Entitlement to service connection for chronic obstructive pulmonary disease (COPD), including as secondary to service-connected posttraumatic stress disorder (PTSD), for accrued benefits purposes, is granted.

Citation Nr: 26001460 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 11-06 566 DATE: January 30, 2026 ORDER Entitlement to service connection for chronic obstructive pulmonary disease (COPD), including as secondary to service-connected posttraumatic stress disorder (PTSD), for accrued benefits purposes, is granted. Entitlement to service connection for a lung disability other than COPD, to include granulomatous disease, bullous lung disease, and noncancerous lung mass, including as secondary to service-connected PTSD for accrued benefits purposes, is granted. Entitlement to service connection for eczema, erythrasma, seborrheic keratoses, benign nevi, and lentigines, claimed as skin condition, prior to August 10, 2022, on a basis other than pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), for accrued benefits purposes, is granted. Entitlement to service connection for peptic ulcer disease, duodenal ulcer, and gastroesophageal reflux disease (GERD), claimed as stomach condition, as secondary to service-connected PTSD for accrued benefits purposes, is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt, the Veteran's COPD is the result of exposure to fuels, cleaners, solvents, and service-connected PTSD. 2. Resolving all reasonable doubt, the Veteran's lung disability, to include granulomatous disease, bullous lung disease, and noncancerous lung mass, is the result of exposure to fuels, cleaners, solvents, and service-connected PTSD. 3. Resolving all reasonable doubt, the Veteran's skin condition, including eczema, erythrasma, seborrheic keratoses, benign nevi, and lentigines, is related to in-service herbicide exposure. 4. Resolving all reasonable doubt, the Veteran's peptic ulcer disease, duodenal ulcer, and GERD is the result of service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for COPD, including as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for lung disability, to include granulomatous disease, bullous lung disease, and noncancerous lung mass, including as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for a skin condition, including eczema, erythrasma, seborrheic keratoses, benign nevi, and lentigines, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for peptic ulcer disease, duodenal ulcer, and GERD as secondary to service-connected PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from November 1969 to July 1971. The appellant is the Veteran's surviving spouse. The Veteran died in January 2025. In a March 2025 correspondence, the agency of original jurisdiction (AOJ) notified the appellant that she was formally recognized as a substitute claimant in the Veteran's appeal. This case has a lengthy procedural history. This appeal arises from a February 2009 claim for service connection for stomach and skin conditions and a March 2009 informal claim for service connection for COPD and a lung disorder (originally claimed as lung nodules). The claims were denied in an April 2010 rating decision, which the Veteran appealed with an April 2010 notice of disagreement. A February 2011 statement of the case was issued, and a March 2011 substantive appeal was submitted. In March 2017, the Veteran testified before a now-retired Veterans Law Judge. In December 2021, he was afforded another hearing and testified before the undersigned Veterans Law Judge. Copies of the transcripts have been associated with the claims file. This case has been previously remanded by the Board in July 2017, May 2022, and November 2024. During the pendency of the appeal, a September 2025 rating decision granted service connection for a skin condition, eczema, effective from August 10, 2022, based on the PACT Act. 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). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for COPD for accrued benefits purposes. 2. Entitlement to service connection for a lung disability other than COPD, to include granulomatous disease, bullous lung disease, and noncancerous lung mass, for accrued benefits purposes. The appellant contends the Veteran's COPD and lung disability are etiologically associated with active service, to include as due to herbicide agent exposure in Vietnam; exposure to fuels, cleaners, and solvents associated with his military occupational specialty (MOS) as an aircraft repair mechanic; and asbestos exposure. The appellant alternatively contends COPD and lung disability are associated with service-connected PTSD. The question for the Board is whether the Veteran has a current disability that began during service or is approximately at least as likely as not related to an in-service injury, event, or disease or, alternatively, service-connected disabilities. The Board concludes that the Veteran's COPD and lung disability is due to service and service-connected PTSD. First, the evidence persuasively weighs in favor of a current disability during the appeal period. The March 2019 and November 2023 VA examination revealed a diagnosis of COPD and emphysema. The March 2019 VA examination revealed the Veteran had lung nodules in the right lung and calcified old granulomatous disease of the right upper lobe. The November 2023 VA examination revealed emphysema and granulomatous disease. The July 2024 VA examination revealed a diagnosis of non-cancerous left lung nodule. The October 2025 VA examination revealed diagnosis of COPD, granuloma of right upper lobe, bullous lung disease, and noncancerous lung mass. Accordingly, the Veteran had diagnoses of COPD and a lung disability to include granulomatous disease, bullous lung disease, and noncancerous lung mass. Additionally, service connection is in effect for PTSD. Further, the evidence persuasively weighs in favor of finding the Veteran had herbicide agent exposure in Vietnam and exposure to fuels, cleaners, and solvents as a result of his MOS as an aircraft mechanic repairman. Military personnel records confirm the Veteran had active service in Vietnam during an appropriate presumptive period. Additionally, the AOJ has conceded exposure to fuels, cleaners, and solvents as a result of his MOS as an aircraft mechanic repairman. Further, the AOJ has conceded exposure to asbestos based on his MOS. Having considered the entirety of the record, the Board will resolve all reasonable doubt and conclude the Veteran's COPD and lung disability is due to service and service-connected PTSD. In a December 2025 informal hearing presentation, the appellant asserted, through her representative, that the Veteran's service-connected PTSD and associated stress led to smoking, which in turn caused the claimed COPD and lung disability. The appellant recited portions of VA articles that advised against negative coping behavior for PTSD symptoms such as smoking due to stress. Additionally, the appellant recited portions of a VA resource indicating nicotine usage is related to stress. The record shows the Veteran first sought treatment for his acquired psychiatric disorder symptoms in May 1973, wherein he reported being nervous, not eating right, not sleeping well, and smoking one and a half packs of cigarettes a day. Of pertinent note, the May 1973 private treatment record indicates the Veteran sought treatment for his acquired psychiatric disorder symptoms close in time to service, specifically within one and a half years after separation from service. Additionally, smoking was reported to his physician as a coping mechanism symptom and in the context of seeking treatment for his mental health symptoms. See Curry v. Brown, 7 Vet. App. 59, 68 (contemporaneous evidence has greater probative value than history as reported by the claimant); see also Fed. R. Evid. 803(4) and accompanying Notes (noting statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth); Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision). For these reasons, the Board finds this is sufficiently probative to support continuity and chronicity of this symptom and further, as due to service-connected PTSD. For claims received by VA after June 9, 1998, a disability will not be considered service-connected on the basis that it resulted from injury or disease attributable to a veteran's use of tobacco products during service. See 38 U.S.C. § 1103; 38 C.F.R. § 3.300(a). However, service connection may be granted on a secondary basis "on the basis of being attributable to the veteran's use of tobacco products during service" if: (1) the service-connected disability caused the veteran to use tobacco products after service; (2) the use of tobacco products as a result of the service-connected disability was a substantial factor in causing a secondary disability; and (3) the secondary disability would not have occurred but for the use of tobacco products caused by the service-connected disability. VAOPGCPREC 6-2003. The March 2019, November 2023, February 2024, July 2024, September 2025, and October 2025 VA examinations have largely attributed the Veteran's COPD and lung disabilities to smoking. 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. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As such, the Board will resolve reasonable doubt in the Veteran's favor and find that service connection is warranted. The claims for COPD and a lung disability are granted as secondary to service-connected PTSD. Additionally, the Board notes the record contains a November 2023 VA examination that determined the Veteran's COPD and lung disability is approximately at least as likely as not caused by exposure to fuels, solvents, and cleaners after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all TERA of the Veteran. Though the November 2023 VA examiner ultimately changed her conclusion in the subsequent February 2024 opinion, the Board notes that the evidence is in approximate equipoise as the examiner's underlying rationale in the November 2023 and February 2024 opinions largely remained the same. Accordingly, the Board concludes, after examining the entirety of the evidence in the light most favorable to the Veteran, that service connection for COPD and a lung disability, including as secondary to service-connected PTSD for accrued benefits purposes is warranted. The appeals are granted. 3. Entitlement to service connection for a skin condition including eczema prior to August 10, 2022, on a basis other than pursuant to the PACT Act. During the pendency of the appeal, a September 2025 rating decision granted service connection for a skin condition, eczema, effective from August 10, 2022, based on the PACT Act. The issue of entitlement to service connection for a skin condition on a basis other than the PACT Act, for the period prior to August 10, 2022, remains before the Board. Johnson v. Collins, 38 Vet. App. 151 (2025). The appellant asserts the Veteran's skin condition (other than service-connected onychomycosis and tinea pedis (effective April 25, 2008)) is related to service, to include experiencing dry skin during active service and exposure to sun, vegetation, and fungal infections from swamps and monsoons, and/or TERA. The evidence persuasively weighs in favor of a current disability during the appeal period. The November 2023 VA examination revealed a diagnosis of eczema. A September 2018 private treatment record documented skin lesions diagnosed as erythrasma, seborrheic keratoses, benign nevi, and lentigines. The AOJ granted service connection based on the PACT Act because the July 2025 VA skin examination determined the Veteran's condition was at least as likely as not caused by the indicated TERA. However, the Board notes the July 2025 VA skin examination additionally included the examiner's statement that "[t]here is medical or scientific evidence available that notes a relationship between the development of the condition(s) at issue and the TERA and/or the geographical location(s) of service." Here, the examiner's use of "and/or" indicates an alternative route to service connection by way of the Veteran's period of service having occurred in Vietnam. Additionally, this is supported by the examiner's rationale that some studies have suggested an increased risk of non-malignant skin disorders, particularly chronic dermatitis and eczema-like conditions, among exposed individuals to herbicide agents. The examiner noted these skin conditions may result from direct dermal exposure to herbicidal agents, immunologic effects of TCDD, or chronic inflammation triggered by environmental toxins. Given the examiner's statements, the Board will resolve all reasonable doubt in the Veteran's favor and conclude the July 2025 VA examination establishes the Veteran's skin condition is also related to herbicide agent exposure in Vietnam. Accordingly, the Board concludes, after examining the entirety of the evidence in the light most favorable to the Veteran, that service connection for a skin condition, to include eczema, erythrasma, seborrheic keratoses, benign nevi, and lentigines, is warranted as due to herbicide agent exposure. The appeal is granted on a basis other than the PACT Act for accrued benefits purposes. 4. Entitlement to service connection for a stomach condition, to include peptic ulcer disease, duodenal ulcer and GERD. The appellant asserts the Veteran's peptic ulcer disease, duodenal ulcer, and GERD (claimed as stomach condition) is related to service and/or as due to service-connected PTSD. The question for the Board is whether the Veteran had a current disability that began during service or is approximately at least as likely as not related to an in-service injury, event, or disease or, alternatively, service-connected disabilities. Resolving all reasonable doubt, the Board concludes that the Veteran's claimed condition is the result of service-connected PTSD. First, the evidence persuasively weighs in favor of a current disability during the appeal period. The March 2019 VA examination revealed a diagnosis of duodenal ulcer. The November 2023 VA examination revealed a diagnosis of GERD. The June 2024 VA examination revealed a diagnosis of peptic ulcer disease. Additionally, service connection is in effect for PTSD. Further, the evidence persuasively weighs in favor of finding the Veteran had exposure to: herbicide agents in Vietnam, fuels, cleaners, solvents and asbestos. Having considered the entirety of the record, the Board will resolve all reasonable doubt and conclude the Veteran's peptic ulcer disease, duodenal ulcer, and GERD are the result of service-connected PTSD. In a December 2025 informal hearing presentation, the appellant asserted, through her representative, that the Veteran's gastrointestinal disability is associated with service-connected PTSD. The informal hearing presentation included excerpts from medical literature indicating significantly higher odds of self-reported gastrointestinal disorders in veterans with PTSD. The Board notes that January 2025 and September 2025 VA opinions indicate the Veteran's gastrointestinal disability is unrelated to service-connected PTSD. However, the January 2025 and September 2025 VA examiners did not address pertinent evidence indicating a relationship between the gastrointestinal disability and service-connected PTSD and, as such, the Board cannot rely on the January 2025 and September 2025 VA opinions. In the May 1973 private treatment record, the Veteran was first prescribed Librium, to be taken 3 or 4 times a day for his mental health symptoms. A July 1973 private treatment record noted he was advised to continue his Librium medication. In a January 1974 private treatment record, the Veteran reported having some stomach trouble for the last month or two. An August 1976 private treatment record indicated that an X-ray revealed a small duodenal bulb ulcer. In short, these private treatment records indicate the Veteran began taking medication for his acquired psychiatric disorder within a year and a half of separation from service. Additionally, gastrointestinal symptoms began within a few months of taking that medication. During the March 2017 hearing, the Veteran testified that he believed his gastrointestinal symptoms were related to stress and "nerve pills" that he was prescribed in the 70s. During the March 2022 hearing, the appellant testified the Veteran's nerves were terrible when he came home after service and he got on "nerve medication" but "his stomach problems kept getting worse." She additionally testified that they were told by a doctor at Ohio State University who informed the Veteran that he needed to be taken off the nerve medicine as it was the quickest way to deal with the ulcers. Records from Ohio State University do not indicate the Veteran's nerve medication as the cause of his gastrointestinal disability. Additionally, the record at this time does not contain an adequate opinion addressing whether the claimed disability is associated with service-connected PTSD. However, the Board acknowledges that the Veteran first sought treatment for his acquired psychiatric disorder symptoms in May 1973, wherein he reported being nervous and was prescribed Librium for his symptoms. He continued to take the medication for months, as often as 3 to 4 times a day. A July 1973 private treatment record noted he was advised to continue his Librium medication. In a January 1974 private treatment record, the Veteran reported having some stomach trouble for a couple of months. In August 1976, an X-ray confirmed a small duodenal bulb ulcer. In short, these private treatment records indicate the Veteran's gastrointestinal symptoms began close in time to when he began taking medication for his acquired psychiatric disorder. Additionally, this all occurred within two years of separation from service. Moreover, the Veteran has credibly testified that his symptoms began after starting "nerve medication" and the appellant has credibly testified that a doctor indicated a relationship between the nerve medicine and the ulcers. For these reasons, the Board finds this is sufficiently probative to support continuity and chronicity of this symptom and further, as due to service-connected PTSD. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). 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. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As such, the Board will resolve reasonable doubt in the Veteran's favor and find that service connection is warranted. The claim for service connection for peptic ulcer disease, duodenal ulcer, and GERD, is granted as secondary to service-connected PTSD. The appeal is granted. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Vang, 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.