New and material evidence having been received, the claim of entitlement to service connection for asthma is reopened.

Citation Nr: 26001465 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 20-29 594 DATE: January 30, 2026 ORDER New and material evidence having been received, the claim of entitlement to service connection for asthma is reopened. New and material evidence having been received, the claim of entitlement to service connection for a lumbar disorder is reopened. New and material evidence having been received, the claim of entitlement to service connection for a cervical disorder is reopened. New and material evidence having been received, the claim of entitlement to service connection for an acquired psychiatric disorder, to include anxiety, depression, and posttraumatic stress disorder (PTSD), is reopened. New and material evidence having been received, the claim of entitlement to service connection for a bilateral foot disorder is reopened. New and material evidence having been received, the claim of entitlement to service connection for carpal tunnel syndrome (CTS), right upper extremity, is reopened. Entitlement to service connection for a lumbar disorder is granted. Entitlement to service connection for a left knee disorder is granted. Entitlement to service connection for a right knee disorder is granted. REMANDED Entitlement to service connection for asthma is remanded. Entitlement to service connection for a cervical disorder is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety, depression, and PTSD, is remanded. Entitlement to service connection for a bilateral foot disorder is remanded. Entitlement to service connection for CTS, right upper extremity, is remanded. Entitlement to service connection for CTS, left upper extremity, is remanded. Entitlement to service connection for sleep apnea is remanded. FINDINGS OF FACT 1. The AOJ last denied the Veteran's claim for service connection for a) asthma, b) a lumbar disorder, c) a cervical disorder, d) an acquired psychiatric disorder, e) a bilateral foot disorder, and f) CTS, right upper extremity, in May 2014. The Veteran did not appeal this decision, nor was new and material evidence received within one year of the notification letter. Therefore, the May 2014 rating decision became final. 2. Evidence received since the final May 2014 rating decision is not cumulative or redundant of the evidence of record, related to an unestablished fact, and raises the possibility of substantiating the Veteran's claim of entitlement to service connection for a) asthma, b) a lumbar disorder, c) a cervical disorder, d) an acquired psychiatric disorder, e) a bilateral foot disorder, and f) CTS, right upper extremity. 3. The Veteran's a) lumbar disorder, b) right knee disorder, and c) left knee disorder onset in and have continued since his active service. CONCLUSIONS OF LAW 1. The May 2014 rating decision denying entitlement to service connection for a) asthma, b) a lumbar disorder, c) a cervical disorder, d) an acquired psychiatric disorder, e) a bilateral foot disorder, and f) CTS, right upper extremity, is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 3.104, 20.1103. 2. The criteria to reopen the claim for service connection for a) asthma, b) a lumbar disorder, c) a cervical disorder, d) an acquired psychiatric disorder, e) a bilateral foot disorder, and f) CTS, right upper extremity, have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for service connection for a) lumbar disorder, b) right knee disorder, and c) left knee disorder have been met. 38?U.S.C. §?5108; 38?C.F.R. §§?3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1997 to December 1999, with additional service in the Army National Guard, to include a period of active duty for training (ACDUTRA) in June 2004. This matter comes before the Board of Veterans' Appeals (board) on appeal from a January 2019 rating decision of an Agency of Original Jurisdiction (AOJ) of the U.S. Department of Veterans Affairs (VA). The Veteran testified before the undersigned in July 2024; a transcript is associated with the record. The claim of service connection for an acquired psychiatric disorder (claimed as anxiety, depression, and PTSD) has been recharacterized in light of Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran, but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). Issue 1: Whether new and material evidence has been received to reopen the claim of entitlement to service connection for asthma New and Material Evidence - General Under 38 U.S.C. § 7104(b), the Board has no jurisdiction to consider a claim based on the same factual basis as a previously disallowed claim. King v. Shinseki, 23 Vet. App. 464 (2010); see DiCarlo v. Nicholson, 20 Vet. App. 52, 55 (2006) (holding that res judicata generally applies to VA decisions). However, the finality of a previously disallowed claim can be overcome by the submission of new and material evidence. See 38 U.S.C. § 5108. New evidence means evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and it must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Merits In 1999, the Army treated the Veteran multiple times for congestion and shortness of breath. In June 2004, the Veteran was on ACDUTRA at Fort A.P. Hill in Virginia. He became ill, and the Army directed private treatment in Fredericksburg where he was diagnosed with acute bronchitis. In January 2007, the Veteran claimed service connection for asthma. He stated: "I became ill during third phase of Drill Sergent School in June of 2003. The diagnosis at that time was Bronchitis. I was never able to breathe very well after that. After failing several APFT's, I went to my doctor, and she began treating me for asthma. I was still unable to pass the two mile run. At this time, my unit administrator had me fill out the paperwork for a permanent profile. I then went back to my doctor and received a Pulmonary Functions Test (PFT). It was at this time that I was diagnosed with asthma. The army reserve granted me with a permanent profile." In September 2007, the AOJ denied the claim without examining him. It denied based on no in-service event and no medical nexus. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the September 2007 rating decision became final. In February 2011, the Veteran again claimed service connection. In August 2011, the AOJ denied reopening the claim, finding the Veteran had not submitted new and material evidence to warrant reopening. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the August 2011 rating decision became final. In August 2013, the Veteran again claimed service connection. In May 2014, the AOJ denied reopening the claim, finding the Veteran had not submitted new and material evidence to warrant reopening. The Veteran did not appeal the denial, was new and material evidence received within one year of the rating decision notification letter. Therefore, the May 2014 rating decision became final. In September 2018, the Veteran again claimed service connection. In January 2019, the AOJ denied reopening the claim, finding the Veteran had not submitted new and material evidence to warrant reopening. In March 2019, the Veteran appealed. In July 2024, the Veteran testified before the undersigned that he developed a respiratory problem during active duty which contends was a precursor to asthma. At the time of the May 2014 denial, the record consisted, as relevant here, of service treatment records. The Veteran's testimony is new. It is also material to the questions of an in-service event and possible nexus. Reopening of the Veteran's claim for service connection for asthma based on the receipt of new and material evidence is therefore warranted. Shade v. Shinseki, 24 Vet. App. 110 (2011) (holding that the phrase "raises a reasonable possibility of substantiating the claim" in applicable regulation as "enabling rather than precluding reopening"). Issue 2: Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a lumbar disorder In August 2013, the Veteran claimed service connection for a back disorder secondary to asthma. In May 2014, the AOJ denied the claim under both direct and secondary theories of entitlement. It denied under a direct theory, at a minimum, because of no medical nexus. It denied under a secondary theory because the claimed primary disability (asthma) was not service connected. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the May 2014 rating decision became final. In September 2018, the Veteran again claimed service connection. He did not specify a theory of entitlement. In November 2018, the AOJ examined him. In January 2019, the AOJ denied reopening the claim despite the November 2018 examination, finding the Veteran had not submitted new and material evidence to warrant reopening. In March 2019, the Veteran appealed. In July 2024, the Veteran testified before the undersigned. The next month, he submitted an August 2024 private medical opinion. At the time of the May 2014 denial, the record consisted, as relevant here, of service treatment records. The November 2018 VA examination, the July 2024 testimony, and the August 2024 private medical opinion are new. They are also material to the questions of an in-service event and possible nexus. Reopening of the Veteran's claim for service connection for a lumbar disorder based on the receipt of new and material evidence is therefore warranted. Shade v. Shinseki, 24 Vet. App. 110 (2011) (holding that the phrase "raises a reasonable possibility of substantiating the claim" in applicable regulation as "enabling rather than precluding reopening"). Issue 3: Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a cervical disorder In August 2013, the Veteran claimed service connection for a cervical disorder secondary to asthma. In May 2014, the AOJ denied the claim under both direct and secondary theories of entitlement. It denied under a direct theory, at a minimum, because of no medical nexus. It denied under a secondary theory because the claimed primary disability (asthma) was not service connected. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the May 2014 rating decision became final. In September 2018, the Veteran again claimed service connection. He did not specify a theory of entitlement. In January 2019, the AOJ denied reopening the claim, finding the Veteran had not submitted new and material evidence to warrant reopening. In March 2019, the Veteran appealed the January 2019 denial of reopening. In July 2024, the Veteran testified before the undersigned. He stated he had neck pain which impairs him as he works. He contends it resulted from repetitive use from his duties as an infantryman based on the equipment he used and the protective gear he wore. At the time of the May 2014 denial, the record consisted, as relevant here, of service treatment records. The July 2024 testimony is new. It is also material to the questions of a current disability, in-service event, and possible nexus. Reopening of the Veteran's claim for service connection for a cervical disorder based on the receipt of new and material evidence is therefore warranted. Shade v. Shinseki, 24 Vet. App. 110 (2011) (holding that the phrase "raises a reasonable possibility of substantiating the claim" in applicable regulation as "enabling rather than precluding reopening"). Issue 4: Whether new and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disorder, to include anxiety, depression, and PTSD In August 2013, the Veteran claimed service connection for depression and anxiety secondary to asthma. In May 2014, the AOJ denied the claims under both direct and secondary theories of entitlement. It denied under a direct theory, at a minimum, because of no medical nexus. It denied under a secondary theory because the claimed primary disability (asthma) was not service connected. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the May 2014 rating decision became final. In September 2018, the Veteran again claimed service connection for PTSD. He did not specify a theory of entitlement. In January 2019, the AOJ denied the claim, finding the evidence did not show a current diagnosis for PTSD. In March 2019, the Veteran appealed. As explained above, the Board has broadened the Veteran's claim to service connection for any acquired psychiatric disorder. In July 2024, the Veteran testified before the undersigned. He discussed purported in-service stressors at Fort Benning and South Korea. At the time of the May 2014 denial, the record consisted, as relevant here, of service treatment records. The July 2024 testimony is new. It is also material to the questions of a current disability, in-service event, and possible nexus. Reopening of the Veteran's claim for service connection for an acquired psychiatric disorder based on the receipt of new and material evidence is therefore warranted. Shade v. Shinseki, 24 Vet. App. 110 (2011) (holding that the phrase "raises a reasonable possibility of substantiating the claim" in applicable regulation as "enabling rather than precluding reopening"). Issue 5: Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a bilateral foot disorder In August 2013, the Veteran claimed service connection for "bilateral fallen arches" and "feet," both as secondary to asthma. In May 2014, the AOJ combined the claims, denying it under a direct theory, at a minimum, because of no medical nexus. It also denied under a secondary theory because the claimed primary disability was not service connected. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the May 2014 rating decision became final. In September 2018, the Veteran claimed service connection for "feet." He did not specify a theory of entitlement. In January 2019, the AOJ denied reopening the claim, finding the Veteran had not submitted new and material evidence to warrant reopening. In addition to its reasoning in May 2014, it also found the Veteran did not have a current disability. In March 2019, the Veteran appealed. In July 2024, the Veteran testified before the undersigned. He testified that VA diagnosed him with plantar fasciitis in May 2024. He also testified that inadequate military-issued footwear and repetitive-use caused his plantar fasciitis. Later that month, the Veteran submitted VA treatment records showing a diagnosis of pes planus, but not plantar fasciitis. At the time of the May 2014 denial, the record consisted, as relevant here, of service treatment records. The July 2024 testimony and VA records submitted that month are new. They are also material to the questions of a current disability, in-service event, and possible nexus. Reopening of the Veteran's claim for service connection for a bilateral foot disorder based on the receipt of new and material evidence is therefore warranted. Shade v. Shinseki, 24 Vet. App. 110 (2011) (holding that the phrase "raises a reasonable possibility of substantiating the claim" in applicable regulation as "enabling rather than precluding reopening"). Issue 6: Whether new and material evidence has been received to reopen the claim of entitlement to service connection for carpal tunnel syndrome (CTS), right upper extremity In August 2013, the Veteran claimed service connection for an "arm condition" secondary to asthma. In May 2014, the AOJ denied the claim for the right arm under both direct and secondary theories of entitlement. It denied under a direct theory, at a minimum, because of no medical nexus. It denied under a secondary theory because the claimed primary disability was not service connected. The Veteran did not appeal the denial, nor was new and material evidence received within one year of the rating decision notification letter. Therefore, the May 2014 rating decision became final. In September 2018, the Veteran claimed service connection for "numbness in arms and hands." He did not specify a theory of entitlement. In January 2019, the AOJ examined him and obtained a negative etiology opinion. Later that month, the AOJ reopened the claim, denying it on the merits under a direct theory of entitlement. In March 2019, the Veteran appealed. In July 2024, the Veteran testified before the undersigned. He contends his repetitive use from his duties as an infantryman caused his CTS. At the time of the May 2014 denial, the record consisted, as relevant here, of service treatment records. The January 2019 VA opinion and July 2024 testimony are new. They are also material to the questions of a current disability, in-service event, and possible nexus. Reopening of the Veteran's claim for service connection for CTS, right upper extremity, based on the receipt of new and material evidence is therefore warranted. Shade v. Shinseki, 24 Vet. App. 110 (2011) (holding that the phrase "raises a reasonable possibility of substantiating the claim" in applicable regulation as "enabling rather than precluding reopening"). Issue 7: Entitlement to service connection for a lumbar disorder Service Connection - Direct Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38?U.S.C. §§?1110, 1131; 38?C.F.R. §?3.303(a). Service connection may be granted for any disease diagnosed after discharge when all the evidence establishes that the disease was incurred in service. 38?C.F.R. §?3.303(d). The United States Court of Appeals for the Federal Circuit has held that a three-element test must be satisfied to establish entitlement to service connection. Specifically, the evidence must show (1) the existence of 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 disease or injury incurred or aggravated during service (the "nexus" requirement). Walker v. Shinseki, 708 F.3d. 1331, 1333 (Fed. Cir. 2013) (citing Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) ((quoting Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004)). Merits In November 2018, a VA examiner diagnosed the Veteran with a lumbosacral strain. In July 2024, X-rays taken at the Waco VA Medical Center showed degenerative arthritis of the lumbar spine. These diagnoses satisfy the first element of a direct service connection claim. For the second element of a direct service connection claim, i.e., in-service event, the Veteran's service treatment records show the Army treated him for back pain in 1998 and 1999. Additionally, the November 2018 VA examiner reported: "Gives history of onset of mechanical low back pain around 1997, early in military career, following long runs and heavy marches, with progression through the years, now such that he has daily constant low back pain with stiffness and achiness, and occasional 'pinching' sensation on the left side with aching down the left leg." Lastly, in a January 2006 Report of Medical History, the Veteran stated he had a history of back pain. Collectively, these satisfy the second element of a direct service connection claim. For the third element of a direct service connection claim, the Veteran submit an August 2024 private opinion from Dr. S.E. who causally connected the Veteran's degenerative arthritis to his service. Dr. S.E. traced the chronology of the Veteran's back symptoms, noting that the November 2018 VA examiner "found no link between [the Veteran's] back condition and his military service. However, [the Veteran] had not yet been found to have degenerative arthritis of the lumbar spine." In turn, after citing multiple medical journal articles, Dr. S.E. opined: "The degenerative arthritis of the lumbar spine [the Veteran] now suffers from is a condition consistent with the type of low back pain he experienced during his military service and for many years following his separation from military service. The referenced medical studies show that military service members have a high prevalence of low back pain during their military service, and this low back pain continues after their discharge from military service until it progresses into a disabling lumbar spine condition such as degenerative arthritis. After reviewing the fact patterns in the medical records and comparing them to the fact patterns in the medical studies, [the Veteran's] degenerative arthritis of the lumbar spine fits the sequence of being caused by the rigors of his service in the infantry which required heavy lifting, bending, crawling, running, and jumping while carrying heavy backpacks. This is a textbook case of a US serviceman who abused his body during active military service, and now has a disabling lumbar spine condition as a result." Given the limitation of the November 2018 VA opinion identified by Dr. S.E. and S.E's well-researched, well-articulated opinion, the Board finds the Veteran has satisfied the third element of a direct service connection claim. Because the Veteran has satisfied all three prongs of his service connection claim, the Board grants the appeal. Issue 8: Entitlement to service connection for a left knee disorder Issue 9: Entitlement to service connection for a right knee disorder Merits In May 2019, the Veteran was diagnosed with "minimal DJD of the [right] knee joint" and "mild DJD of the [left] knee joint" via x-rays at a VA facility. Despite this, the AOJ, in the September 2019 rating decision on appeal, found the Veteran did not have a current disability in either knee. The AOJ erred, as the bilateral degenerative joint disease diagnoses satisfy the first element of a direct service connection claim for these issues. For the second element of a direct service connection claim, the Board notes the Veteran served as an infantryman in the Army. In July 2024, the Veteran testified that he believed his knee disabilities resulted from repetitive use injuries including running on concrete, physical training, and road marches. While the Veteran's service treatment records do not show a musculoskeletal injury involving his knees, the Board must apply 38 U.S.C.§ 1154(a). Under this statute, the Board must consider the places, types, and circumstances of the Veteran's service as shown by his service record, the official history of each organization in which such Veteran served, his medical records, and all pertinent medical and lay evidence. The Board finds the Veteran testified competently and credibly about the nature of his military duties, the pain he sustained in performing them, and his post-service treatment of such pain. Despite the lack of a documented injury in service, the Board will resolve doubt in the Veteran's favor and find his contentions credible. As such, considering 38 U.S.C.§ 1154(a), the Board finds the Veteran injured himself as he contends. This satisfies the second element of a direct service connection claim for these issues. For the third element of a direct service connection claim for both issues, the Veteran submitted an August 2024 private opinion from Dr. S.E. who causally connected the Veteran's bilateral degenerative arthritis of his knees to his service. Dr. S.E. acknowledged the Veteran's service treatment records are silent for knee complaints. Nevertheless, Dr. S.E. concluded that his in-service spinal treatment "supports that his service in the infantry placed abnormal stresses on his body." In turn, after citing multiple medical journal articles, S.E. opined: "In conclusion, the evidence shows that [the Veteran] served in the US Army infantry, and has a long history of knee pain that went undiagnosed until x-rays showed that he has degenerative arthritis in both knees. The referenced medical studies show that military service members, and infantrymen in particular, have a high prevalence of developing degenerative osteoarthritis of the knees as a result of their military training and duties, and the arthritis can take many years to appear. After reviewing the medical records and medical studies in their entirety, and comparing the fact patterns in the medical records to the fact patterns in the medical studies, [the Veteran's] degenerative osteoarthritis of both knees fits the sequence of being caused by the rigors of his service as an infantryman in the US Army. This is a textbook case of a soldier who abused his body during infantry training, and now has a disabling knee condition as a result. The absence of complaints of knee pain in the military service medical records does not dissuade me from concluding that his degenerative osteoarthritis of both knees is a result of his service as an infantryman." Based on S.E.'s well-researched, well-articulated opinion, the Board finds the Veteran has satisfied the third element of a direct service connection claim. Because the Veteran has satisfied all three prongs of his service connection claims, the Board grants the appeal. REASONS FOR REMAND Issue 10: Entitlement to service connection for asthma Issue 11: Entitlement to service connection for a cervical disorder Issue 12: Entitlement to service connection for an acquired psychiatric disorder, to include anxiety, depression, and PTSD Issue 13: Entitlement to service connection for a bilateral foot disorder The United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.159(c)(4) provides that an examination or opinion is necessary if the evidence of record: 1) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of a disability; and 2) establishes that the Veteran suffered an event, injury, or disease in service; and 3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service, but 4) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Court noted that the third prong of 38 C.F.R. § 3.159(c)(4) is a low threshold standard. Based on the evidence cited above in Issues 1, 3, 4, and 5, respectively, the Board finds the Veteran merits a compensation examination. Issue 14: Entitlement to service connection for CTS, right upper extremity Issue 15: Entitlement to service connection for CTS, left upper extremity In January 2019, the AOJ examined the Veteran for Issues 14 and 15. The examiner diagnosed CTS in the bilateral upper extremities but opined: "The veteran's claimed numbness hands, now diagnosed as Carpal Tunnel Syndrome, Bilateral, is less likely than not (50 percent or greater probability) incurred in or caused by the hand pain during service. The Veteran's records do not support the position that his currently diagnosed bilateral carpal tunnel syndrome resulted from or was incurred in service due to any incident or task or behaviors. The Veteran's records show two instances when the Veteran injured his right hand; neither resulted in numbness of created conditions conducive to develop his bilateral carpal tunnel syndrome. The Veteran served in the United States Army from 06 March 1997 through 22 December 1999 (2 years, 9 months). The Veteran's 13 February 1997 Report of Medical Examination showed no pre-existing or current numbness or hand condition. A note dated 29 November 1997 shows that the Veteran injured his right hand (had it slammed in a car door). He complained of pain, but denied numbness. He had full ROM of his fingers. He followed up on 10 September 1997 with some residual symptoms. His 26 January 1999 Report of Medical Examination showed no evidence of hand numbness or complaint for carpal tunnel syndrome. A note dated 07 August 1999 showed that the Veteran injured his right hand by punching a wall. He fractures his small finger. His 13 January 2006 Report of Medical Examination was free of any mention for nerve condition or numbness of the hands. His Report of Medical History dated the same showed he reported numbness or tingling. There is no further clarification of what that complaint was associated with, but he did also mention back problems." The Board finds this opinion adequately addressed the two in-service events documented in the Veteran's service treatment records. However, the Veteran raised a new contention at his July 2024 hearing: repetitive use from his duties as an infantryman caused his CTS. Given this, the Board will remand for an addendum to address this contention. Issue 16: Entitlement to service connection for sleep apnea In September 2018, the Veteran claimed service connection. He did not specify a theory of entitlement. In January 2019, the AOJ denied the claim, finding that the Veteran did not have a current disability or an in-service event. In March 2019, the Veteran appealed. In May 2019, VHA diagnosed him with obstructive sleep apnea. In July 2024, the Veteran testified before the undersigned. He contends he developed sleep apnea either during service or as secondary to his asthma. Based on his diagnosis and testimony, the Board finds the Veteran merits a compensation examination under McLendon vs. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Mail the Veteran a VA Form 21-0781 and request he completed and return it to the AOJ. If the Veteran returns it, undertake all necessary development. 2. Schedule the Veteran for an examination to determine the nature and etiology of his asthma. The clinician must review the claims file including this Remand. In addition to the customary examination, the examiner must opine: a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's asthma began during, or was otherwise caused by, his military service? Why or why not? In answering this question, the clinician must answer: i) Was the Veteran's treatment for congestion and shortness of breath in 1999 a precursor or first manifestation of his subsequently diagnosed asthma? If yes, why? If no, why not? ii) Was the Veteran's treatment for acute bronchitis in June 2004 a precursor or first manifestation of his subsequently diagnosed asthma? If yes, why? If no, why not? 3. Schedule the Veteran for an examination to determine the nature and etiology of his claimed cervical disorder. The clinician must review the claims file including this Remand. In addition to the customary examination, the examiner must opine: a) Please identify any cervical disability by either (i) diagnosis or (ii) functional impairment. b) As to each cervical disability identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the disability began during, or was otherwise caused by, his military service? Why or why not? In answering this question, the clinician should address the Veteran's contention that his claimed disability resulted from a) a repetitive-use injury from his duties as an infantryman, or b) the equipment he used and the protective gear he wore during his duties as an infantryman. 4. Schedule the Veteran for an examination to determine the nature and etiology of his acquired psychiatric disorder. The clinician must review the claims file including this Remand. In addition to the customary examination, the examiner must opine: a) Clearly identify all psychiatric disorders which have existed since approximately September 2018, the date of the Veteran's claim. If the examiner finds that the Veteran meets the criteria for PTSD, the examiner must identify the specific stressor(s) underlying any PTSD diagnosis and comment upon the link between the current symptomatology and the Veteran's stressor(s) b) Then, as to any psychiatric disorder other than PTSD, the examiner should indicate whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's acquired psychiatric disorder began during, or was otherwise caused by, his military service? Why or why not? In answering this question, the clinician should address the Veteran's July 2024 testimony regarding in-service events in Korea and at Fort Benning. 5. Schedule the Veteran for an examination to determine the nature and etiology of his bilateral foot disorder. The clinician must review the claims file including this Remand. In addition to the customary examination, the examiner must opine: a) Please identify any foot disability by either (i) diagnosis or (ii) functional impairment. b). As to each foot disability identified, opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that foot disability began during, or was otherwise caused by, his military service? Why or why not? In answering this question, the clinician should address the Veteran's contention that his claimed disability resulted from a) a repetitive-use injury from his duties as an infantryman, or b) military-issued footwear he used during his duties as an infantryman. 6. Obtain an addendum medical opinion to determine the nature and etiology of his bilateral CTS. The clinician must review the claims file including this Remand. The examiner must opine: a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral CTS began during, or was otherwise caused by, his military service? Why or why not? In answering this question, the clinician should address the Veteran's contention that his bilateral CTS resulted from a repetitive-use injury from his duties as an infantryman. 7. Schedule the Veteran for an examination to determine the nature and etiology of his sleep apnea. The clinician must review the claims file including this Remand. The examiner must opine: a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's sleep apnea began during, or was otherwise caused by, his military service? Why or why not? b) If not, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's asthma CAUSED the Veteran's sleep apnea? Why or why not? c) If not, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's asthma AGGRAVATES the Veteran's sleep apnea? Why or why not? In answering the question regarding aggravation, the clinician is reminded that aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury. The clinician is advised that finding that the Veteran's sleep apnea was aggravated due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. The Board recognizes the Veteran's asthma is not, as of this decision, service connected. However, it is ordering this opinion to conserve resources if his asthma ultimately is service-connected. A complete rationale is required. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Sopko, 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.