots and carrying heavy equipment, standing for long periods of time, and walking the flight line due to his MOS duties. The Board notes that the Veteran is competent to report the presence of pain in his feet. His service treatment and personnel records document that he served as Military Police during his period of active duty in the Air Force, and thus, his statements regarding the in-service incurrence element of service connection are consistent with his circumstances of service. Moreover, he has credibly reported that pain, as well as neurological symptoms, in his feet worsened following service and that such symptoms have been present in other parts of his body, such as his neck and back, as well as upper and lower extremities. Thus, the second element of service connection is met.

Regarding the nexus element, i.e., a causal relationship between the Veteran's current bilateral plantar fasciitis and his active duty, the claims file contains the medical opinions of Dr. J. W. E. from August 2020. Specifically, the doctor noted that while the Veteran was in law enforcement in service, there was a lot of standing, walking, and marching in physical training. By the time the Veteran left active duty in the Air Force, he was having pain in the arch of both feet, especially his heels. He had tried several types of shoes and orthotics, as well as shots in the arches of his feet. The doctor opined that it was more likely than not that the Veteran's wearing of combat boots and the extra weight in law enforcement caused increased stresses on his muscles, tendons, and joints in the bottom of the feet, which caused tendonitis in the arches of the feet and calcium deposits in the calcaneus of both feet causing bilateral plantar fasciitis.

In light of this evidence, the Board finds that after resolving reasonable doubt in the Veteran's favor, the evidence is at least in equipoise that his bilateral plantar fasciitis disability is caused by his active duty. See 38 U.S.C. § 5107(b). Although there is some evidence against the claim, the Board finds that the August 2020 private medical opinion by Dr. J. W. E. place the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. The Board notes that this doctor's medical opinions are supported by citation to and review of the Veteran's pertinent records, as well as a thorough rationale. The Board therefore attaches significant probative value to his opinions, as they were well reasoned, detailed, consistent with
doubt in the Veteran's favor, the evidence is at least in equipoise that his bilateral plantar fasciitis disability is caused by his active duty. See 38 U.S.C. § 5107(b). Although there is some evidence against the claim, the Board finds that the August 2020 private medical opinion by Dr. J. W. E. place the evidentiary record in relative equipoise. See Lynch, 21 F.4th at 781. The Board notes that this doctor's medical opinions are supported by citation to and review of the Veteran's pertinent records, as well as a thorough rationale. The Board therefore attaches significant probative value to his opinions, as they were well reasoned, detailed, consistent with other evidence of record, and considered the history and nature of the Veteran's service in the Air Force, his MOS duties, and his current bilateral plantar fasciitis. See Prejean, 13 Vet. App. at 448-49.

The Board finds it significant that the Veteran's claims file does not contain any medical opinion that indicates or shows that the current bilateral plantar fasciitis was not caused by his active duty.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for bilateral plantar fasciitis is warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

4. Entitlement to service connection for a cervical spine disability, to include cervical strain, degenerative arthritis, and IVDS, is granted.

5. Entitlement to service connection for a right upper extremity nerve disability, to include right cervical spine nerve impingement, is granted.

6. Entitlement to service connection for a left upper extremity nerve disability, to include left cervical spine nerve impingement, is granted.

7. Entitlement to service connection for a lumbar spine disability, to include lumbosacral strain with degenerative arthritis and IVDS, is granted.

8. Entitlement to service connection for a right lower extremity nerve disability, to include right sciatic L4, L5, and S1 spinal nerve impingement, is granted.

9. Entitlement to service connection for a left lower extremity nerve disability, to include left sciatic L4, L5, and S1 spinal nerve impingement, is granted.

The Veteran contends that his current neck and back disabilities are caused by an injury during a period of service in the Army National Guard where he fell while repelling from the top of a hill. Furthermore, he contends that his bilateral upper and lower extremity nerve symptoms are caused by his neck and back disabilities. For example, the Veteran testified during the July 2025 Board hearing that during his monthly training activities with the Army National Guard, two Army Majors taught him and a group of servicemembers how to perform "air assault suicide repelling." During the training where the Veteran was required to repel approximately 40 to 50 feet down from the top of a hill, he hit the side of the hill after a rope malfunction. He also fell from a height of about 15 to 20 feet to the ground. He testified that the wind was knocked out of him and that while his fellow soldiers checked on him, he did not receive medical treatment at that time. He also did not have an opportunity to undergo a medical evaluation during that drill service. He stated that this training exercise, as well as the repelling accident injury, occurred in approximately 1989 during a monthly training. He stated that the current symptoms in his neck and back started years after this incident and that he has had surgery on his cervical spine, as well as continued pain in his lower back.

Regarding the existence of a present disability, the record shows that the Veteran has current cervical spine, lumbar spine, bilateral upper extremity, and bilateral lower extremity disabilities. For example, Dr. J. W. E. diagnosed the Veteran with cervical strain, degenerative arthritis, and IVDS. He also diagnosed the Veteran with right and left cervical spinal nerve impingement in the upper extremities. The doctor further diagnosed the Veteran with lumbosacral strain with degenerative arthritis and IVDS and right and left sciatic L4, L5, and S1 spinal nerve impingement. Additionally, the AOJ has made favorable findings in the May 2021 rating decision on appeal that the Veteran was diagnosed with these disabilities based on this August 2020 private medical evaluation. The Board is bound by such favorable findings absent clear and unmistakable error, which are not resent in this case. See 38 C.F.R. §§ 3.104(c), 20.801(a). Thus, the record establishes that the Veteran has current cervical
Veteran with right and left cervical spinal nerve impingement in the upper extremities. The doctor further diagnosed the Veteran with lumbosacral strain with degenerative arthritis and IVDS and right and left sciatic L4, L5, and S1 spinal nerve impingement. Additionally, the AOJ has made favorable findings in the May 2021 rating decision on appeal that the Veteran was diagnosed with these disabilities based on this August 2020 private medical evaluation. The Board is bound by such favorable findings absent clear and unmistakable error, which are not resent in this case. See 38 C.F.R. §§ 3.104(c), 20.801(a). Thus, the record establishes that the Veteran has current cervical spine, lumbar spine, bilateral upper extremity, and bilateral lower extremity disabilities.

Although the Veteran's service treatment records do not document complaints of, or treatment for, cervical and/or lumbar spine disabilities, the Board determines that after resolving reasonable doubt in the Veteran's favor, the in-service incurrence or aggravation of a disease or injury element of service connection is met for these claims. Specifically, the February 1976, September 1982, April 1989, and April 1991 evaluations do not document complaints of or treatment for abnormal spinal symptoms. In addition to noting normal head, face, neck, and scalp, as well as spine, other musculoskeletal systems, the Veteran denied having recurrent back pain during these evaluations. However, after resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran sustained injuries to his cervical spine and thoracolumbar spine in the line of duty during ACDUTRA or INACDUTRA service when he fell during a repelling accident. As discussed above, the Veteran has credibly reported that he sustained such an injury during a monthly training exercise in approximately 1989. Furthermore, the Veteran submitted a January 2025 written statement from a fellow service member who was present at the time that the injury occurred. This individual provided the details of this injury and confirmed the Veteran's reports of this injury. The fellow service member also provided his observations of the Veteran's injuries and stated that the Veteran's lower back had not been the same since this fall. Overall, the Board determines that the Veteran provided credible and detailed testimony and lay evidence regarding the circumstances of the injury to his cervical and thoracolumbar spine during the repelling exercise, as well as his subsequent self-treatment for these injuries and an explanation why these injuries and treatment were not documented in his service treatment records, including during a period of ACDUTRA and/or INACDUTRA. Accordingly, the Board determines that the second element of service connection is met for the cervical and lumbar spine disabilities.

Regarding the nexus element of service connection for the cervical and lumbar spine claims, as well as the bilateral upper and lower extremity nerve disabilities claims, the Board notes that the claims file contains the medical opinions by Dr. J. W. E. from August 2020. Specifically, the doctor noted that while participating in a repelling training, the Veteran came down the side of a hill and his rope malfunctioned. He reported that he slammed into the side of the hill where he hit his back, upper back, and lower neck on the rocks. He reported that it was very painful. The Veteran informed the doctor that he had x-rays performed on his back sometime after he returned from this period of training and he was told that he did not have any broken bones. He continued to have pain in his back and his neck. He reported that he began having numbness down the legs, including the dorsal and lateral aspects of both legs.

The doctor further documented that the Veteran performed law enforcement duties while in the Air Force. He had to carry a lot of his law enforcement equipment, as well as a backpack and armor. He reported that such equipment was very heavy. He also stated that he began to have pain in his neck with numbness down his arms into the thumbs and fingers. He began waking up at night with pain in the back of his neck and arms. He continued to have pain that was so severe that he had headaches in the back of his head that started "from behind his eyes." He described these painful headaches as "tight and throbbing."

Following a thorough review of the Veteran's service and post-service treatment records, as well as noting his self-reported history and symptoms, the doctor opined that it was more likely than not that the initial repelling accident caused a muscle tendon unit strain of the cervical, thoracic, and lumbar spine. The doctor further opined that it was more likely than not that the initial straining of the Veteran's muscles, ligaments, and vertebral structures of the cervical, thoracic, and lumbar spine caused increased muscle spasms in the paraspinous muscles in the cervical, thoracic, and lumbar spine, which, in turn, caused continued muscle spasms and increased pressure on the discs in the neck and back. The doctor opined that it was more likely than not that the Veteran's work in law enforcement, where he carried heavy equipment, as well as his work during Operation Desert Strom, and the additional extra equipment caused increased pressure on the vertebrae of the cervical spine and lumbar spine. In regard to the bilateral upper extremity nerve disabilities, the doctor determined that it was more likely than not that the increased pressure on the vertebrae and annular fibers of the cervical, thoracic, and lumbar spine caused deranged discs and degenerative discs in the neck, which caused spinal nerve impingement down both upper extremities. Likewise, regarding the bilateral lower extremity nerve disabilities, the doctor opined that it was more likely than not that the increased spasm and tightness of the lumbar paraspinous muscles and carrying extra weight due to his law enforcement duties and during Operation Desert Storm caused increased pressure on the injured discs in the lower lumbar discs, which caused impingement of the spinal nerves down both legs.

Given this evidence, and after resolving reasonable doubt in the Veteran's favor, his current cervical and lumbar spine disabilities are caused by his active duty and/or were incurred in line of duty during ACDUTRA or INACDUTRA service, including a repelling accident. Furthermore, the Board finds that after resolving reasonable doubt in his favor, his right and left upper extremity nerve disabilities are caused by his cervical spine disability, and his right and left lower extremity nerve disabilities are caused by his lumbar spine disability. Thus, although there is some evidence against the claims, such as the Reports of Medical Examination and Reports of Medical History discussed above, the Board finds that the Veteran's credible statements throughout the appeal, the January 2025 statement by a fellow service member, as well as the August 2020 private medical opinions place the evidentiary record in relative equipoise as to these claims. See 38 C.F.R. §§ 3.303, 3.304, 3.310; see also Lynch, 21 F.4th at 781.

The Board notes that the Veteran's claims file does not contain any contrary medical opinion that indicates or shows that the current cervical and lumbar spine disabilities are not related to the Veteran's active duty or a period of ACDUTRA and/or INACDUTRA. Furthermore, the Board finds it significant that the claims file does not contain any medical opinion that contradicts Dr. J. W. E.'s medical opinion that the Veteran's bilateral upper and lower extremity nerve disabilities are secondary to his cervical spine and lumbar spine disabilities, respectively.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, grants of service connection for a cervical spine disability, right upper extremity nerve disability, left upper extremity nerve disability, lumbar spine disability, right lower extremity nerve disability, and left lower extremity nerve disability are warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

10. Entitlement to service connection for migraine headaches is granted.

The Veteran contends that his migraine headaches are caused by his active duty. For example, he asserted in the October 2020 VA Form 21-526EZ that his migraine headaches began in 1988 and that they were also due to Gulf War Syndrome. Furthermore, he reported to the April 2021 VA examiner that his headaches began in 1992 after his service in Operation Desert Storm. Likewise, he testified during the July 2025 Board hearing that his current migraine headaches onset after his service in Operation Desert Storm and have been continuous since that time.

Regarding the existence of a present disability, the record reflects that the Veteran was diagnosed with a headache disability during the appeal. Specifically, an April 2021 VA examination for headaches showed that he was diagnosed with a migraine, including migraine variants. Likewise, in the August 202
in the October 2020 VA Form 21-526EZ that his migraine headaches began in 1988 and that they were also due to Gulf War Syndrome. Furthermore, he reported to the April 2021 VA examiner that his headaches began in 1992 after his service in Operation Desert Storm. Likewise, he testified during the July 2025 Board hearing that his current migraine headaches onset after his service in Operation Desert Storm and have been continuous since that time.

Regarding the existence of a present disability, the record reflects that the Veteran was diagnosed with a headache disability during the appeal. Specifically, an April 2021 VA examination for headaches showed that he was diagnosed with a migraine, including migraine variants. Likewise, in the August 2020 private medical evaluation, Dr. J. W. E. diagnosed the Veteran with migraine headaches. Moreover, the AOJ has made a favorable finding in the May 2021 rating decision on appeal that the Veteran was diagnosed with migraine headaches based on the April 2021 VA examination report. Thus, the record establishes that the Veteran has a current disability.

Regarding the in-service incurrence or aggravation of a disease or injury element of service connection, the Board notes that although the Veteran's service treatment records document that he complained of a headache in connection with a cold/viral syndrome in May 1979, his service treatment records do not document the presence of a headache or migraine disability. Nonetheless, the Board notes that the Veteran has asserted throughout the appeal that his current migraines manifested in 1992, or within one year of separation from active duty in April 1991 after he had service in the Southwest Asia Theater of Operations. See 38 C.F.R. §§ 3.307, 3.309.

Moreover, the Board notes that the AOJ has made favorable findings in the May 2021 rating decision on appeal that the Veteran was exposed to environmental hazards in the Persian Gulf due to his service in Saudi Arabia from January 1991 to March 1991. The Board further notes that the AOJ determined that the Veteran's migraine headaches were secondary to his sinusitis, post-service neck surgery, and spinal nerve impingement disabilities, which the AOJ determined were nonservice connected disabilities. The Board shall discuss the secondary service connection theory of entitlement further below. The Board is bound by the favorable findings in the May 2021 rating decision absent clear and unmistakable error, which the Board does not find to be present. See 38 C.F.R. §§ 3.104(c), 20.801(a). Thus, the second element of service connection is met.

Regarding the nexus element, i.e., a causal relationship between the Veteran's current migraine headaches and his active duty, the claims file contains the August 2020 private medical opinion by Dr. J. W. E, as well as the medical opinions of the April 2021 and May 2021 VA examiners. In the August 2020 medical opinion, Dr. J. W. E. stated that since the Veteran injured his neck, he had always had pain in the back of his neck. The pain manifested "from behind his eyes and temporal areas." The Veteran reported that there was a change in his headaches in the last several years and that the headaches currently had a throbbing component. The Veteran reported that he could tell when that type of headache was coming on and that he would get nauseated and sometimes had difficulty focusing. He reported that bright lights and noise bothered him. He reported that he had not been treated with any migraine medication. He stated that the headaches occurred daily and that they throbbed.

The doctor opined that it was more likely than not that the Veteran's sinusitis, neck surgery, and spinal nerve impingement have caused sensitization of the trigeminal nerve, which had caused a new type of headache of migraine headache syndrome. The Board notes that the record shows that the Veteran had cervical spine surgery in December 2016. The doctor explained that that the migraine headache syndrome initially caused a vasoconstriction of the blood vessels, which the Veteran experienced as an aura, and then the dilation, which manifested as a throbbing headache in the temporal areas. The doctor opined that it was more likely than not that the Veteran's migraine headaches were different from the muscle tension headaches that were a part of his cervical disability.

The Veteran underwent a VA examination for headaches in April 2021, during which the examiner documented that the Veteran's migraines onset in approximately 1992. The Veteran reported that he thought that his migraines were headaches and he did not seek treatment at that time. The examiner noted that the Veteran was treated for the previous few years and was sent for a neurological evaluation in 2018. The examiner noted that the neurology service performed a full work-up with multiple imaging studies that all came back normal, at which time the
as a throbbing headache in the temporal areas. The doctor opined that it was more likely than not that the Veteran's migraine headaches were different from the muscle tension headaches that were a part of his cervical disability.

The Veteran underwent a VA examination for headaches in April 2021, during which the examiner documented that the Veteran's migraines onset in approximately 1992. The Veteran reported that he thought that his migraines were headaches and he did not seek treatment at that time. The examiner noted that the Veteran was treated for the previous few years and was sent for a neurological evaluation in 2018. The examiner noted that the neurology service performed a full work-up with multiple imaging studies that all came back normal, at which time the Veteran was diagnosed with atypical migraines and began treatment.

Following an in-person examination, as well as a review of the Veteran's records and notation of his self-reported history and symptoms, the examiner opined that the Veteran's migraines were at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran's migraine headaches were a diagnosable chronic multi-symptom illness with a partially explained etiology. The examiner opined that it was at least as likely as not that the migraine headaches were related to the exposure event experienced in Southwest Asia. The examiner explained that the Veteran had no problems with headaches until returning home from Desert Storm. She noted that since onset in 1992, the Veteran has had numerous, detailed work-ups of his migraines that always revealed no abnormal findings other than the symptoms that he was experiencing, such as a drooping face and difficulty speaking with no other signs of a stroke. She noted that the Veteran was currently being treated for atypical migraines and continued to suffer from them at least two times per week.

In a May 2021 addendum VA medical opinion, another VA examiner opined that the Veteran's current migraine headaches were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. She stated that the Veteran's headache condition was a disease with a clear and specific etiology and diagnosis. She noted that the Veteran had multiple conditions that could attribute to the migraine headaches. She noted that his sinusitis, neck surgery, and the spinal nerve impingement could all be attributed to headache symptoms. She opined that it was less likely that his history of alcohol abuse would cause migraines, and that it was less likely as not that the migraine headaches were related to a specific exposure event in Southwest Asia. After providing general medical information about migraine headaches within the general population, the examiner stated that a nexus had not been established. Furthermore, the examiner cited to the August 2020 private medical evaluation and appears to have supported the opinion by Dr. J. W. E. that it was more likely than not that the Veteran's sinusitis, his neck surgery, and his spinal nerve impingement caused sensitization of the trigeminal nerve, which caused a new type of headache of migraine headaches syndrome. She stated that there was no medical literature to date linking migraines to a specific environmental exposure in Southwest Asia.

In light of this evidence, although the claims file contains the medical opinion of the May 2021 VA examiner that the Veteran's current migraine headaches were less likely than not due to his active duty, the Board finds that the evidence is at least in equipoise as to whether entitlement to service connection for migraine headaches is warranted. See 38 U.S.C. § 5107(b). Specifically, the Board finds that after resolving reasonable doubt in the Veteran's favor, his current migraine headaches are caused by or otherwise related to his active duty, to include as due to environmental exposures during his service in the Southwest Asia Theater of Operations, and/or are caused by his service connected sinusitis, cervical spine, and bilateral cervical spine nerve impingement. In that regard, the April 2021 VA examiner attributed the current migraine headaches to the Veteran's service, to include his in-service exposures to environmental hazards while in Southwest Asia. Moreover, both the August 2020 private medical opinion and the May 2021 VA medical opinion attributed the Veteran's current migraines to his sinusitis, surgery related to his cervical spine disability, and bilateral cervical nerve impingement disabilities, which are service-connected disabilities following the Board's decisions above. See 38 C.F.R. § 3.310.

The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection for migraine headaches is warranted. See Lynch, 21 F.4th at 781; see also Gilbert, 1 Vet. App. at 55-56.

ANTHONY C. SCIRÉ, JR.

Veterans
Asia. Moreover, both the August 2020 private medical opinion and the May 2021 VA medical opinion attributed the Veteran's current migraines to his sinusitis, surgery related to his cervical spine disability, and bilateral cervical nerve impingement disabilities, which are service-connected disabilities following the Board's decisions above. See 38 C.F.R. § 3.310.

ANTHONY C. SCIRÉ, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Hodzic, 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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