BRONCHITIS

Summary

The Veteran served from August 1986 to August 1990. The Veteran appeals the denial of an initial compensable rating for hypertension and seeks a 30 percent rating for chronic bronchitis. The Board granted a 30 percent rating for chronic bronchitis, finding that the Veteran's reported shortness of breath, combined with a September 2024 post-bronchodilator FEV-1 of 68 percent predicted, warranted the rating, resolving reasonable doubt in the Veteran's favor. The Board noted that while most PFT results suggested a lower rating, the continuing symptoms and the FEV-1 result supported the 30 percent evaluation. The Board also attributed all of the Veteran's respiratory distress to the service-connected chronic bronchitis, as it was not possible to separate the symptoms from non-service-connected conditions like COPD. The claim for hypertension was denied, as the evidence persuasively weighed against the criteria for a compensable rating, with blood pressure readings consistently below the thresholds for higher ratings and no clear indication of continuous medication use for predominantly high diastolic pressure during the relevant periods. The claim for chronic sinusitis was remanded for a new VA examination due to inadequate prior opinions.

Rationale

September 2024 post-bronchodilator FEV-1 of 68 percent predicted; Continuing reports of shortness of breath; Benefit of the doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: A26021976
Decision Date: 03/11/26	Archive Date: 03/11/26

DOCKET NO. 250819-586202
DATE: March 11, 2026

ORDER

Entitlement to an initial rating of 30 percent, but no higher, for chronic bronchitis is granted, subject to regulations governing the payment of monetary awards.

An initial compensable rating for hypertension is denied.

REMANDED

Entitlement to service connection for chronic sinusitis is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, the Veteran's chronic bronchitis has manifested during the period on appeal by a forced expiratory volume in one second of 56 to 70 percent of predicted.

2. The Veteran's hypertension has not been manifested by diastolic pressure predominantly 100 or more; or systolic pressure predominantly 160 or more; or by a history of diastolic pressure predominantly 100 or more requiring continuous medication for control.

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CONCLUSIONS OF LAW

1. Throughout the period on appeal, the criteria for a rating of 30 percent, but no higher, for residuals of chronic bronchitis are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.103, 3.105, 4.1, 4.2, 4.25, 4.3, 4.7, 4.96, and 4.97, Diagnostic Code 6600.

2. The criteria for entitlement to an initial compensable rating for hypertension are not met.  38 U.S.C. § 1155; 5107, 38 C.F.R. §§ 3.102, 4.1-4.14, 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1986 to August 1990.

The rating decision on appeal was issued in December 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In an August 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket.

As a preliminary matter, the Board notes that the Veteran's August 2025 VA Form 10182 identified a July 2024 rating decision as the decision on appeal along with a request for an extension of time to file the VA Form 10182.  Except as provided in the case of simultaneously contested claims, a claimant, or his or her representative, must file a properly completed VA Form 10182 with a decision by the agency of original jurisdiction (AOJ) within one year from the date that the agency mails the notice of the decision.  38 U.S.C. § 7105(b)(1)(A); 38 C.F.R. § 20.203(b).  

The July 2024 rating decision deferred a decision on entitlement to compensation for chronic bronchitis, hypertension, and sinusitis, and thus, did not determine a specific issue or make adjudication of a specific entitlement as to chronic bronchitis, hypertension, and sinusitis.  As the July 2024 rating decision was not an adverse action, it was not appealable as to the issues of chronic bronchitis, hypertension, and sinusitis.

However, a December 2024 rating decision made determinations as to the issues of chronic bronchitis, hypertension, and sinusitis, and the August 2025 VA Form 10182 was filed within one year from the date that the agency mailed the December 2024 notice of the decision.

Therefore, the Board liberally construes the August 2025 VA Form 10182 as appealing the December 2024 rating decision concerning chronic bronchitis, hypertension, and sinusitis, which will permit the Board to take the most Veteran-friendly approach and consider the most developed record.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 AOJ decision 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.

For the issues seeking an increased rating for bronchitis and hypertension, 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.
 the Board may only consider the evidence of record at the time of the December 2024 AOJ decision 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.

For the issues seeking an increased rating for bronchitis and hypertension, 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 claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

Because the Board is remanding the claim of entitlement to service connection for chronic sinusitis, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim.  38 C.F.R. § 3.103(c)(2)(ii).

Increased Ratings

VA's percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  If two disability evaluations are potentially applicable, 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.  All reasonable doubt will be resolved in favor of the claimant.  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 disability present.  38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).  While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. 

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  This decision will focus on the evidence pertinent to the rating criteria and disability severity during the relevant period on appeal, but the Board has considered the entire record to have a full picture of the disability.  See 38 C.F.R. §§ 4.1, 4.2, 4.41; Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits.  VA shall consider all information and the lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

1. Entitlement to an initial rating of 30 percent, but no higher, for chronic bronchitis is granted.

Legal Criteria

The Veteran is currently assigned a noncompensable evaluation for chronic bronchitis pursuant to 38 C.F.R. § 4.97, Diagnostic Code 6600.

Ratings under that formula are based off of pulmonary function tests (PFTs), including forced expiratory volume in one second (FEV-1), forced vital capacity (FVC), FEV-1/FVC ratios, and diffusion capacity of the lung for carbon monoxide by the single breath method (DLCO (SB)).  Post-bronchodilator studies are required when PFTs are done for disability evaluation purposes, except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why.  38 C.F.R. § 4
 4.97, Diagnostic Code 6600.

Ratings under that formula are based off of pulmonary function tests (PFTs), including forced expiratory volume in one second (FEV-1), forced vital capacity (FVC), FEV-1/FVC ratios, and diffusion capacity of the lung for carbon monoxide by the single breath method (DLCO (SB)).  Post-bronchodilator studies are required when PFTs are done for disability evaluation purposes, except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why.  38 C.F.R. § 4.96(d).

When evaluating based on PFTs, post-bronchodilator results should be used in applying the evaluation criteria in the rating schedule, unless the post-bronchodilator results were poorer than the pre-bronchodilator results.  In those cases, the pre-bronchodilator values should be used for rating purposes.  Id.

When there is a disparity between the results of different PFTs (FEV-1, FVC, etc.), so that the level of evaluation would differ depending on which test result is used, the test result that the examiner states most accurately reflects the level of disability should be utilized.  Id.

If the FEV-1 and the FVC are both greater than 100 percent, a compensable evaluation based on a decreased FEV-1/FVC ratio may not be assigned.  Id.

The formula assigns a 10 percent rating when FEV-1 is 71 to 80 percent of predicted; when FEV-1/FVC is 71 to 80 percent of predicted; or when DLCO (SB) is 66 to 80 percent of predicted.  Diagnostic Code 6600.

A higher 30 percent rating is assigned when FEV-1 is 56 to 70 percent of predicted; or FEV-1/FVC is 56 to 70 percent of predicted; or DLCO (SB) is 56 to 65 percent of predicted.  Id.

A 60 percent rating is assigned when FEV-1 is 40 to 55 percent of predicted; or FEV-1/FVC is 40 to 55 percent of predicted; or DLCO (SB) is 40 to 55 percent of predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min in (with cardiorespiratory limit).

A 100 percent rating is assigned when FEV-1 is less than 40 percent of predicted value, or; the FEV-1/FVC is less than 40 percent, or; DLCO (SB) is less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy.  Id.

In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.  38 CFR § 4.31.

Factual Background

An October 2023 VA treatment record reflects that the Veteran reported chronic cough, post-nasal drainage, nasal congestion, and feeling like there was "gunk" in his chest.

In an April 2024 VA examination, the Veteran reported coughing and shortness of breath.  He reported using Flonase, chlorpheniramine, oral steroids, albuterol via nebulizer as needed, and antibiotics.  The VA examiner indicated that the Veteran does not require outpatient oxygen therapy for his respiratory condition.  The Veteran's pre-bronchodilator results were FVC of 44 percent predicted, FEV-1 of 38 percent predicted, and FEV-1/FVC of 61 percent and DLCO of 85 percent predicted.  His post-bronchodilator results were FVC of 62 percent predicted, FEV-1 of 74 percent predicted, and FEV-1/FVC of 85 percent.  The VA examiner erroneously listed the Veteran's predicted results for FVC, FEV-1, and DLCO on the VA examination report, as opposed to the percent predicted results; however, the full and complete plethysmography report is of record, allowing for an accurate accounting of the Veteran's FVC, FEV-1, and DLCO percent predicted results.  The April 2024 VA examiner opined that the
 FEV-1/FVC of 61 percent and DLCO of 85 percent predicted.  His post-bronchodilator results were FVC of 62 percent predicted, FEV-1 of 74 percent predicted, and FEV-1/FVC of 85 percent.  The VA examiner erroneously listed the Veteran's predicted results for FVC, FEV-1, and DLCO on the VA examination report, as opposed to the percent predicted results; however, the full and complete plethysmography report is of record, allowing for an accurate accounting of the Veteran's FVC, FEV-1, and DLCO percent predicted results.  The April 2024 VA examiner opined that the FEV-1 percent predicted test results most accurately reflected the Veteran's level of disability.  The VA examiner noted that the Veteran has multiple respiratory conditions, including chronic obstructive pulmonary disease (COPD) and bronchitis, and that COPD is predominantly responsible for the limitation in pulmonary function.  The VA examiner opined that the Veteran's chronic bronchitis posed no functional impact in performing occupational tasks.

At a September 2024 VA examination, the Veteran reported coughing and shortness of breath.  He reported using chlorpheniramine, oral steroids, albuterol via nebulizer as needed, antibiotics, and intermittent inhalational bronchodilator therapy.  The VA examiner indicated that the Veteran does not require outpatient oxygen therapy for his respiratory condition.  The Veteran's pre-bronchodilator results were FVC of 62 percent predicted, FEV-1 of 61 percent predicted, and FEV-1/FVC of 70 percent and DLCO of 96 percent predicted.  His post-bronchodilator results were FVC of 61 percent predicted, FEV-1 of 68 percent predicted, and FEV-1/FVC of 79 percent.  The September 2024 VA examiner opined that the FEV-1 percent predicted test results most accurately reflected the Veteran's level of disability.  The VA examiner noted that the Veteran has multiple respiratory conditions, including COPD, chronic bronchitis, and severe obstructive lung disease, and that chronic bronchitis and severe obstructive lung disease are predominantly responsible for the limitation in pulmonary function.  The VA examiner opined that the Veteran's chronic bronchitis results in a functional impact in performing occupational tasks in that the Veteran's respiratory condition can significantly hinder his ability to work by causing symptoms such as shortness of breath, chronic coughing, and fatigue, which can reduce overall stamina and productivity.  The VA examiner further noted that frequent medical appointments or exacerbations may lead to absenteeism, further impacting job reliability, and the need to avoid certain environments, such as those with poor air quality or allergens, may limit employment opportunities.

A September 2024 VA treatment record reflects that the Veteran denied any shortness of breath and the treating nurse observed that his breathing pattern was unlabored.

Analysis

Resolving reasonable doubt in the Veteran's favor, the Board finds that a disability evaluation of 30 percent for the Veteran's chronic bronchitis is most appropriate. 

In this regard, both VA examiners opined that the FEV-1 percent predicted test was the test that most accurately reflected the Veteran's level of disability.  The Veteran's April 2024 post-bronchodilator FEV-1 was 74 percent predicted, which is within the guidelines of a 10 percent disability evaluation, and his September 2024 post-bronchodilator FEV-1 was 68 percent predicted, which is within the guidelines of a 30 percent disability evaluation.

The Veteran's April 2024 post-bronchodilator FEV-1/FVC was 85 percent, which is within the guidelines of a noncompensable rating, and his September 2024 post-bronchodilator FEV-1/FVC was 79 percent, which is within the guidelines of a 10 percent disability evaluation.

The Veteran's April 2024 post-bronchodilator DLCO was 85 percent predicted, and his September 2024 post-bronchodilator DLCO was 96 percent predicted, both of which are within the guidelines of a noncompensable rating,

While the majority of the Veteran's PFT results would indicate the appropriateness of a noncompensable or 10 percent disability evaluation, the Board finds probative the Veteran's continuing reports of the symptom of shortness of breath in April 2024 and September 2024.  The Veteran is competent to report having difficulty breathing.  

As both VA examiners opined that the FEV-1 percent predicted test was the test that most accurately reflected the Veteran's level of disability,
-bronchodilator DLCO was 85 percent predicted, and his September 2024 post-bronchodilator DLCO was 96 percent predicted, both of which are within the guidelines of a noncompensable rating,

While the majority of the Veteran's PFT results would indicate the appropriateness of a noncompensable or 10 percent disability evaluation, the Board finds probative the Veteran's continuing reports of the symptom of shortness of breath in April 2024 and September 2024.  The Veteran is competent to report having difficulty breathing.  

As both VA examiners opined that the FEV-1 percent predicted test was the test that most accurately reflected the Veteran's level of disability, the September 2024 post-bronchodilator FEV-1 was within the guidelines of a 30 percent disability evaluation, and the Veteran reported continuing symptoms of shortness of breath, the Board resolves the benefit of the doubt in favor of the Veteran as to the degree of disability and finds that these symptoms were present throughout the period on appeal.  38 C.F.R. § 4.3; see Swain v. McDonald, 27 Vet. App. 219, 224 (2015).  

The Board notes that the Veteran has other respiratory disorders, including COPD and sleep apnea, which are not service connected.  There is insufficient evidence to determine to what extent each condition contributed to the Veteran's respiratory distress; therefore, the Board will attribute all of the Veteran's respiratory distress to his service-connected lung condition.  See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (noting that, when it is not possible to separate signs and symptoms of a service-connected disability from signs and symptoms of a non-service-connected disability, 38 C.F.R. § 3.102 clearly dictates that reasonable doubt be resolved in the veteran's favor and that such signs and symptoms be attributed to the service-connected disability).

The Veteran's chronic bronchitis does not more closely approximate the criteria for a 60 percent rating at any point during the appeal period.

In this regard, only the Veteran's September 2024 post-bronchodilator FEV-1 results were within the guidelines of a 30 percent disability evaluation; his April 2024 FEV-1 and his April 2024 and September 2024 FEV-1/FVC and DLCO results were all within the guidelines of a 10 percent or noncompensable disability evaluation.  Furthermore, the evidence fails to show that the Veteran has a maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiac or respiratory limitation.

The Board has considered whether higher ratings can be assigned under any alternative diagnostic code under diseases of the trachea and bronchi; however, the Board finds that no other potentially applicable diagnostic codes warrant a higher rating and a rating under Diagnostic Code 6600 is most favorable to the Veteran.  38 C.F.R. § 4.97.

The Board has also considered whether a separate rating for impairment under another diseases of the trachea and bronchi diagnostic code is appropriate.  Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes is to be avoided when rating a veteran's service-connected disabilities.  38 C.F.R. § 4.14.  However, that does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code.  Esteban v. Brown, 6 Vet. App. 259 (1994).

Here, however, ratings under Diagnostic Codes 6600 through 6817 and 6822 through 6847 may not be combined with each other.  38 C.F.R. § 4.96.

In finding that a rating in excess of 30 percent is not warranted, the Board acknowledges that the Veteran uses various medications which may have beneficial effects on his service-connected chronic bronchitis.  The Board may not consider the ameliorative effects of medication unless such effects are explicitly contemplated by the rating criteria.  Jones v. Shinseki, 26 Vet. App. 56 (2012).  Here, the Board finds that the rating criteria used to evaluate the Veteran's respiratory condition contemplate the effects of medication.  In this regard, § 4.96 indicates that when evaluating a respiratory condition based on PFT results, the post-bronchodilator results should be used unless those results were poorer than the pre-bronchodilator results.  Thus, the Board finds that the rating criteria used to evaluate the Veteran's respiratory condition
 have beneficial effects on his service-connected chronic bronchitis.  The Board may not consider the ameliorative effects of medication unless such effects are explicitly contemplated by the rating criteria.  Jones v. Shinseki, 26 Vet. App. 56 (2012).  Here, the Board finds that the rating criteria used to evaluate the Veteran's respiratory condition contemplate the effects of medication.  In this regard, § 4.96 indicates that when evaluating a respiratory condition based on PFT results, the post-bronchodilator results should be used unless those results were poorer than the pre-bronchodilator results.  Thus, the Board finds that the rating criteria used to evaluate the Veteran's respiratory condition as a whole contemplate the effects of medication, and Jones is not applicable.  See McCarroll v. McDonald, 28 Vet. App. 267, 273 (2016) (holding that because the hypertension Diagnostic Code lists "continuous medication for control" as a criterion in the 10 percent evaluation, that Diagnostic Code, when read as a whole, contemplates the effects of medication in assigning a disability evaluation).

Based on the foregoing, the Board concludes that the evidence is at least in approximate balance and finds that a disability evaluation of 30 percent, but no higher, for the Veteran's chronic bronchitis is warranted pursuant to Diagnostic Code 6600.  Therefore, the Board resolves all reasonable doubt in the Veteran's favor and grants entitlement to an initial rating of 30 percent, but no higher, for chronic bronchitis.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. An initial compensable rating for hypertension is denied.

Legal Criteria

The Veteran is currently assigned a noncompensable evaluation for hypertension, pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7101.

Under Diagnostic Code 7101, an evaluation of 10 percent is warranted for diastolic pressure predominantly 100 or more; systolic pressure predominantly 160 or more; or, as the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.  38 C.F.R. § 4.104, Diagnostic Code 7101.

An evaluation of 20 percent is assigned for diastolic pressure predominantly 110 or more; or systolic pressure predominantly 200 or more.  Id.

An evaluation of 40 percent is contemplated for diastolic pressure predominantly 120 or more.  Id.

An evaluation of 60 percent is warranted for diastolic pressure predominantly 130 or more.  Id.

Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days.  For VA compensation purposes, the term hypertension means that diastolic blood pressure is predominantly 90 or greater, and isolated systolic hypertension means that systolic blood pressure is predominantly 160 or greater with diastolic blood pressure less than 90.  38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1).

Factual Background

The Veteran contends that an initial compensable rating is warranted for his service-connected hypertension.  August 2025 VA Form 10182.

An October 2023 VA treatment record documents a blood pressure reading of 125/81.

In April 2024, the Veteran underwent a VA examination.  The examiner noted a diagnosis of hypertension with an onset of 1990.  Since onset, the course of the condition has stayed the same.  The examiner noted that the Veteran's treatment plan includes taking continuous medication for hypertension or isolated systolic hypertension, noting that the Veteran takes Lisinopril and hydrochlorothiazide.  As the Veteran had a previously established diagnosis of hypertension, the VA examiner took three blood pressure readings on the day of the examination.  The Veteran's blood pressure readings were 138/71, 134/74, and 133/73.  The VA examiner reported that the Veteran does not have a history of diastolic blood pressure elevation to predominately 100 or more.

An April 2024 VA treatment record lists a blood pressure reading of 124/79.

A June 2024 VA treatment record documents a blood pressure reading of 110/73.

An October 2024 VA treatment record reflects blood pressure readings of 134/81 and 144/90.

In an effort to trace the medical history of the Veteran, the Board notes that from 1985, the year of enlistment, to 1990, the date of onset of hypertension, treatment records note diastolic pressure less than 100 and systolic pressure less than 160.  See, e.g., April 1985 Service Treatment Record (138
 of diastolic blood pressure elevation to predominately 100 or more.

An April 2024 VA treatment record lists a blood pressure reading of 124/79.

A June 2024 VA treatment record documents a blood pressure reading of 110/73.

An October 2024 VA treatment record reflects blood pressure readings of 134/81 and 144/90.

In an effort to trace the medical history of the Veteran, the Board notes that from 1985, the year of enlistment, to 1990, the date of onset of hypertension, treatment records note diastolic pressure less than 100 and systolic pressure less than 160.  See, e.g., April 1985 Service Treatment Record (138/68), September 1986 Service Treatment Record (140/90), January 1987 Service Treatment Record (124/60), and February 1989 Service Treatment Record (124/70).

Similarly, from 1990, the date of onset of hypertension, to 1996, service treatment records note diastolic pressure less than 100 and systolic pressure less than 160.  See, e.g., February 1990 Service Treatment Record (120/78), May 1990 Service Treatment Records (120/70 and 146/80), July 1990 Service Treatment Records (128/80 and 122/60), and July 1994 Service Treatment Records (158/98 and 148/88).

The July 1994 Report of Medical History indicates that the Veteran had no current medication.  Similarly, the October 1995 Report of Medical History indicates the Veteran was not on medication.  As such, there is no indication that the Veteran was on continuous medication for hypertension or isolated systolic hypertension during this time.

Analysis

Based on the foregoing, the Board finds that the evidence persuasively weighs against a finding that the Veteran's diastolic pressure has been predominantly 100 or more or that his systolic pressure has been predominantly 160 or more, or that the Veteran has a history of diastolic pressure predominantly 100 or more and requires continuous medication for control.  

In this regard, the Veteran's blood pressure readings during the appeal period fail to show his systolic pressure being over 160 on any occasion, nor his diastolic pressure being over 100 on any occasion.

Additionally, the evidence does not reflect that the Veteran has a history of diastolic pressure predominantly 100 or more that requires continuous medication for control.  The record reflects that the Veteran requires continuous medication for control of his blood pressure.  In particular, the April 2024 VA examination report reflects that he takes Lisinopril and hydrochlorothiazide for his high blood pressure.  Thus, what remains to be established is whether an increased 10 percent rating is warranted on account of the Veteran having a history of diastolic pressure predominantly 100 or more without the use of continuous medication.

In this regard, the Veteran was diagnosed with hypertension in 1990.  It is unclear when the Veteran began taking continuous medication for his high blood pressure, however, as of 1995, the Veteran reported that he was not taking medication.  The Veteran's historical service treatment records show blood pressure readings of 120/78, 120/70, 146/80, 128/80, 122/60, 158/98, and 148/88, all of which are diastolic pressure of less than 100 without the use of continuous medication.

Therefore, the Board finds that the evidence weighs persuasively against the criteria for a compensable evaluation for hypertension and the Board concludes that a higher initial evaluation is not warranted.

As the evidence is not in approximate balance, the "benefit of the doubt" doctrine is not applicable and a compensable rating for hypertension is denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

Entitlement to service connection for chronic sinusitis is remanded.

The Veteran contends that he has chronic sinusitis due to his service.

The December 2024 rating decision made favorable findings that the Veteran was diagnosed with chronic sinusitis and was exposed to asbestos during military service.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104.  

The Veteran was provided with a VA examination in April 2024.  The VA examiner opined that the Veteran's chronic sinusitis is less likely than not incurred in or caused by the service and less likely than not caused by the indicated toxic exposure risk activities (TERA), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran.  The VA examiner rationalized that she was unable to relate the Veteran's sinusitis
4 rating decision made favorable findings that the Veteran was diagnosed with chronic sinusitis and was exposed to asbestos during military service.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104.  

The Veteran was provided with a VA examination in April 2024.  The VA examiner opined that the Veteran's chronic sinusitis is less likely than not incurred in or caused by the service and less likely than not caused by the indicated toxic exposure risk activities (TERA), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran.  The VA examiner rationalized that she was unable to relate the Veteran's sinusitis to his service due to a lack of medical record information.

Thereafter, in September 2024, a VA clinician reviewed the Veteran's claims file and opined that the claimed condition was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran.  The VA clinician reasoned that in a December 1998 response, an ENT specialist stated that a review of all possible literature available on Medline since 1960 does not support a causal relationship between asbestos exposure and chronic sinusitis.

Both of these opinions are inadequate, as a medical opinion must support its conclusion with an analysis that the Board can weigh, and a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision.  Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).  Accordingly, the Board finds that both the April 2024 VA medical opinion and the September 2024 VA medical opinion are conclusory and inadequate.

In the December 2024 rating decision, the AOJ denied the claim without obtaining an addendum or new VA examination to address the above-noted deficiencies.  This is a pre-decisional duty to assist error.  A remand is necessary to correct it.

The matter is REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician to address the etiology and pathophysiology of the Veteran's chronic sinusitis.

Following a review of the Veteran's claims file, the examiner is asked to provide an opinion on the following:

Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's chronic sinusitis is due to the Veteran's service, to include his exposure to TERA.

When providing the opinion regarding TERA, the examiner must consider: 1) the total potential exposure through all applicable deployments; and 2) the synergistic, combined effect of all toxic exposure risk activities of the Veteran. 

A complete rationale must be provided for all opinions rendered. 

If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation.  The clinician must indicate whether there was any further need for information or testing necessary to make a determination.  Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner.

The clinician is asked to explain the reasons behind any opinions expressed and conclusions reached.  The clinician is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather, that the likelihood is at least approximately balanced or nearly equal, if not higher.  Note that the lack of documented treatment in service, or a long period after, while probative, cannot serve as the sole basis for a negative finding.  The Veteran's lay contentions must be considered and weighed in making the determination.

 

 

M. SORISIO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Knerr

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.