LEG IMPAIRMENT OF

Summary

The Veteran, who served in the Army from July 1967 to February 1969, appeals the denial of service connection for a right leg condition and tinnitus, as well as the denial of a compensable evaluation for hypertension and an increased evaluation for bilateral hearing loss and coronary artery disease (CAD). The Veteran also appeals the reduction of his CAD rating from 10% to 0%. The Board reviewed new and relevant evidence submitted after prior decisions, allowing for readjudication of the right leg and foot claims. For the right foot and right leg conditions, the Board found the evidence in approximate balance, applying the benefit of the doubt to grant service connection. Service connection for PTSD was also granted, with the evidence establishing a nexus between an in-service stressor and the disorder. Tinnitus was granted service connection, with the evidence in approximate balance regarding noise exposure. The claim for hypertension was denied as the criteria for a compensable evaluation were not met. The bilateral hearing loss claim was denied an increased evaluation as the criteria were not met. The Board found the reduction in the CAD rating improper and reinstated the 10% evaluation, while denying an increased evaluation for CAD from March 2024.

Rationale

Establishes causal relationship to in-service injury

Full Decision Text

Citation Nr: A25101455
Decision Date: 11/21/25	Archive Date: 11/21/25

DOCKET NO. 250214-515740
DATE: November 21, 2025

ORDER

New and relevant evidence having been received, the claim for entitlement to service connection for a right leg disability may be readjudicated.

Entitlement to service connection for a right foot disability is granted.

Entitlement to service connection for a right leg disability is granted.

Entitlement to service connection for an acquired psychiatric disorder, diagnosed as posttraumatic stress disorder (PTSD), is granted.

Entitlement to service connection for tinnitus is granted.

Entitlement to a compensable evaluation for hypertension from March 11, 2023 is denied.

Entitlement to an evaluation in excess of 50 percent for bilateral hearing loss from March 11, 2024 is denied.

The reduction in evaluation for coronary artery disease (CAD), status post coronary artery bypass draft and residual scarring from 10 percent to 0 percent was not proper and the 10 percent evaluation is reinstated effective July 2, 2024.

Entitlement to an evaluation in excess of 10 percent for CAD, status post coronary artery bypass draft and residual scarring from March 11, 2024 is denied.

FINDINGS OF FACT

1. New and relevant evidence having been received after the September 2009 rating decision and prior to the June 2024 rating decision, the claim for entitlement to service connection for a right leg disability may be readjudicated.

2. The evidence is in approximate balance as to whether a causal relationship exists between an in-service disease or injury and the Veteran's right foot disability.

3. The evidence of record establishes a causal relationship between an in-service disease or injury and the Veteran's right leg disability.

4. The evidence of record establishes a nexus between an in-service stressor and the Veteran's acquired psychiatric disorder, diagnosed as PTSD.

5. The evidence is in approximate balance as to whether a causal relationship exists between in-service noise exposure and the Veteran's tinnitus.

6. From March 11, 2023, the Veteran's hypertension was not manifested by diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; a history of diastolic pressure predominantly 100 or more and requiring continuous medication for control.

7. From March 11, 2024, the Veteran's speech discrimination test results and hearing thresholds did not meet the criteria for a rating in excess of 50 percent under Diagnostic Code (DC) 6100.

8. The reduction of the 10 percent disability rating for the Veteran's CAD, status post coronary artery bypass draft and residual scarring violated due process procedural requirements.

9. From March 11, 2024, the Veteran's CAD, status post coronary artery bypass draft and residual scarring was not manifested by workload of 5.1-7.0 METs resulting in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging).

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim of entitlement to service connection for a right leg disability are met. 38 C.F.R. §§ 3.156(d), 3.2500, 3.2501.

2. The criteria for entitlement to service connection for a right foot disability have been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for a right leg disability have been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. § 3.303.

4. The criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304(f), 4.125.

5. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to a compensable evaluation for hypertension from March 11, 2023 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.104, DC 7101.

7. The criteria for entitlement to an evaluation in excess of 50 percent for bilateral
.R. §§ 3.303, 3.304(f), 4.125.

5. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to a compensable evaluation for hypertension from March 11, 2023 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.104, DC 7101.

7. The criteria for entitlement to an evaluation in excess of 50 percent for bilateral hearing loss from March 11, 2024 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.85, DC 6100.

8. The reduction in rating for the service-connected CAD, status post coronary artery bypass draft and residual scarring from 10 percent to 0 percent effective July 2, 2024 was not proper and the 10 percent evaluation is reinstated effective July 2, 2024. 38 U.S.C. §§ 5104B, 5112; 38 C.F.R. §§ 3.105(e) and (i), 3.2502, 3.2601.

9. The criteria for entitlement to an evaluation in excess of 10 percent for CAD, status post coronary artery bypass draft and residual scarring from March 11, 2024 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.104, DC 7005.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty service from July 1967 to February 1969.

A rating decision was issued in September 2009, which, in relevant part, denied service connection for a right leg condition and tinnitus.

A rating decision was issued in August 2021, which, in relevant part, denied service connection for a right foot condition.

In March 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim for the issues of service connection for a right leg condition, right foot condition, and tinnitus from the September 2009 and August 2021 rating decisions.

In June 2024, the Agency of Original Jurisdiction (AOJ) issued one of the rating decisions on appeal, which, in relevant part, granted service connection for hypertension with an evaluation of 0 percent effective March 11, 2023 and denied service connection for memory loss.

In June 2024, the AOJ issued another rating decision on appeal, which denied service connection for a right foot condition, a right leg condition, and tinnitus, denying service connection for a right foot condition on the merits. In doing so, it made an implicit finding of new and relevant evidence to readjudicate the issue of entitlement to service connection for a right foot condition. This is a favorable finding by the AOJ and the Board will proceed to the address the claim on the merits. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). The June 2024 rating decision also found that new and relevant evidence had been received to reconsider the claim for tinnitus and adjudicated it, continuing and confirming the denial of service connection for tinnitus.

In July 2024, the AOJ issued the third rating decision on appeal, which increased the evaluation for bilateral hearing loss from 0 percent disabling to 50 percent effective March 11, 2024 and decreased the evaluation of CAD, status post coronary artery bypass draft and residual scarring from 10 percent disabling to 0 percent effective July 2, 2024.

In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the appellant elected the Hearing option. The Veteran testified at a June 2025 video hearing with the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed and associated with the claims file. Accordingly, the Board may only consider the evidence of record at the time of the June 2024 AOJ decisions on appeal for the issues of entitlement to a compensable evaluation for hypertension from March 11, 2023, entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD, entitlement to service connection for a right foot disability, entitlement to service connection for a right leg disability, and entitlement to service connection for tinnitus, as well as any evidence submitted by the appellant or
Notice of Disagreement) (NOD), the appellant elected the Hearing option. The Veteran testified at a June 2025 video hearing with the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed and associated with the claims file. Accordingly, the Board may only consider the evidence of record at the time of the June 2024 AOJ decisions on appeal for the issues of entitlement to a compensable evaluation for hypertension from March 11, 2023, entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD, entitlement to service connection for a right foot disability, entitlement to service connection for a right leg disability, and entitlement to service connection for tinnitus, as well as any evidence submitted by the appellant or his attorney at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Board may only consider the evidence of record at the time of the July 2024 AOJ decision on appeal for the issues of entitlement to an evaluation in excess of 50 percent for bilateral hearing loss from March 11, 2024, whether the reduction in evaluation for CAD, status post coronary artery bypass draft and residual scarring from 10 percent to 0 percent was proper, and entitlement to an evaluation in excess of 10 percent for CAD, status post coronary artery bypass draft and residual scarring from March 11, 2024, as well as any evidence submitted by the appellant or his attorney at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the claims. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file 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.

This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2).

1. New and relevant evidence having been received, the claim for entitlement to service connection for a right leg disability may be readjudicated.

Under the Appeals Modernization Act (AMA), a claimant may continuously pursue a claim or issue by filing a supplemental claim following notice of a decision by the AOJ or the Board. 38 C.F.R. § 3.2500(c). If new and relevant evidence is presented or secured with respect to the supplemental claim, the AOJ will readjudicate the claim taking into consideration all the evidence of record. 38 C.F.R. § 3.2501.

A claim may be readjudicated based on new and relevant evidence. 38 C.F.R. § 3.156(d). New evidence is evidence not previously part of the actual record before agency adjudicators. Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. 38 C.F.R. § 3.2501(a)(1).

As provided above, a September 2009 rating decision denied service connection for a right leg condition. The Veteran did not appeal this denial and new and material evidence was not received within one year of the denial; therefore, it became final in the Legacy system. In March 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, in relevant part, for the issue of service connection for a right leg condition from the September 2009 rating decision. The June 2024 rating decision denied service connection for a right leg condition because the evidence submitted was not new and relevant.

In this case, a Records Research Center Response providing that exposure to herbicides was conceded based on the Veteran's duty or visitation (boots on ground) in the Republic of Vietnam and a VA memorandum showing that the Veteran participated in a toxic exposure risk activity (TERA) were added to the claims file between the September 2009 rating decision and the June 2024 rating decision. This evidence is new, as it was not previously part of the record before agency adjudicators. It is also relevant, as it tends to prove a matter at issue in the claim. Accordingly, readjudication of the claim for entitlement to service connection for a right leg disability is warranted.

SERVICE CONNECTION

In seeking VA disability compensation, a Veteran generally seeks to establish
 case, a Records Research Center Response providing that exposure to herbicides was conceded based on the Veteran's duty or visitation (boots on ground) in the Republic of Vietnam and a VA memorandum showing that the Veteran participated in a toxic exposure risk activity (TERA) were added to the claims file between the September 2009 rating decision and the June 2024 rating decision. This evidence is new, as it was not previously part of the record before agency adjudicators. It is also relevant, as it tends to prove a matter at issue in the claim. Accordingly, readjudication of the claim for entitlement to service connection for a right leg disability is warranted.

SERVICE CONNECTION

In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303.

Establishing service connection generally requires competent evidence showing: (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 present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases, including tinnitus, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1110, 1112; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for a right foot disability

The Veteran claims entitlement to service connection for a right foot disability. Following a thorough review of the Veteran's medical records, the Board finds that he is entitled to an award of service connection.

In the June 2024 rating decision, the AOJ made favorable findings that established the first and second elements of service connection for a right foot disability. Specifically, the Veteran had been diagnosed with right foot plantar fasciitis in medical records. Additionally, the evidence showed that a qualifying event, injury, or disease had its onset during service. Specifically, the Veteran's exit examination showed a complaint of foot trouble. As the Board is bound by these favorable findings, the analysis will focus on whether a nexus exists between the Veteran's current right foot disability and his active duty service.

Turning to evidence of a causal relationship between the present disability and a disease or injury during service, the Board finds that the medical and lay evidence of record is in approximate balance as to whether a nexus exists between an in-service disease or injury and the Veteran's right foot disability.

In an August 2021 opinion, a VA examiner determined that the claimed right foot disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She wrote:

No records found that he was seen for right foot pain during his service period from July 18, 1967 to February 19, 1969. He had only several documented visits to provider for right foot pain on June 1, 2009, December 20, 2009, November 1, 2010 and September 6, 2013. This is for right foot pain, 40 years after he was discharged from the military. Although he says that he had right foot pain since the military, there are no medical records to substantiate the claim. It is very likely that his right foot plantar fasciitis developed as a result of aging and presence of pes planus. Therefore, it is my contention that his right foot pain diagnosed as right plantar fasciitis is less likely than not incurred or proximately due
 February 19, 1969. He had only several documented visits to provider for right foot pain on June 1, 2009, December 20, 2009, November 1, 2010 and September 6, 2013. This is for right foot pain, 40 years after he was discharged from the military. Although he says that he had right foot pain since the military, there are no medical records to substantiate the claim. It is very likely that his right foot plantar fasciitis developed as a result of aging and presence of pes planus. Therefore, it is my contention that his right foot pain diagnosed as right plantar fasciitis is less likely than not incurred or proximately due to right foot pain during service.

In May 2025, a physician reviewed the evidence of record. She wrote that the Veteran began experiencing foot pain during his service in Vietnam, where his duties as an infantryman required long-distance marches while carrying heavy gear, placing continuous strain on his feet. Although not formally treated in service, he managed symptoms independently for years and consistently reported chronic right foot pain dating back to that time. She wrote that in the context of his service as an infantryman, the aggravation of pes planus could be attributed to several interrelated factors, including mechanical overload from long-distance marches, structurally inadequate footwear, and underlying intrinsic foot characteristics. She then discussed medical literature addressing each of these factors in support of her opinion. She wrote that plantar fasciitis was a well-documented condition among military infantrymen and its development in this specific Veteran was consistent with the chronic overuse and physical stress he experienced during his service due to daily marching, extended patrols, continuous standing while carrying heavy gear, and wearing combat boots. She concluded by writing:

The cumulative nature of [his] injury is medically consistent with studies showing how chronic microtrauma accumulates over time, particularly in the context of military training regimens involving running, jumping, and extended standing. Both intrinsic risk factors such as his flatfoot deformity and extrinsic influences namely inadequate footwear and high physical load heightened his susceptibility to plantar fasciitis. Additionally, the persistent physical and psychological stress of combat service may have affected his pain tolerance and delayed care seeking behaviors, complicating both diagnosis and early management. In conclusion, although the VA previously denied service connection for [his] plantar fasciitis...citing the absence of medical treatment for 40 years and attributing the condition to aging and pes planus, this position fails to fully account for the Veteran's credible and documented history. Notably, the VA conceded an in-service injury, referencing his exit examination, which included a complaint of right foot problems. [He] has consistently reported that his foot pain began during his Vietnam service and has persisted ever since. For decades, he managed his condition with home remedies and self-care, a common practice among Veterans who did not always report injuries during service or seek immediate post-discharge treatment. His military duties, prolonged marching, standing, and carrying heavy loads are medically recognized risk factors for plantar fasciitis, especially when combined with his service-related pes planus. The examiner's conclusion that the condition is due to aging and pes planus overlooks the fact that pes planus itself was first symptomatic during service and directly contributed to biomechanical overload on the plantar fascia. Given the in-service documentation of foot complaints, the continuous nature of symptoms, and the well-established relationship between pes planus, military overuse, and plantar fasciitis, it is at least as likely as not that [his] current plantar fasciitis is related to his in-service right foot injury.

The Board finds that the August 2021 and May 2025 opinions are probative, as they provide clear conclusions with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Thus, the Board finds these opinions to be adequate as well as probative.

On review, the record contains both positive and negative evidence regarding nexus. Thus, the Board finds that the competent and credible evidence is approximately balanced as to whether a nexus exists between in-service disease or injury and the Veteran's right foot disability. The benefit of the doubt doctrine applies. 38?U.S.C. § 5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is granted.

2. Entitlement to service connection for a right leg disability

The Veteran also claims entitlement to service connection for a right leg disability. Following a thorough review of the Veteran
 well as probative.

On review, the record contains both positive and negative evidence regarding nexus. Thus, the Board finds that the competent and credible evidence is approximately balanced as to whether a nexus exists between in-service disease or injury and the Veteran's right foot disability. The benefit of the doubt doctrine applies. 38?U.S.C. § 5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is granted.

2. Entitlement to service connection for a right leg disability

The Veteran also claims entitlement to service connection for a right leg disability. Following a thorough review of the Veteran's medical records, the Board finds that he is entitled to an award of service connection. As the Board is granting the benefit sought in full on the theory of direct service connection, a discussion of other theories is moot.

As an initial matter, the Board finds that the Veteran has satisfied the first element of service connection, a current disability. A review of the Veteran's medical treatment records shows that he has current diagnoses of chronic patellofemoral pain syndrome, medial knee soft-tissue strain/pes anserine bursitis, and lower-leg myofascial overuse syndrome. See Private Medical Opinion dated May 2025. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability.

With regards to the second prong of service connection, evidence of an in-service disease or injury, in the May 2009 claim, the Veteran wrote that he was requesting service connection for the right leg. He wrote that it began during service.

A June 2021 VA Memorandum provided that exposure to herbicides was conceded based on the Veteran's duty or visitation (boots on ground) in the Republic of Vietnam. Additionally, a March 2024 VA Memorandum provided that the Veteran participated in a TERA. The Memorandum provided that the Veteran was exposed to, "Herbicide Agent - 2, 3, 7, 8 - Tetrachlorodibenzodioxin (TCDD). Herbicide Exposure Verification Memo, received June 17, 2021. Military personnel record, received August 11, 2015 - Republic of Vietnam service." Thus, the Board finds the Veteran has satisfied the second prong of direct service connection: evidence of an in-service event.

Turning to evidence of a causal relationship between the present disability and a disease or injury during service, the Board finds sufficient credible evidence which establishes this nexus.

In May 2025, a physician reviewed the evidence of record. She wrote that the Veteran began experiencing right leg pain during his service in Vietnam. She wrote that, as an infantryman, he routinely carried heavy loads over long distances, placing continuous stress on his lower extremities, which likely led to overuse injury and compensatory strain in the right leg. She wrote that the Veteran asserted that his current right leg condition was the direct result of the physical demands of service. She wrote that the Veteran's duties required prolonged marching, load carriage, and strenuous physical activity over uneven terrain conditions known to contribute to cumulative overuse and mechanical stress on the patellofemoral joint. She wrote that the pathophysiology of patellofemoral pain syndrome was multifactorial, involving mechanical overload, anatomical predispositions, and neuromuscular factors that impaired patellofemoral joint mechanics. She also wrote that cumulative overuse, a hallmark of infantry service, was a significant risk factor for patellofemoral pain syndrome. She wrote that medical literature demonstrated that repetitive military activities such as marching, running, and kneeling placed substantial stress on the patellofemoral joint. She then discussed relevant medical literature in support of this contention. She also discussed that biomechanical factors and neuromuscular control deficits played critical roles in patellofemoral pain syndrome development. She concluded by writing:

In conclusion, while the June 26, 2024 VA rating decision denied service connection for [his] right leg condition based on the absence of a documented in-service injury and lack of a formal diagnosis, the totality of the evidence, both lay and medical, demonstrates a clear and consistent basis for service connection. [He] has credibly and consistently reported right leg pain beginning during his Vietnam service, developing concurrently with his now service-connected right foot condition. His military occupational specialty (MOS) as an infantryman involved repetitive load-bearing, long-distance marches, and uneven terrain, all known risk factors for lower-extremity overuse syndromes...These pathologies are well documented in the medical literature as common sequelae of foot dysfunction and overuse in military settings. Although a formal diagnosis may not have been documented in the record at the time
 right leg condition based on the absence of a documented in-service injury and lack of a formal diagnosis, the totality of the evidence, both lay and medical, demonstrates a clear and consistent basis for service connection. [He] has credibly and consistently reported right leg pain beginning during his Vietnam service, developing concurrently with his now service-connected right foot condition. His military occupational specialty (MOS) as an infantryman involved repetitive load-bearing, long-distance marches, and uneven terrain, all known risk factors for lower-extremity overuse syndromes...These pathologies are well documented in the medical literature as common sequelae of foot dysfunction and overuse in military settings. Although a formal diagnosis may not have been documented in the record at the time of the VA's decision, the absence of diagnosis does not equate to absence of disease, particularly when symptoms have persisted for over five decades and are consistent with identifiable musculoskeletal syndromes. Taken together, the historical context, biomechanical evidence, [and] symptom chronicity...support the conclusion that [his] right leg condition is at least as likely as not related to his active-duty service and warrants service connection.

The Board finds that the May 2025 opinion is probative, as the opinion provides clear conclusions with supporting data and reasoned medical explanations connecting the two. Stefl, 21 Vet. App. 124-25; Nieves-Rodriguez, 22 Vet. App. 304. Thus, the Board finds this opinion to be adequate as well as probative. There is no nexus evidence to the contrary.

The competent and credible evidence persuasively weighs in favor of finding entitlement to service connection for a right leg disability is warranted. The claim is granted.

3. Entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD

The Veteran claims entitlement to service connection for memory loss. After reviewing the Veteran's medical records and statements to the Board, the issue of entitlement to service connection for memory loss has been recharacterized as a broader claim for entitlement to service connection for an acquired psychiatric disorder, diagnosed as PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that when a claimant makes a claim he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled).

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the in-service stressor occurred. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997).

The Veteran contends that his acquired psychiatric disorder is due to his active duty service. In the March 2024 claim, the Veteran wrote that he was requesting service connection for memory loss due to in-service herbicide exposures. He cited to the June 2021 Records Research Center Response. During the June 2025 hearing, the Veteran testified about his in-service stressors. The Veteran's attorney stated that for years, the Veteran's treatment notes had had references to treatment for PTSD and accompanying symptomology.

The first and most fundamental requirement for any service-connection claim is the existence of a current disability. 38 U.S.C. § 1110; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). VA requires a diagnosis that conforms to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to compensate for a psychiatric disability. Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 401 (2020). As an initial matter, the Board finds that the Veteran has satisfied the first element of service connection: a current disability, diagnosed as PTSD. See Psychological Evaluation dated May 2025 and PTSD Examination dated June 2025. During the May 2025 psychological evaluation and accompanying examination in June 2025, a licensed psychologist wrote that the Veteran had a DSM-5 diagnosis of PTSD. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability.

The second element of service connection, an in-service stressor, is established through the Veteran's Combat Infantryman Badge. 38 C.F.R. § 3.304(d). Therefore, the Board finds that the Veteran has satisfied the second prong of service connection: evidence of an in-service stressor.

With respect to the third requirement, medical evidence of a link between current symptomatology and the claimed in-service stressor during his military service, the Board finds that
 2025 psychological evaluation and accompanying examination in June 2025, a licensed psychologist wrote that the Veteran had a DSM-5 diagnosis of PTSD. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability.

The second element of service connection, an in-service stressor, is established through the Veteran's Combat Infantryman Badge. 38 C.F.R. § 3.304(d). Therefore, the Board finds that the Veteran has satisfied the second prong of service connection: evidence of an in-service stressor.

With respect to the third requirement, medical evidence of a link between current symptomatology and the claimed in-service stressor during his military service, the Board finds that the evidence weighs in favor of finding that the Veteran's PTSD is due to his in-service stressor.

With regards to a link between service and the Veteran's PTSD, in May 2025, a licensed psychologist provided a psychological evaluation of the Veteran. The psychologist reviewed the Veteran's record and discussed his history, including past and present illness, work/education history, and family/social history. He then provided a mental status examination, a DSM-5 diagnosis of PTSD, and a discussion/prognosis. He concluded by writing:

[The Veteran] suffers from PTSD. He meets the full DSM-5 criteria for this condition. It is at least as likely as not that his difficulties associated with PTSD are related to combat experiences in Vietnam. He should be considered disabled with occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, and mood...The mental status examination and clinical interview indicated significant deficits in memory, concentration, and in particular, emotional functioning. He clearly is not able to tolerate the stress of being in the presence of coworkers and supervisors much less interacting with them effectively. He is not able to maintain regular attendance at a competitive position. He cannot adapt to even simple stressful circumstances in work or work-like settings. He has a long history of employment and relational difficulties. He has a history of impaired impulse control leading to paranoid ideation as well as chronic difficulty getting along with others which includes family relations. He is clearly not able to be in the presence of other people without losing control of his anger. Even if he was able to work independently by himself and was limited to simple, repetitive tasks he would be prone to difficulties and not be able to tolerate the stress of an employment setting without accommodations.

The Board finds that the May 2025 psychological evaluation provides a clear and well-reasoned explanation with supporting data, and reasoned medical explanations connecting the two. Thus, the Board finds this opinion to be adequate as well as probative. Stefl, 21 Vet. App. 124-25; Nieves-Rodriguez, 22 Vet. App. 304. There is no nexus evidence to the contrary. Therefore, the Board finds the May 2025 psychological evaluation is sufficient evidence to satisfy the nexus element between the Veteran's PTSD and his in-service stressor.

As the Veteran has a current diagnosis of PTSD in accordance with 38 C.F.R. § 4.125, an in-service stressor established through his Combat Infantryman Badge, and medical evidence linking the two, the Board finds that the Veteran's PTSD was due to his in-service stressor. Thus, the Board finds that service connection for an acquired psychiatric disorder, diagnosed as PTSD, is warranted. The claim is granted.

4. Entitlement to service connection for tinnitus

The Veteran also claims entitlement to service connection for tinnitus. Following a thorough review of the Veteran's medical records, the Board finds that he is entitled to an award of service connection.

The Veteran is competent to describe observable symptoms such as ringing in the ears. Charles v. Principi, 16 Vet. App. 370, 374-75 (2002).

In the June 2024 rating decision, the AOJ made favorable findings that established the first and second elements of service connection for tinnitus. Specifically, the evidence showed that the Veteran had been diagnosed with tinnitus in a May 2024 VA examination. Additionally, the evidence showed that a qualifying event, injury, or disease had its onset during service. Specifically, the Veteran's DD214 documented a MOS of Infantryman, which had a high probability of noise exposure. As the Board is bound by these favorable findings, the analysis will focus on whether a nexus exists between the current disability and his service.

In the May 2009 claim, the Veteran wrote that he was requesting service connection for tinnitus that began during service.

With regards to whether a causal relationship exists between the Veteran's current tinnitus and his active duty service, in a September 2009 opinion, a VA examiner determined that the tinnitus, as reported and described by the Veteran, was not the result of military activity. He wrote:

The Veteran
 showed that a qualifying event, injury, or disease had its onset during service. Specifically, the Veteran's DD214 documented a MOS of Infantryman, which had a high probability of noise exposure. As the Board is bound by these favorable findings, the analysis will focus on whether a nexus exists between the current disability and his service.

In the May 2009 claim, the Veteran wrote that he was requesting service connection for tinnitus that began during service.

With regards to whether a causal relationship exists between the Veteran's current tinnitus and his active duty service, in a September 2009 opinion, a VA examiner determined that the tinnitus, as reported and described by the Veteran, was not the result of military activity. He wrote:

The Veteran's service treatment records (STRs) lacked evidence of the status of his hearing at the time of his separation from the Army. The existence at that time of the high-frequency hearing loss associated with exposure to high-intensity noise cannot be ruled out. The Veteran's description of the current pattern of tinnitus was not consistent with the tinnitus associated with exposure to high-intensity noise during the period of his military service. His description indicated no permanence or recurrent patterns stemming from noise exposure in combat, but instead temporary tinnitus as a reaction most people would experience after periodic exposure to loud noise.

In a May 2024 opinion, a VA examiner determined that the Veteran's tinnitus was less likely than not caused by or a result of military noise exposure. She wrote:

Veteran's MOS of Infantryman had a high probability for hazardous noise exposure. Audiograms were reviewed. Veteran's previous C&P exam from 2009 was also reviewed. During the Veteran's 2009 C&P, provider reported the Veteran's tinnitus "did not seem to occur with any pattern, but occurred whenever he was exposed to loud noise. In such cases the tinnitus lasted from about 20 to 30 minutes up to one hour. He gave as an example: time when he had been driving a truck on a high-speed highway and then pulled off onto a quieter highway." This was the first report of the Veteran's tinnitus. There are no records prior to his C&P or after his C&P in his STRs pertaining to his tinnitus. Today, Veteran's report of tinnitus was consistent with previous documentation. The Veteran's description of the current pattern of tinnitus was not consistent with the tinnitus associated with exposure to high-intensity noise during the period of his military service. Veteran also reported his tinnitus began "roughly 30 years ago," 25 years post military service. There is not sufficient evidence from longitudinal studies in humans to determine whether permanent noise-induced hearing loss or tinnitus can develop much later in one's lifetime, long after the cessation of that noise exposure. Although the definitive studies to address this issue have not been performed, based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely that such delayed effects occur. Due to the Veteran's report of time and circumstance of onset of his tinnitus, it is less likely than not the Veteran's tinnitus is due to his military service.

The examiner then cited to medical literature in support of her opinion.

In May 2025, a physician reviewed the evidence of record. She wrote that the Veteran had experienced tinnitus for over 30 years. She discussed his MOS in service and his regular exposure to noise. She wrote that he reported that the ringing in his ears began long after such exposure, initially while driving on highways, and had progressively worsened. It occurred now almost daily and interfered with his ability to sleep. She wrote:

The pathophysiology of delayed-onset tinnitus secondary to cumulative noise exposure, as observed in [this] case, is multifactorial encompassing peripheral auditory system damage, central neuroplastic changes, and psychological modulation. [He] served as an infantryman in Vietnam, a role inherently associated with prolonged and unprotected exposure to hazardous noise from gunfire, artillery, machinery, and explosives. Tinnitus defined as the perception of sound without an external source has a strong, well-documented link to occupational noise exposure, particularly among military personnel. Multiple studies support the role of cumulative acoustic trauma in the development of chronic tinnitus symptoms. Exposure to hazardous noise, especially from impact sources such as small arms fire and explosives, is a primary risk factor for auditory system dysfunction in combat Veterans. The Noise Outcomes in Servicemembers Epidemiology (NOISE) Study confirmed that military personnel are regularly exposed to hazardous noise throughout their careers, increasing the risk of...tinnitus...Kordmiri et al. (2025) demonstrated that annual noise exposure is strongly correlated with auditory processing deficits, with infantry units like [his] exhibiting elevated rates of tinnitus...due to the intensity and frequency of noise exposure. These findings directly support the plausibility of cumulative noise trauma sustained
 military personnel. Multiple studies support the role of cumulative acoustic trauma in the development of chronic tinnitus symptoms. Exposure to hazardous noise, especially from impact sources such as small arms fire and explosives, is a primary risk factor for auditory system dysfunction in combat Veterans. The Noise Outcomes in Servicemembers Epidemiology (NOISE) Study confirmed that military personnel are regularly exposed to hazardous noise throughout their careers, increasing the risk of...tinnitus...Kordmiri et al. (2025) demonstrated that annual noise exposure is strongly correlated with auditory processing deficits, with infantry units like [his] exhibiting elevated rates of tinnitus...due to the intensity and frequency of noise exposure. These findings directly support the plausibility of cumulative noise trauma sustained during [his] infantry service.

The examiner discussed and cited to relevant medical literature in support of her opinion. She continued by writing:

In light of these findings, [his] tinnitus is medically consistent with delayed-onset auditory dysfunction caused by cumulative acoustic trauma sustained during active-duty service. The absence of immediate onset or early complaint should not preclude service connection, particularly in light of his high-risk military role, coexisting bilateral hearing loss, and credible symptom history. In conclusion, while the VA denied service connection for [his] tinnitus...primarily on the basis that he reported onset approximately 30 years after service. This rationale overlooks both the nature of cumulative acoustic trauma and the well documented phenomenon of delayed-onset tinnitus. [He] served as an infantryman in Vietnam, where he was routinely exposed to high-intensity combat noise without adequate hearing protection. This occupational exposure is medically recognized as a significant risk factor for permanent auditory dysfunction. Although he did not seek treatment during service or immediately after discharge, he has credibly and consistently reported that his tinnitus began decades ago and has progressively worsened over time. Contemporary research confirms that delayed-onset tinnitus following cumulative noise exposure is not only plausible but increasingly supported by neurophysiological studies demonstrating long-term changes in cochlear nerve activity and central auditory processing. [He] is already service-connected for bilateral hearing loss, further supporting a shared origin of damage within the auditory system. His reported symptoms, functional impact on sleep, and history of hazardous noise exposure are consistent with noise-induced tinnitus, even in the absence of contemporaneous STR documentation. Therefore, it is at least as likely as not that [his] tinnitus is related to his military service, and the delayed onset should not be interpreted as evidence against service connection, but rather as part of the known progression of noise-induced auditory pathology.

The Board finds that the September 2009, May 2024, and May 2025 opinions are probative, as they provide clear conclusions with supporting data, and reasoned medical explanations connecting the two. Stefl, 21 Vet. App. 124-25; Nieves-Rodriguez, 22 Vet. App. 304.

On review, the record contains both positive and negative evidence regarding nexus. Thus, the Board finds that the competent and credible evidence is approximately balanced as to whether a nexus exists between in-service noise exposure and the Veteran's tinnitus. The benefit of the doubt doctrine applies. 38?U.S.C. § 5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is granted.

Increased Ratings

A disability rating is determined by applying VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

If there is a question as to which evaluation to apply to the Veteran's disability, 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.

Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and coordination of rating with impairment of function. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire
imates 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.

Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and coordination of rating with impairment of function. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of his disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

5. Entitlement to a compensable evaluation for hypertension from March 11, 2023

The Veteran's hypertension is rated as noncompensable from March 11, 2023 under DC 7101. The Veteran seeks a higher rating. The period on appeal begins on March 11, 2023, the effective date of the award of service connection for this disability.

Hypertension is rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). 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.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

In rating hypertension under Diagnostic Code 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 Diagnostic Code 7101 contemplates the effects of medication and therefore Jones v. Shinseki, 26 Vet. App. 56 (2012) does not apply).

An April 2024 medical treatment record showed a blood pressure reading of 160/98.

In a July 2024 hypertension examination, the Veteran had previously been on medication but had taken himself off it and said that he was controlling it with goat milk. The examiner determined that the course of the condition since onset had stayed the same. He wrote that there were no current symptoms. The Veteran's treatment plan did not include taking continuous medication for hypertension or isolated systolic hypertension. He also did not have a history of a diastolic blood pressure elevation to predominantly 100 or more. The current blood pressure readings were reported as 142/88, 142/90, and 142/88.

In a May 2025 private opinion, a physician wrote that the Veteran had a longstanding pattern of elevated blood pressure readings, including multiple diastolic values at or above 100 mmHg and systolic values exceeding 160 mmHg, consistent with the criteria for a 10 percent rating. The examiner cited to blood pressure readings from August 2009, July 2010, August 2014, July 2017, January 2020, and April 2024. This opinion was reiterated by the Veteran's attorney in correspondence received in September 2025. While the Board acknowledges these blood pressure readings, as the period on appeal begins on March 11, 2023, only the April 2024 blood pressure reading is applicable to the period on review. While the Board acknowledges the April 2024 blood pressure reading of 160/98, the Board finds that this single blood pressure reading is not synonymous with systolic pressure predominantly 160 or more consistent with a higher 10 percent rating. As provided above, Merriam-Webster defines predominant to mean "being most frequent or common." As the April 2024 blood pressure reading is a single instance during the period on appeal and there is no other evidence of systolic pressure 160 or more, the Board finds that the evidence of record during the appeal period does not show that the Veteran's hypertension resulted in systolic pressure predominantly 160 or more as articulated by the 10 percent rating criteria. Thus, while the Board acknowledges the May 2025 opinion, as the evidence of record does not show diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or
olic pressure predominantly 160 or more consistent with a higher 10 percent rating. As provided above, Merriam-Webster defines predominant to mean "being most frequent or common." As the April 2024 blood pressure reading is a single instance during the period on appeal and there is no other evidence of systolic pressure 160 or more, the Board finds that the evidence of record during the appeal period does not show that the Veteran's hypertension resulted in systolic pressure predominantly 160 or more as articulated by the 10 percent rating criteria. Thus, while the Board acknowledges the May 2025 opinion, as the evidence of record does not show diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; a history of diastolic pressure predominantly 100 or more requiring continuous medication for control, a compensable evaluation is not warranted.

On review, medical evidence during the period for review does not show diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. In making this determination, the Board has reviewed the medical evidence of record. The disability picture does not meet or more nearly approximate the criteria for a compensable rating.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to a compensable evaluation for hypertension from March 11, 2023 is warranted. Rather, the evidence persuasively weighs against this. The benefit of the doubt doctrine does not apply. 38?U.S.C. §?5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied.

6. Entitlement to an evaluation in excess of 50 percent for bilateral hearing loss from March 11, 2024

The Board finds that at no time from March 11, 2024 has the Veteran's bilateral hearing loss warranted the assignment of a rating in excess of 50 percent under DC 6100. The period on appeal begins on March 11, 2024, the date of the Veteran's claim for an increased rating.

In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992); 38 C.F.R. § 4.85. Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometric tests at the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). To evaluate the degree of disability from bilateral defective hearing, the rating schedule establishes 11 auditory acuity levels designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. Id.

When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VI(a), whichever results in the higher numeral. Each ear will be evaluated separately. See 38 C.F.R. § 4.86(a). Similarly, if the puretone threshold is 30 decibels or less at 1000 Hz, and 70 decibels or more at 2000 Hz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VI(a), whichever results in the higher numeral, and that numeral will be elevated to the next higher Roman numeral.

Lastly, the Board must also assess the competence and credibility of lay statements and testimony. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran's lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010).

The Veteran was provided a VA audiological examination in July 2024. This examination revealed puretone thresholds, in decibels, as follows: 

	HERTZ

	1000	2000	3000	4000	Avg

RIGHT	70	80	90	105+	86.25

LEFT	70	80	90
 Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran's lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010).

The Veteran was provided a VA audiological examination in July 2024. This examination revealed puretone thresholds, in decibels, as follows: 

	HERTZ

	1000	2000	3000	4000	Avg

RIGHT	70	80	90	105+	86.25

LEFT	70	80	90	95	83.75

The VA examiner additionally administered the Maryland CNC word list pursuant to VA regulations. See 38 C.F.R. § 3.485. The Veteran attained 96 percent in both ears. These audiometric findings equate to Level III in both ears under Table VI. Applying these results to Table VII results in a noncompensable (0 percent) rating. 38 C.F.R. § 4.85, Tables VI and VII. During his examination, the Veteran reported, "I have trouble hearing and understanding people." Martinak v. Nicholson, 21 Vet. App. 447 (2007).

The Board has considered the Veteran's lay reports of symptoms. While the Veteran is competent as a lay person to report difficulty hearing, he is not competent to assign puretone threshold findings or speech recognition scores to his perceived hearing impairment. The assignment of such findings requires medical training and expertise which the Veteran is not shown to possess. Thus, the Board places greater probative weight on the audiometric findings recorded in the examination during the course of the appeal. See Layno v. Brown, 6 Vet. App. 465, 469 (1994).

The "rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment... Thus, when a claimant's hearing loss results in an inability to hear or understand speech or to hear other sounds in various contexts, those effects are contemplated by the schedular rating criteria." Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017). Thus, the Board finds that the current 50 percent rating contemplates difficulty hearing and understanding people.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to an evaluation in excess of 50 percent for bilateral hearing loss from March 11, 2024 is warranted. Rather, the evidence persuasively weighs against this. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied.

7. The reduction in evaluation for CAD, status post coronary artery bypass draft and residual scarring from 10 percent to 0 percent was not proper and the 10 percent evaluation is reinstated effective July 2, 2024.

In the July 2024 rating decision, the AOJ decreased the evaluation for the Veteran's CAD, status post coronary artery bypass draft and residual scarring from 10 percent to 0 percent effective July 2, 2024. The Veteran's CAD, status post coronary artery bypass draft and residual scarring is rated under DC 7005. This reduced his combined disability rating from 60 percent to 50 percent, creating a true reduction.

The Veteran asserts that the reduction in evaluation for CAD, status post coronary artery bypass draft and residual scarring from 10 percent to 0 percent was improper.

The provisions of 38 C.F.R. § 3.105(e) allow for the reduction in evaluation of a service-connected disability when warranted by the evidence, but only after following certain procedural guidelines. The Regional Office (RO) must issue a rating action proposing the reduction and setting forth all material facts and reasons for the reduction. The Veteran must then be given 60 days to submit additional evidence and to request a predetermination hearing. Then a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105(e). The effective date of the reduction will be the last day of the month in which a 60-day period from the date of notice to the Veteran of the final action expires. 38 C.F.R. § 3.105(e), (i)(2)(i).

The July 2024 rating decision reduced the Veteran's rating from 10 to 0 percent without following any of the due process requirements of 38 C.F.R. § 3
 setting forth all material facts and reasons for the reduction. The Veteran must then be given 60 days to submit additional evidence and to request a predetermination hearing. Then a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105(e). The effective date of the reduction will be the last day of the month in which a 60-day period from the date of notice to the Veteran of the final action expires. 38 C.F.R. § 3.105(e), (i)(2)(i).

The July 2024 rating decision reduced the Veteran's rating from 10 to 0 percent without following any of the due process requirements of 38 C.F.R. § 3.105. The reduction is therefore void ab initio (at its inception). Hayes v. Brown, 9 Vet. App. 67, 73 (1996) (where VA reduces the appellant's rating without observing applicable laws and regulations the rating is void ab initio). The appropriate remedy in this case is a reinstatement of the 10 percent disability rating for service-connected CAD, status post coronary artery bypass draft and residual scarring effective July 2, 2024. Id. at 73 (improper reduction reinstated effective date of reduction).

8. Entitlement to an evaluation in excess of 10 percent for CAD, status post coronary artery bypass draft and residual scarring from March 11, 2024

The Veteran's CAD, status post coronary artery bypass draft and residual scarring is rated as 10 percent disabling from March 11, 2024. The Veteran seeks a higher rating. The period on appeal begins on March 11, 2024, the date of the Veteran's claim for an increased rating.

Effective November 14, 2021, VA amended the rating criteria for arteriosclerotic heart disease (CAD) under 38 C.F.R. § 4.104, DC 7005. 86 Fed. Reg. 54089 (Sep. 30, 2021). This amended regulation applies to all applications for benefits received by VA or that are pending before the AOJ on or after November 14, 2021. Claims pending prior to the effective date will be considered under both the pre- and post-amendment rating criteria, and whichever is more favorable to the Veteran will be applied. However, the Board may not apply the post-amendment rating criteria to a period prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Conversely, the Board is not precluded from applying the pre-amendment rating criteria to a period on or after the effective date of the post-amendment rating criteria so long as it was in effect during the pendency of the appeal.

In this case, as the entirety of stage being adjudicated falls after the effective date of the amended criteria, the Board will only consider the post-amendment rating criteria in its analysis.

Effective November 14, 2021, under 38 C.F.R. § 4.104, DC 7005, arteriosclerotic heart disease (CAD) is rated in accordance with the General Rating Formula for Diseases of the Heart. A 10 percent rating is warranted where a workload of 7.1-10.0 METs results in heart failure symptoms; or continuous medication is required for control. A 30 percent rating is warranted where a workload of 5.1-7.0 METs results in heart failure symptoms, or where there is cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging). A 60 percent rating is warranted where a workload of 3.1-5.0 METs results in heart failure symptoms. A 100 percent rating is warranted where a workload of 3.0 METs or less results in heart failure symptoms.

Under the post-amendment rating criteria, one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104, Note (2). When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms may be used. Id.

For purposes of the General Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breath
 oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104, Note (2). When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms may be used. Id.

For purposes of the General Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).

A July 2024 echocardiogram report showed normal left ventricle chamber size and systolic function. LVEF was 55 to 60 percent. There was moderate concentric left ventricular pretrip with grade 1 diastolic dysfunction, and severe left atrial enlargement, mild aortic valve stenosis with a fixed right coronary cusp. Mild aortic regurgitation peak velocity was 2.8 m/s, mean gradient was 18 mmHg, and AVA was 1.4 cm squared. There was moderate mitral annular calcification with mild mitral regurgitation, a dilated aortic root measuring 4.1 cm, and normal right-sided filling pressures.

In a July 2024 heart conditions examination, the examiner determined that the course of the Veteran's condition since onset had stayed the same. There were no current symptoms. Continuous medication was not required for control of the Veteran's heart condition. After review of the July 2024 echocardiogram report, the examiner determined that there was no evidence of cardiac hypertrophy or cardiac dilatation. The examiner wrote that during an interview-based METs test, the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity.

In September 2025 correspondence, the Veteran's attorney wrote that the Veteran's cardiac damage should be considered evidence of ongoing disease activity that affected functional capacity over time.

The Board finds that the Veteran is not entitled to a disability rating of 30 percent for this period as the record does not demonstrate workload of 5.1-7.0 METs resulting in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging). On the contrary, the July 2024 examiner provided that during an interview-based METs test, the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. Additionally, after review of the July 2024 echocardiogram report, the July 2024 examiner determined that there was no evidence of cardiac hypertrophy or cardiac dilatation. As the evidence of record during the appeal period does not show that the Veteran's CAD, status post coronary artery bypass draft and residual scarring resulted in workload of 5.1-7.0 METs resulting in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging), the evidence of record does not show that the Veteran's CAD, status post coronary artery bypass draft and residual scarring caused the impairment articulated by a higher 30 percent disability rating. Therefore, the Board finds that the Veteran's CAD symptoms more closely approximate a 10 percent disability rating for this period.

The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board acknowledges that the Veteran believes that a rating in excess of 10 percent is warranted for his CAD, status post coronary artery bypass draft and residual scarring; however, as the evidence of record does not show that his CAD, status post coronary artery bypass draft and residual scarring resulted in workload of 5.1-7.0 METs resulting in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging, the Board finds that a higher 30 percent rating is not warranted.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to an evaluation in excess of 10 percent for CAD, status post coronary artery bypass draft and residual scarring from March 11, 2024 is warranted. Rather, the evidence persuasively weighs against a rating in excess of 
 his CAD, status post coronary artery bypass draft and residual scarring resulted in workload of 5.1-7.0 METs resulting in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging, the Board finds that a higher 30 percent rating is not warranted.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to an evaluation in excess of 10 percent for CAD, status post coronary artery bypass draft and residual scarring from March 11, 2024 is warranted. Rather, the evidence persuasively weighs against a rating in excess of 10 percent. The benefit of the doubt doctrine does not apply. 38?U.S.C. §?5107(b), Lynch, 21 F.4th 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied.

 

Laura E. Collins

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.