HEARING LOSS

C.A. SKOW · 2026 · Case ID: A26000039

DENIED

Summary

The veteran, who served from October 1985 to November 1985 and March 1986 to September 1986, appeals the denial of service connection for bilateral hearing loss, tinnitus, and sleep apnea, as well as an increased rating for hypertension. The Board denied service connection for bilateral hearing loss, finding no current disability for VA purposes, despite acknowledging in-service left ear hearing loss and noise exposure, as the evidence did not support a current hearing loss disability. The Board also denied service connection for tinnitus, finding the veteran's assertions not credible due to conflicting statements and the absence of complaints or diagnoses in medical records. The claim for sleep apnea was denied due to lack of current diagnosis, with VA examinations and a sleep study finding no evidence of clinically significant obstructive sleep apnea, and attributing the veteran's reported sleep problems to his service-connected PTSD. The Board granted service connection for hypertension with a 10 percent evaluation, effective March 31, 2023, finding that the veteran's blood pressure readings did not meet the criteria for a higher rating, and that lay statements regarding symptoms were not competent to establish a link to hypertension. The Board also denied the attorney's motion to withdraw representation due to insufficient good cause.

Rationale

No current bilateral hearing loss disability for VA purposes.; In-service findings of abnormal hearing thresholds in left ear, but not for VA purposes.; No in-service complaints of hearing loss.; VA and private medical records do not show reports or diagnoses of hearing loss.; VA examination found no bilateral hearing loss disability; results inconsistent with organic hearing loss.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250917-587658

Full Decision Text

Citation Nr: A26000039
Decision Date: 01/02/26 Archive Date: 01/02/26

DOCKET NO. 250917-587658
DATE: January 2, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for tinnitus is denied.

Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) with alcohol use disorder or as due to toxic exposure risk activity (TERA), is denied.

Entitlement to an initial evaluation in excess of 10 percent for service-connected hypertension is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had a hearing loss disability at any time during or approximate to the pendency of the claim.

2. The evidence of record persuasively weighs against finding that the Veteran has had tinnitus at any time during or approximate to the pendency of the claim.

3. The evidence of record persuasively weighs against finding that the Veteran has had sleep apnea at any time during or approximate to the pendency of the claim.

4. During the rating review period, the Veteran's hypertension did not manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

CONCLUSIONS OF LAW

1. The criteria for service connection for a bilateral hearing loss disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.

2. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for a disability rating in excess of 10 percent for service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1985 to November 1985 and from March 1986 to September 1986.

The rating decisions on appeal were issued in September 2024 and October 2024; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. See Rating Decision (September 2024); Rating Decision (October 2024). The AMA automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1).

In May 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issues of entitlement to service connection for high blood pressure, bilateral hearing loss, and tinnitus most recently addressed in a May 2023 rating decision. See VA Form 20-0995 Supplemental Claim Application (May 2024). In September 2024, the agency of original jurisdiction (AOJ) issued one of the supplemental claim decisions on appeal, which found that new and relevant evidence had been received and denied service connection for hearing loss and tinnitus. See Rating Decision (October 2024).

In September 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issue of entitlement to service connection for OSA most recently addressed in an October 2023 rating decision. See VA Form 20-0995 Supplemental Claim Application (May 2024). In October 2024, the AOJ issued the other supplemental claim decision on appeal, which found that new and relevant evidence had been received, denied service connection for OSA, and granted service connection for hypertension, assigning a 10 percent evaluation, effective March 31, 2023. See Rating Decision (October 2024).

In a September 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the
: Supplemental Claim, and requested readjudication of the issue of entitlement to service connection for OSA most recently addressed in an October 2023 rating decision. See VA Form 20-0995 Supplemental Claim Application (May 2024). In October 2024, the AOJ issued the other supplemental claim decision on appeal, which found that new and relevant evidence had been received, denied service connection for OSA, and granted service connection for hypertension, assigning a 10 percent evaluation, effective March 31, 2023. See Rating Decision (October 2024).

In a September 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. See VA Form 10182 Notice of Disagreement (September 2025). Therefore, the Board may only consider the evidence of record at the time of the September 25, 2024, and October 28, 2024, AOJ decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the 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.

The Board notes that the issue of entitlement to service connection for a right leg disorder is currently on appeal under an earlier docket number (241230-538180). Thus, the issue will be addressed in a separate Board decision and is not considered herein.

Preliminary Matters

First, the Board finds that remand for examinations is not warranted prior to adjudicating the service connection claims. When entitlement to a benefit cannot be established without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination or reexamination, action shall be taken in accordance with 38 C.F.R. § 3.655(b) or (c) as appropriate. 38 C.F.R. § 3.655(a). When a claimant fails to report for a medical examination scheduled in conjunction with an original compensation claim, without good cause, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(b). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, or death of an immediate family member. 38 C.F.R. § 3.655(a).

Here, the record shows that the Veteran was scheduled for a hearing loss and tinnitus examination in July 2024, but he failed to report for that examination. See Exam Request (July 2024). The evidence does not show, and the Veteran does not allege that the Veteran did not receive notice of the examination. In October 2024, the Veteran's attorney requested that the examination be rescheduled noting that the Veteran missed the examination due to a mental health crisis. See VA 21-4138 Statement In Support of Claim (September 2024). The attorney did not provide any additional information regarding this crisis, to include whether the Veteran was hospitalized or was otherwise unable to leave his home. Notably, although the Veteran missed an appointment at VA in June 2024, he attended other medical appointments in July and August 2024 and spoke with a medical provider on the phone on the day of the scheduled examination. See CAPRI at 1, 45, 52, 48 (September 2024). Without more specific information from the Veteran or his attorney regarding the circumstances and/or effects of a mental health crisis, the Board thus finds that good cause has not been shown. The Board may, therefore, proceed to adjudicate the issues on appeal.

Second, the Board denies the Veteran's attorney's motion to withdraw representation of the Veteran. After an appeal to the Board of Veterans' Appeals has been filed, a representative may not withdraw services as representative in the appeal unless good cause is shown on motion. 38 C.F.R. § 20.6. Good cause for such purposes is the extended illness or incapacitation of an agent admitted to practice before the Department of Veterans Affairs, an attorney-at-law, or other individual representative; failure of the appellant to cooperate with proper preparation and presentation of the appeal; or other factors which make the continuation of representation impossible, impractical, or unethical. 38 C.F.R. § 20.6. Such motions must be in writing and must include the name of the veteran, the name of the claimant or appellant if other than the veteran, the applicable Department of Veterans Affairs file number, and the reason why withdrawal should be permitted, and a signed statement certifying that a copy of the motion was sent by first-class mail, postage prepaid, to the appellant, setting forth the address to which the copy was mailed. 38 C.F.R. § 20.6.

Here, in December 2025, after the appeal was filed, the Veteran's attorney, James Brzezinski, submitted a written motion to withdraw representation of the Veteran. See VA 21-4138 Statement In Support of Claim (December 2025). The attorney stated that there was good cause to withdraw as there was "inability to continue providing representation and due to changes in the circumstances affecting representation." See VA 21-4138 Statement In Support of Claim at 2 (December 2025). Although the attorney's statement met the other criteria contained in 38 C.F.R. § 2.6, the Board finds that the vague statement provided does not meet the standard of good cause. Notably, the attorney did not explain why there was an inability to continue representation or provide any information regarding the claimed changes in circumstances. The withdrawal of representation thus does not comply with the requirements set out at 38C.F.R. § 20.6. Because the attorney has not submitted a valid motion to withdraw which satisfies the regulatory requirements, it is without force or effect. Thus, Mr. Brzezinski remains the Veteran's attorney. He may file a motion to withdraw at any time that complies with the requirements of 38 C.F.R. § 20.6.

Service Connection

Service connection may be granted 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). Establishing service connection generally requires the following: (1) evidence of a current disability; (2) evidence of in- service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, service connection for certain chronic diseases, including bilateral hearing loss and tinnitus, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 111
condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be granted on a secondary basis for disability which is due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

1. Entitlement to service connection for bilateral hearing loss.

The Veteran has asserted that he misses things people say. See C&P Exam at 5 (May 2023).

The Board finds that the most persuasive evidence of record weighs against finding that there is a bilateral hearing loss disability for VA purposes. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.

The Board finds that there is not a current bilateral hearing loss disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1110; Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed. Cir. 1997). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. For VA purposes, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 159 (1993).

There are no in-service complaints of hearing loss. See STR - Medical (November 2009); STR (March 2010). In a January 1984 audiogram conducted for enlistment into the National Guard, there were normal right ear hearing thresholds. See STR at 21 (March 2010). There were left ear thresholds of 35 at 3000 and 4000 Hertz. See STR at 21 (March 2010). An October 1985 audiogram showed a right ear hearing threshold of 25 at 3000 Hertz and left ear hearing thresholds of 45 at 3000 and 4000 Hertz, which reflect abnormal hearing at these levels. See STR at 11 (March 2010); Hensley, 5 Vet. App. at 159. Despite the abnormal findings, the right ear threshold does not show a hearing loss for VA purposes; the left ear audiogram findings do show a hearing loss for VA purposes. See STR at 11 (March 2010); 38 C.F.R. § 3.385. Likewise, an audiogram in March 1986 noted
2010). An October 1985 audiogram showed a right ear hearing threshold of 25 at 3000 Hertz and left ear hearing thresholds of 45 at 3000 and 4000 Hertz, which reflect abnormal hearing at these levels. See STR at 11 (March 2010); Hensley, 5 Vet. App. at 159. Despite the abnormal findings, the right ear threshold does not show a hearing loss for VA purposes; the left ear audiogram findings do show a hearing loss for VA purposes. See STR at 11 (March 2010); 38 C.F.R. § 3.385. Likewise, an audiogram in March 1986 noted a right ear auditory threshold of 25 at 3000 Hertz, which reflects abnormal hearing at that level, but not a hearing disability for VA purposes. See STR - Medical at 9 (November 2009); Hensley, 5 Vet. App. at 159; 38 C.F.R. § 3.385. The March 1986 audiogram noted a left ear auditory threshold of 25 at 2000 Hertz, 35 at 3000 Hertz, and 45 at 4000 Hertz, which reflect abnormal hearing and a hearing disability for VA purposes. See STR - Medical at 9 (November 2009); Hensley, 5 Vet. App. at 159; 38 C.F.R. § 3.385. There is no service discharge audiogram. The Veteran denied hearing loss in Reports of Medical History dated in January 1984, October 1985, and March 1986. See STR - Medical at 9 (November 2009); STR at 10, 21 (March 2010). Thus, there was one instance noted of right ear abnormal hearing, but no hearing loss for VA purposes; there was left ear hearing loss for VA purposes. Furthermore, the AOJ conceded noise exposure due to the Veteran's award of Rifle Sharpshooter Badge. See Rating Decision at 4,5 (September 2024).

It is uncontroverted that the Veteran had an in-service left ear hearing loss and noise exposure. However, neither the lay nor the medical supports a finding that there is a current right or left ear hearing loss disability for VA purposes. In a September 2022 VA treatment record, the Veteran reported normal hearing. See VAMC Other Output/Reports at 65 (May 2024). The VA treatment records dated from 2010 to 2024 do not show reports of hearing loss, a diagnosis of hearing loss, or audiogram findings. See e.g., CAPRI (August 2022); CAPRI (March 2024); CAPRI (September 2023); CAPRI (September 2024); JLV/MTF (May 2024); VAMC Other Output/Reports (May 2024). Likewise, private medical records do not demonstrate reports of hearing loss, a diagnosis of hearing loss, or audiogram findings. See Medical Treatment Record - Non-Government Facility (November 2021); Medical Treatment Records - Furnished by SSA (March 2024).

Furthermore, a May 2023 VA-obtained Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ) determined that there was no bilateral hearing loss disability. See C&P Exam at 2, 3 (May 2023). The clinician noted that the puretone threshold test results were not valid for rating purposes and were inconsistent with organic hearing loss. See C&P Exam at 2 (May 2023). Speech discrimination scores were noted to be 100%, bilaterally. See C&P Exam at 3 (May 2023). Based on these findings, the clinician opined that there was normal hearing. See C&P Exam at 3 (May 2023). Thus, the medical evidence of record demonstrates that there is no hearing loss disability for VA purposes.

The Veteran has asserted that he misses things people say. See C&P Exam at 5 (May 2023). The Veteran is competent to report hearing loss symptoms. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). But the diagnosis of a hearing loss disability for VA purposes is not susceptible to lay observation because it requires audiological testing by a state licensed audiologist for auditory thresholds at the frequencies 500, 1000, 2000, 3000, or 4000 Hertz and speech recognition scores the Maryland CNC Test. 38 C.F.R. § 3.385. Therefore, competent lay evidence has not been presented of a hearing loss disability.

Accordingly, the claim is denied because neither the lay nor the medical evidence of record demonstrates a current hearing loss disability. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for tinnitus.

The Veteran has reported tinnitus. See C&P Exam at 5 (May 2023).

The Board finds that the most persuasive evidence of record weighs against finding that there is current disability of tinnitus. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

The Board finds that there is not a current tinnitus disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1110; Degmetich, 104 F.3d at 1332. Evidence must show that the Veteran currently has the disability for which benefits are being claimed.

There are no in-service complaints or diagnoses of tinnitus. See STR - Medical (November 2009); STR (March 2010). The AOJ, however, conceded noise exposure due to the Veteran's award of Rifle Sharpshooter Badge. See Rating Decision at 4, 5 (September 2024).

But in a September 2022 VA treatment record, the Veteran reported normal hearing. See VAMC Other Output/Reports at 65 (May 2024). The VA treatment records dated from 2010 to 2024 do not show reports of tinnitus or a diagnosis of tinnitus. See e.g., CAPRI (August 2022); CAPRI (March 2024); CAPRI (September 2023); CAPRI (September 2024); JLV/MTF (May 2024); VAMC Other Output/Reports (May 2024). Likewise, private medical records do not demonstrate reports of tinnitus or a diagnosis of tinnitus. See Medical Treatment Record - Non-Government Facility (November 2021); Medical Treatment Records - Furnished by SSA (March 2024). Furthermore, a May 2023 VA-obtained Hearing Loss and Tinnitus DBQ determined that there was no tinnitus. The clinician noted that the Veteran denied recurrent tinnitus. See C&P Exam at 6 (May 2023).

The Veteran has asserted that he has tinnitus. See C&P Exam at 5 (May 2023). The Veteran is competent to report tinnitus symptoms. See Washington, 19 Vet. App. at 368. Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. Davidson, 581 F.3d at 1316; Kahana, 24 Vet. App. at 435. But the Board does not find the assertions of the presence of tinnitus credible as there are conflicting statements of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Notably, the Veteran denied tinnitus at the VA-obtained examination. See C&P Exam at 6 (May 2023). Additionally, as noted above, the Veteran's private and VA medical records do not show complaints or diagnoses of tinnitus. Silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record. Kahana v. Shinseki, 24 Vet. App. at 440 (Lance, J., concurring). The Board finds that the tinnitus would have been reported at some point in either VA or private medical treatment if it had been present, particularly where the Veteran reported headaches, rashes, and sinus problems. See VAMC Other Output/Report at 75 (May 2024); CAPRI at 33, 186 (March 2024); JLV/MTF (May 2024). Where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the condition or symptoms did not exist. Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). Accordingly, the lay evidence does not support a finding of the presence of tinnitus.

Accordingly, the claim is denied because neither the lay nor the medical evidence of record demonstrates a current disability of tinnitus. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for sleep apnea, to include as secondary to service-connected PTSD or as due to a TERA.

The Veteran contends that as of 2020, he began having an inability to fall and stay asleep, wakes 5 to 6 times per night, grinds his teeth, snores, and gasps, all of which cause him to be agitated and to have impaired memory and concentration. See C&P Exam at 2 (September 2022).

The Board concludes that the evidence of record weighs against finding the Veteran has a current disability of sleep apnea. See 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303; Holton, 557 F.3d at 1366.

There are no in-service complaints, symptoms, or diagnoses of sleep apnea. See e.g., STR - Medical (November 2009); STR (March 2010). Rather, the Veteran denied trouble sleeping in January 1984, October 1985, and March 1986. See STR - Medical (November 2009); STR at 11, 22 (March 2010).

Additionally, the post-service VA and private medical records do not contain any diagnoses or treatment of sleep apnea. See e.g., CAPRI (September 2023); CAPRI (September 2024); CAPRI (October 2024); VAMC Other Output/Reports (May 2024); VAMC Other Output/Reports (March 2023); JLV/MTF (May 2024). The Veteran has reported sleep problems. See CAPRI at 104 (August 2022); CAPRI at 248, 276 (September 2023); CAPRI at 36, 79, 130, 131, 142 (October 2024). But VA examination reports dated in 2021, 2023
do not contain any diagnoses or treatment of sleep apnea. See e.g., CAPRI (September 2023); CAPRI (September 2024); CAPRI (October 2024); VAMC Other Output/Reports (May 2024); VAMC Other Output/Reports (March 2023); JLV/MTF (May 2024). The Veteran has reported sleep problems. See CAPRI at 104 (August 2022); CAPRI at 248, 276 (September 2023); CAPRI at 36, 79, 130, 131, 142 (October 2024). But VA examination reports dated in 2021, 2023, and 2024 relate the Veteran's sleep problems to his service-connected PTSD. See C&P Exam at 5 (May 2024); C&P Exam at 5 (May 2023); C&P Exam at 7 (December r2021); C&P Exam at 9 (August 2021).

Furthermore, in a September 2022 VA-obtained Sleep Apnea DBQ, the clinician determined there was no diagnosis of sleep apnea. See C&P Exam (September 2022). A VA-obtained sleep study determined there was no evidence of clinically significant obstructive sleep apnea. See C&P Exam at 3 (October 2022). In an October 2024 VA-obtained Sleep Apnea DBQ and opinion report, the clinician again determined there was no diagnosis of sleep apnea. See C&P Exam at 1, 3 (October 2024); C&P Exam at 2 (October 2024). Thus, the objective evidence of record does not demonstrate a current diagnosis of sleep apnea.

The Veteran has asserted sleep apnea and sleep problems. See C&P Exam at 2 (September 2022). The Veteran is competent to report symptoms such as difficulty sleeping, daytime fatigue, gasping, and snoring. See Washington, 19 Vet. App. at 368. Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. Davidson, 581 F.3d at 1316; Kahana, 24 Vet. App. at 435. But the diagnosis of sleep apnea, to include attributing sleep symptoms to sleep apnea versus a psychiatric disorder that includes sleep difficulty, is not susceptible to lay observation and requires medical knowledge as to disease processes and their likely causes, which the Veteran is not shown to possess. See Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, although the Veteran is competent and credible to report symptoms, they are not competent to relate these symptoms to a diagnosis of sleep apnea. Thus, the lay evidence of record does not demonstrate a sleep apnea diagnosis.

Accordingly, the claim for service connection for sleep apnea is denied as there is no current disability. As the evidence of record persuasively weighs against the claims, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Evaluations

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41.
38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999).

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009).

4. Entitlement to an initial evaluation in excess of 10 percent for service-connected hypertension.

On March 31, 2023, the AOJ received a claim for service connection for hypertension. See VA 21-526EZ, Fully Developed Claim (March 2023). In a May 2023 rating decision, the AOJ denied service connection for high blood pressure. See Rating Decision (May 2023). In May 2024, the AOJ received a supplemental claim for service connection for high blood pressure. See VA Form 20-0995 Supplemental Claim Application (May 2024). In an October 28, 2024 rating decision, the AOJ granted service connection for hypertension, and assigned a 10 percent evaluation, effective March 31, 2023. See Rating Decision (October 2024). This appeal arises from the Veteran's disagreement with that decision. See VA Form 10182 Notice of Disagreement (September 2025). Thus, the relevant rating review period begins on March 31, 2023, the effective date of the award of service connection; and ends on October 28, 2024, the date of the rating decision on appeal.

Hypertension is rated pursuant to 38?C.F.R. §?4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or; it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

In rating hypertension under DC 7101, the Board may consider blood pressure readings taken while a veteran is using medication. McCar
?4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or; it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

In rating hypertension under DC 7101, the Board may consider blood pressure readings taken while a veteran is using medication. McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (holding that DC 7101 contemplates the effects of medication and thus Jones v. Shinseki, 26 Vet. App. 56 (2012), does not apply).

The term predominant is not defined in the rating criteria. With respect to its definition as applicable to hypertension, the Veterans Benefits Administration has issued guidance in the M21-1 Adjudication Procedures Manual (M21-1) defining such terms. The M21-1 is not binding on the Board; however, the Board also has a responsibility to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases. Overton v. Wilkie, 30 Vet. App. 257 (2018). In regard to this case, the M21-1 provides the following relevant definition of predominant under 38 CFR 4.104, Diagnostic Code as requiring the "most common or prevailing" blood pressure reading. See M21-1, Part V, Subpart iii, Chapter 5, Section 3.e.

The Board finds that the Veteran's hypertension did not more nearly manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

The evidence of record shows that blood pressure readings during the rating review period showed systolic pressure of less than 200 and diastolic pressure was not 110 or more in August 2024, June 2024, May 2024, April 2024, and January 2024. See CAPRI at 7 (October 2024); CAPRI at 78, 115, 138 (September 2024); Medical Treatment Records - Furnished by SSA (March 2024). A September 2024 VA-obtained Hypertension examination was conducted. See C&P Exam (October 2024). Readings taken were as follows: 162/109; 173/105; and 156/106. See C&P Exam at 3 (October 2024).

Thus, during the rating review period, the Veteran's hypertension did not manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Accordingly, the Veteran's hypertension does not more nearly approximate the criteria corresponding to a 20 percent rating.

The Board acknowledges that in the September 2024 VA-obtained Hypertension examination report, the Veteran reported symptoms of headaches, shaking, dizziness, and chest pain that radiates to the left arm. See C&P Exam at 2 (October 2024). Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran is competent to report any observable symptomatology. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). But the etiology of these symptoms - whether they are related to hypertension - is not susceptible to lay observation and requires medical knowledge as to disease processes and their likely causes, which the Veteran is not shown to possess. See Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, these lay statements do not establish that any such symptoms are due to his service-connected hypertension, as opposed to any non-service-connected conditions.

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Furthermore, in the September 2024, VA-obtained examination report, the clinician found bilateral lower extremity edema that
- whether they are related to hypertension - is not susceptible to lay observation and requires medical knowledge as to disease processes and their likely causes, which the Veteran is not shown to possess. See Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, these lay statements do not establish that any such symptoms are due to his service-connected hypertension, as opposed to any non-service-connected conditions.

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Furthermore, in the September 2024, VA-obtained examination report, the clinician found bilateral lower extremity edema that was related to the hypertension diagnosis, but did not list any other physical finding, complication, condition, sign, or symptom that was part of the hypertension disability. See C&P Exam at 3 (October 2024). This finding weighs against the Veteran's alleged symptoms as related to the service-connected hypertension. The Board does not find the lay evidence of probative value because it is not competent evidence of symptoms that are secondary to the service-connected hypertension and it is outweighed by the September 2024 clinician's opinion that any such symptoms were not part of the hypertension disability. See Washington, 19 Vet. App. at 368 (providing that it is the responsibility of the Board to assess the probative weight of the evidence). Additionally, although the clinician found that lower extremity edema was part of the hypertension disability, this symptom is not eligible for service connection as the evidence does not indicate functional impairment of earning capacity due to edema. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (noting that a formal diagnosis is not required to satisfy the current disability element for all service-connection claims because that pain alone may constitute a current disability if it functionally impairs earning capacity).

Accordingly, the claim is denied. As the evidence of record persuasively weighs against a rating in excess of 10 percent for service-connected hypertension, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

C.A. SKOW

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K.M.

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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