Case A26040999

S. B. MAYS · 2026 · Case ID: A26040999

GRANTED

Summary

The Veteran, an Army veteran who served from July 1980 to November 1991, appeals the denial of service connection for Marfan's syndrome and the grant of service connection for left lower extremity neuropathy of the sciatic nerve (claimed as left foot disability), peripheral neuropathy of the right lower extremity (claimed as right leg condition), and a low back disability (degenerative joint disease of the lumbar spine). The Veteran withdrew the appeal for Marfan's syndrome, which the Board dismissed. For the left lower extremity neuropathy, the Board found service connection was already granted by the agency of original jurisdiction (AOJ) in February 2026 and, adhering to the Green v. McDonough precedent, granted the appeal to avoid prejudice, noting ancillary benefits or an earlier effective date might still be at issue. For the right lower extremity peripheral neuropathy, the Board found service connection warranted on a presumptive basis due to chronic disease in service and continuity of symptoms post-service, despite an unfavorable May 2015 VA opinion that was deemed inadequate for failing to address favorable evidence and consistent lay statements. For the low back disability, the Board found the Veteran had a current diagnosis and documented in-service complaints and treatment following a 1983 motor vehicle accident and subsequent incidents involving heavy lifting. While a May 2015 VA opinion was unfavorable, the Board found it inadequate for not addressing all favorable evidence and the Veteran's consistent reports of continuing symptoms. Resolving reasonable doubt in the Veteran's favor, the Board found the symptoms of degenerative arthritis of the lumbar spine were continuous since service, granting service connection.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

211013-191093

Full Decision Text

Citation Nr: A26040999
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 211013-191093
DATE: April 30, 2026

ORDER

The appeal concerning the issue of entitlement to service connection for Marfan's syndrome is dismissed.

Entitlement to service connection for left lower extremity neuropathy of the sciatic nerve (claimed as left foot disability) is granted.

Entitlement to service connection for peripheral neuropathy of the right lower extremity (claimed as right leg condition) is granted.

Entitlement to service connection for a low back disability, diagnosed as degenerative joint disease of the lumbar spine, is granted.

FINDINGS OF FACT

1. On June 18, 2025, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant, through his authorized representative, that a withdrawal of the appeal of entitlement to service connection for Marfan's syndrome is requested.

2. The Veteran was treated for and diagnosed with bilateral peripheral neuropathy, including sural neuropathy, during service.

3. In a February 2026 rating decision, the agency of original jurisdiction (AOJ) granted service connection for the Veteran's left lower extremity neuropathy of the sciatic nerve (claimed as a left foot disability), and there is no evidence of record that identifies a clear and unmistakable error in that favorable finding.

4. The Veteran is currently diagnosed with peripheral neuropathy of the right lower extremity.

5. The Veteran was diagnosed with peripheral neuropathy during service and resolving any reasonable doubt in his favor, his symptoms of peripheral neuropathy of the right lower extremity have been continuous since service separation.

6. The Veteran is currently diagnosed with a low back disability, including degenerative joint disease of the lumbar spine.

7. The Veteran received medical treatment for multiple instances of back pain in service, and resolving all reasonable doubt in his favor, his symptoms of the degenerative arthritis of the spine have been continuous since service separation.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of an appeal for service connection for Marfan's syndrome by the appellant's authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for entitlement to service connection for left lower extremity neuropathy of the sciatic nerve (claimed as a left foot disability) have been met. 38 C.F.R. §§ 3.104(c), 20.801(a).

3. The criteria for entitlement to service connection for right lower extremity peripheral neuropathy (claimed as a right leg condition) have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a).

4. The criteria for entitlement to service connection for low back degenerative arthritis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from July 1980 to November 1991.

Although the Veteran initially requested Higher-Level Review when submitting the June 2020 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development.

In the October 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On March 28, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the September 2021 AOJ supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38?C.F.R. §?20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the supplemental claim decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. Additional evidence including medical records and private medical opinions were submitted within 90 days following the request to withdrawal.

If the Veteran would
supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38?C.F.R. §?20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the supplemental claim decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. Additional evidence including medical records and private medical opinions were submitted within 90 days following the request to withdrawal.

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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Marfan's Syndrome - Withdrawal

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. As this case is governed by the Appeals Modernization Act (AMA), the applicable regulation is 38 C.F.R. § 20.205, which requires that the withdrawal includes the name of the appellant and the file number. Additionally, the Veteran or representative must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. See 38 C.F.R. § 20.205(b)(1). Under 38 C.F.R. § 20.205(c) withdrawal of an appeal will be deemed a withdrawal of the Notice of Disagreement as to all issues to which the withdrawal applies.

In the present case, the Veteran, through his authorized representative, has withdrawn the appeal for service connection for Marfan's syndrome and, hence, there remain no allegations of errors of fact or law for appellate consideration. Specifically, the withdrawal was made in a written statement, received by VA on June 18, 2025, that included the name of the Veteran, the VA file number (social security number), and a statement that the appeal of entitlement to service connection for Marfan's syndrome was withdrawn. Additionally, the Veteran submitted a statement, first in May 2025 and then again in June 2025, where he stated he wished to withdrawal his pending claim for Marfan's syndrome. See May and June 2025 Correspondence. As there remain no allegations of errors of fact or law, the claim of entitlement to service connection for Marfan's syndrome is dismissed.

Parenthetically, the Board notes that Marfan's syndrome is a genetic disorder that affects the connective tissue, and although the Veteran filed a claim for such, a review of the record provides no clear evidence that the Veteran in fact has a current diagnosis of Marfan's syndrome.

Left Lower Extremity Neuropathy of the Sciatic Nerve (Claimed as a Left Foot Disability) - Evidence and Analysis

The Veteran contends that his left foot disability is due to service. Specifically, he contends that running in boots and needing to wear inserts in his shoes during service caused his current left foot disability. See May 2015 VA Examination and May 2025 Correspondence.

In a February 2026 rating decision, the AOJ granted service connection for the Veteran's left lower extremity neuropathy of the sciatic nerve (claimed as a left foot disability) on a direct basis. The Board is bound by these prior favorable AOJ findings as the Board finds that they are not clearly and unmistakably erroneous. 38 C.F.R. §§ 3.104(c), 20.801(a).

Although the rating decision has already established service connection for the claimed condition, the Board finds a grant of the claim is appropriate so as not to prejudice the Veteran. See Green v. McDonough, 37 Vet. App. 127, 136-48 (2024) (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).

Accordingly, the left foot appeal currently before the Board is not moot as certain ancillary benefits or a potential earlier effective date remain at issue. See Green, 37 Vet
3.104(c), 20.801(a).

Accordingly, the left foot appeal currently before the Board is not moot as certain ancillary benefits or a potential earlier effective date remain at issue. See Green, 37 Vet. App. 127, 136-48.

Based on the favorable determination in February 2026 by the AOJ, service connection for the Veteran's left lower extremity neuropathy of the sciatic nerve (claimed as a left foot disability) is granted.

Service Connection - General Legal Principles

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

Establishing service connection generally requires three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009).

Peripheral neuropathy and degenerative joint disease are considered "chronic" diseases under 38 C.F.R. § 3.309(a). Therefore, in this instance the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service must be considered. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic diseases in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b).

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events, or the presence of disability, or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although lay persons are considered competent to provide opinions on some medical issues, some medical issues fall outside of the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

Right Lower Extremity Peripheral Neuropathy - Evidence and Analysis

The Veteran contends that his right lower extremity disability began in service and has continued to the present day. Specifically, he contends that following his in-service motor vehicle accident in 1983 he experienced pain and numbness in his right thigh which has continued since service. See February 2015 VA Form 21-526EZ and May 2025 Correspondence.

Right Lower Extremity Peripheral Neuropathy - Evidence and Analysis

Here, the AOJ made the following favorable findings. First, the Veteran is diagnosed with neuropathy. See March 2016 H & P Medicine Admission History and Physical. Second, the evidence shows that a qualifying event, injury, or disease had its onset during service. Service treatment records (STRs) reflect complaints and treatment for peripheral neuropathy of the right lower extremity. See STR - April 1989 Consultation Sheet, April 1989 Chronological Record of Medical Care, June 1989 Consultation Report diagnosing early sural neuritis bilateral, and June 1989 Electromyography and Nerve Conduction Examinations confirming sural neuropathy. The Board is bound by these favorable AOJ findings as they are not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c).

Upon review of the evidence, the Board finds that service connection on a presumptive basis is warranted.

Although there is no adequate medical opinion addressing whether the Veteran's peripheral neuropathy is related to the in-service diagnosed bilateral peripheral neuropathy, peripheral neuropathy is an organic disease of the nervous system and therefore a chronic disease. Fields v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 2361 ("chronic diseases listed under 38 C.F.R. 3.309(a), including peripheral neuropathy which is an organic disease of the nervous system..."). See Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge memorandum decisions may be relied upon for any persuasiveness or reasoning they contain).

Pursuant to 38 C.F.R. § 3.303(b), if there is a "chronic disease shown as such in service" and "subsequent manifestations of the same chronic disease at any later date, however remote," a finding of service connection is warranted, unless the manifestations "are clearly attributable to intercurrent causes." See 38 C.F.R. § 3.303(b) ("When the disease identity is established... , there is no requirement of evidentiary showing of continuity); Groves v. Peake, 524 F.3d 1306, 1309-1310 (2008) (medical nexus evidence demonstrating an etiological link is not necessary to prove service connection when evidence shows that a veteran had a chronic disease in service and that he still has the same chronic disease).

Even without an adequate nexus opinion, service connection is warranted because the Veteran was diagnosed in service and continued to report symptoms of his disability since service. Following service, the Veteran continued to report numbness and pain in his lower extremities. The Veteran is competent to report symptoms capable of lay observation, such as numbness and pain, and how long he has experienced them. The pain in the Veteran's lower extremities was noted by medical providers to be neurological. See Layno v. Brown, 6 Vet. App. 465 (1994); January 2008 Primary Care Note, October 2014 Telephone Encounter Note, November 2014 H & P Note, February 2015 Spine Lumbosacral Min 2 Views, March 2015 Nurse Telephone Note, March 2015 Nurse Note, and May 2025 Correspondence. As such, the evidence demonstrates that the Veteran showed ongoing symptoms post-service of the lower extremity peripheral neuropathy that he was initially diagnosed with in service.

The evidence of the currently diagnosed peripheral neuropathy of the right lower extremity and the STRs showing a diagnosis of bilateral peripheral neuropathy during service, along with the Veteran's consistent statements about his symptoms both during and post-service, are sufficient to satisfy the criteria of chronic disease shown as such in service and manifestations of the same chronic disease diagnosed as bilateral lower extremity peripheral neuropathy at a later date. The probative evidence is in favor of the claim. The criteria to establish service connection for peripheral neuropathy of the right lower extremity are met under 38 C.F.R. § 3.303(b).

The Board acknowledges that the record contains a negative May 2015 VA opinion and a June 2025 private opinion. However, as the evidence is sufficient to grant the claim on a presumptive basis, those opinions need not be addressed herein.

For these reasons, the claim for entitlement to service connection for right lower
his symptoms both during and post-service, are sufficient to satisfy the criteria of chronic disease shown as such in service and manifestations of the same chronic disease diagnosed as bilateral lower extremity peripheral neuropathy at a later date. The probative evidence is in favor of the claim. The criteria to establish service connection for peripheral neuropathy of the right lower extremity are met under 38 C.F.R. § 3.303(b).

For these reasons, the claim for entitlement to service connection for right lower extremity peripheral neuropathy is granted.

Back Disability

The Veteran also seeks service connection for a low back disability. Specifically, he contends that his low back disability began in-service after a motor vehicle accident in April 1983 and he has continued to experience issues with his low back to the present day. See May 2025 Correspondence.

The Board first finds that the Veteran has a current lumbar spine disability, variously diagnosed as degenerative joint disease and degenerative disc disease of the lumbar spine. See, e.g., May 2015 VA examination report.

The Veteran's STRs document multiple instances of low back complaints and treatment. In this regard, the Veteran was involved in a head-on collision while driving a motor vehicle, according to an April 1983 STR. He hit his chest and abdomen on the steering wheel. He was transferred by ambulance to a local hospital and then to a military hospital. He was hospitalized for two weeks, including in the intensive care unit.

According to a May 1983 STR, the Veteran reported that after the motor vehicle accident, he experienced pain in the upper femur and pelvic areas while walking. He was referred for evaluation by a doctor and muscle spasms were diagnosed.

In August 1983, the Veteran complained of low back pain for 17 days after being involved in a carnival ride incident. He had pain in the spinal area. Muscle aches were diagnosed.

According to a November 1989 STR, the Veteran complained of low back pain from heavy lifting work. Impression was muscle spasms in the low back. He was prescribed medication and advised to apply heat to the low back.

According to a June 15, 1990 Chronological Record of Medical Care, the Veteran complained of low back pain for two weeks from heavy lifting while in the field. He stated that the pain comes and goes. Although the writing is difficult to fully decipher, it appears that the Veteran was placed on profile because of his low back pain.

The Veteran received emergency room treatment on the evening of June 15, 1990 for complaints of low back pain with radiation. He reported that the pain was constant. On examination, there was tenderness on palpation of the lumbar spine. He was diagnosed with low back pain, and modified duty was ordered.

He separated from service in November 1991. According to his November 1991 Report of Medical History, the Veteran reported having had recurrent back pain, as relevant here. The examiner noted that the Veteran experiences spasms in the low back. Evaluation of the spine was noted as normal on the November 1991 Report of Medical Examination.

Post-service private primary care notes taken during an annual visit in August 2010 indicate that the Veteran reported a history of chronic low back pain for which over the counter medication is taken as needed.

October 2014 emergency room notes document the Veteran's complaint of low back pain for two days, treated with Ibuprofen and Flexeril.

X-rays of the lumbosacral spine taken in February 2015 showed evidence of mild multilevel degenerative changes.

In May 2015, the Veteran was afforded a VA back examination and the examiner determined that the Veteran's current low back disability is less likely related to the Veteran's military service.

X-rays of the lumbar spine taken in May 2020 showed evidence of mild multilevel spondylosis more pronounced at L4-L5 and L5-S1 levels.

In an October 2020 private medical treatment record, the Veteran's symptoms were noted to be consistent with acute on chronic lumbar back pain with spasm.

In November 2020, the Veteran underwent a minimally invasive hemilaminectomy, facetectomy, foraminotomy, and transforaminal lumbar interbody fusion at the L4-5 level based on a preoperative diagnosis of degenerative disc disease, stenosis, and radiculopathy.

Within 90 days of the Veteran's March 2025 hearing withdrawal, the Veteran submitted May 2025 correspondence,
2020 showed evidence of mild multilevel spondylosis more pronounced at L4-L5 and L5-S1 levels.

In an October 2020 private medical treatment record, the Veteran's symptoms were noted to be consistent with acute on chronic lumbar back pain with spasm.

Within 90 days of the Veteran's March 2025 hearing withdrawal, the Veteran submitted May 2025 correspondence, in which he described his in-service April 1983 motor vehicle accident as a serious head-on collision which required intensive care in the hospital for six days. He stated that "[m]y lower back has continually bothered me since the motor vehicle accident in 1983. I tried many therapies, including epidural injections, ice, heat and physical therapy to relieve the symptoms. My condition deteriorated to the point where I could barely move, and I underwent a lower back fusion around 2021 which included implantation of screws."

The Board finds that the evidence is at least in relative equipoise on the question of whether symptoms of degenerative joint disease of the lumbar spine have been continuous since service separation. While there is an absence of medical treatment records for the low back after service and prior to 2010, the Board finds that the Veteran competently and credibly reported that he experienced lumbar spine symptoms since the motor vehicle accident in service which continued after service separation. The record includes several documented reports of continuous symptomatology since service, including consistent lay statements from the Veteran both in his lay statements and his medical records.

(Continued on the next page)

While the May 2015 VA nexus opinion is unfavorable, the opinion is inadequate as it is not based on an accurate factual predicate because it does not address all favorable evidence in the Veteran's STRs and does not address the Veteran's competent reports of continuing back symptoms since service.

Resolving reasonable doubt in the Veteran's favor, the Board finds that symptoms of degenerative arthritis of the lumbar spine were continuous since service to meet the requirements for presumptive service connection for the chronic disease of arthritis. See 38 C.F.R. § 3.303(b). The appeal is therefore granted.

S. B. MAYS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Elsbach, E. R.

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