CHRONIC SINUSITIS

DAVID GRATZ · 2026 · Case ID: A26032496

MIXED

Summary

The veteran, who served with multiple periods of service between January 2003 and February 2017, appeals the denial of service connection for a pelvic condition and an acquired psychiatric disorder, including PTSD and insomnia. The veteran also appeals the reduction of his 10 percent rating for chronic sinusitis with nasal polyps, and the denial of service connection for loss of sense of taste and smell. The Board found the reduction of the chronic sinusitis rating improper, noting the agency of original jurisdiction (AOJ) failed to provide sufficient information regarding changes in disability, consider all applicable diagnostic codes, or properly address the impact of medication. Service connection for loss of taste and smell was granted on a secondary basis to the service-connected chronic sinusitis, as the evidence established these losses were symptoms of that condition. The claim for a pelvic condition was denied due to a lack of current diagnosis or symptoms, and the veteran's own denial of a pelvic issue during examination. The claim for an acquired psychiatric disorder beyond unspecified trauma and stressor related disorder was denied, as the evidence only supported the existing diagnosis of unspecified trauma and stressor related disorder, and did not contain a diagnosis of another psychiatric disorder. The Board remanded the claims for chronic sinusitis (for further examination and rating), bilateral hearing loss (for additional examination due to insufficient evidence), chronic bronchitis (for proper pulmonary function testing), erectile dysfunction (for adequate medical opinions considering all evidence), left ankle and foot disabilities (for further examination and history solicitation), and sleep apnea (as it was encompassed by the psychiatric disorder claim but not adjudicated).

Rationale

AOJ failed to meet requirements for rating reduction; Insufficient information to determine actual change in disability; AOJ did not address all applicable diagnostic codes

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6522

Docket No.

250502-544622

Full Decision Text

Citation Nr: A26032496
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 250502-544622
DATE: April 8, 2026

ORDER

Restoration of the 10 percent evaluation of chronic sinusitis to include nasal polyps, effective July 1, 2024, is granted.

Entitlement to service connection for loss of sense of taste is granted.

Entitlement to service connection for loss of sense of smell is granted.

Entitlement to service connection for pelvic condition is denied.

Entitlement to service connection for an acquired psychiatric disorder beyond unspecified trauma and stressor related disorder, to include posttraumatic stress disorder (PTSD) and insomnia, is denied.

REMANDED

Evaluation of chronic sinusitis to include nasal polyps is remanded.

Entitlement to a compensable rating for bilateral hearing loss disability is remanded.

Entitlement to an initial compensable rating for chronic bronchitis is remanded.

Entitlement to service connection for erectile dysfunction is remanded.

Entitlement to service connection for left ankle disability is remanded.

Entitlement to service connection for left foot disability is remanded.

Entitlement to service connection for sleep apnea is remanded.

FINDINGS OF FACT

1. Under the ordinary conditions of life, the Veteran's chronic sinusitis to include nasal polyps disability had not improved.

2. The Veteran's loss of sense of taste is a symptom of his service-connected chronic sinusitis to include nasal polyps disability.

3. The Veteran's loss of sense of smell is a symptom of his service-connected chronic sinusitis to include nasal polyps disability.

4. The Veteran has not had a pelvic disability at any time during or approximate to the pendency of the claim.

5. The Veteran has not had an acquired psychiatric disorder beyond unspecified trauma and stressor related disorder at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The reduction of the disability rating for chronic sinusitis to include nasal polyps from 10 to 0 percent, effective July 1, 2021, was improper. 38 C.F.R. §§ 3.4.2, 4.10.

2. The criteria for entitlement to service connection for loss of sense of taste as secondary to chronic sinusitis to include nasal polyps have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to service connection for loss of sense of smell as secondary to chronic sinusitis to include nasal polyps have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for entitlement to service connection for pelvic condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for an acquired psychiatric disorder beyond unspecified trauma and stressor related disorder, to include PTSD and insomnia, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2003 to November 2003, from June 2013 to May 2014 and from February 2016 to February 2017, with additional periods of inactive duty training and active duty for training.

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the February and April 2025 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that
AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the granted and denied 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. However, for the claims being remanded, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Restoration of the 10 percent evaluation of chronic sinusitis to include nasal polyps, effective July 1, 2024

Upon review of the evidence of record, the Board finds the reduction of the Veteran's chronic sinusitis rating was improper for multiple reasons and is not supported by the record.

In an October 2024 rating decision, the agency of original jurisdiction (AOJ) reduced the rating for the Veteran's chronic sinusitis to include nasal polyps disability from 10 to 0 percent, effective July 1, 2024, the date of a VA sinusitis examination. In the same decision, the AOJ also granted service connection for additional disabilities effective June 4, 2024, so this reduction did not reduce the Veteran's combined (overall) rating. Therefore, the provisions of 38 C.F.R. § 3.105(e) are not applicable to the Veteran's appeal. See Stelzel v. Mansfield, 508 F.3d 1345, 1346-47 (Fed. Cir. 2007). Nevertheless, certain requirements must be met for all rating reductions. Here, the AOJ failed to meet all the requirements to properly reduce the Veteran's rating.

The Court of Appeals for Veterans Claims (Court) has stated that "the [regional office] and Board are required in any rating-reduction case to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations." Brown v. Brown, 5 Vet. App. 413, 421 (1993) (emphasis added). The Court has also concluded, "in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work." Stern v. McDonough, 34 Vet. App. 51, 56 (2021) (quoting Brown v. Brown, 5 Vet. App. 413, 421 (1993)). The AOJ reduced the Veteran's rating based on a July 2024 examination report that does not provide sufficient information to determine if there was an actual change in the Veteran's disability that reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Moreover, the AOJ did not address all applicable diagnostic codes when reducing the Veteran's rating.

The October 2024 rating decision reduced the Veteran's rating based on a lack of polyps, relying on the rating criteria for rhinitis. However, the July 2024 examination report does not address what impact the Veteran's medication has on him or whether his medication was considered when determining the severity of his disability.

The Court has held that the Board may not deny a higher rating on the basis of "relief provided by medication when those effects are not specifically contemplated by the rating criteria."? Jones v. Shinseki, 26?Vet. App.?56, 63 (2012). The rating criteria for rhinitis do not specifically contemplate the relief provided by medication. 38 C.F.R. § 4.97, Diagnostic Code 6522. The evidence of record establishes that the Veteran takes medication for his disability; however, it is not clear whether any examiner discounted the ameliorative effects of the Veteran's medication when evaluating his symptoms. Furthermore, an August 2022 VA sinusitis examination, which was relied upon to assign the Veteran's initial 10 percent rating, showed similar symptoms as were noted in July 2024, including loss of smell and test, but it is unclear if the Veteran had polyps at that time. Moreover, there was a difference in noted medications when comparing the August 2022 (Claritin) and July 2024 (Dupixent) examinations report. Therefore, to the extent there was a change in signs or symptoms, the Board is unable to determine whether any change between August 2022 and July 2024 was merely due to taking different medication, or was an "actual change in the disability." Brown v. Brown, 5 Vet. App. 413, 421 (1993). Furthermore, even if there was a change in the actual disability as it related to polyps, the AOJ did not consider the Veteran's rating under the General Rating Formula for Sinusitis. See October 2024 rating decision.

In other words, even if a rating reduction was warranted under Diagnostic Code 6522 as it related polyps, consideration was not given to other applicable diagnostic codes. See August 2022 VA sinusitis examination report (boxes checked indicating Veteran had three non-incapacitating episodes in prior twelve months of sinusitis characterized by headaches, pain, and purulent discharge or crusting); 38 C.F.R. § 4.97, General Rating Formula for Sinusitis (10 percent rating for three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting). Additionally, the AOJ didn't consider the Veteran's loss of smell and taste when evaluating the Veteran's sinusitis and reducing his rating. See 38 C.F.R. § 4.87a.

Finally, the AOJ reduced the Veteran's rating under the criteria for rhinitis, noting a higher evaluation of 10 percent is not warranted for allergic rhinitis unless the evidence shows rhinitis without polyps, but with greater than 50 percent obstruction of the nasal passages on both sides; or complete obstruction of the nasal passages on one side. However, neither the August 2022 nor the July 2024 examination report evaluated rhinitis or whether there was such an obstruction. See August 2022 examination report, pages 3-4 and July 2024 examination report, pages 3-4; see also April 25, 2017 private treatment record (assessment includes allergic rhinitis); April 12, 2019 VA treatment record (review of chronic medical problems includes chronic rhinitis). More importantly, the Veteran's initial 10 percent rating was not based on rhinitis criteria (polyps), and was instead based on the sinusitis rating criteria, but the AOJ did not address this criteria when reducing the Veteran's rating. See October 2022 rating decision, pages 2-3.

In light of the above, the Board is not able to determine "that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work." Stern v. McDonough, 34 Vet. App. 51, 56 (2021) (quoting Brown v. Brown, 5 Vet. App. 413, 421 (1993)). Therefore, when conducting a de novo review of the evidence, the Board finds the reduction was improper and there is insufficient evidence to cure the AOJ's errors. See Lewis v. McDonough, 110 F.4th 1273, 1279 (2024) (de novo review of rating reduction). Accordingly, the rating will be restored to 10 percent, effective July 1, 2024.

2. Entitlement to service connection for loss of sense of taste
life and work." Stern v. McDonough, 34 Vet. App. 51, 56 (2021) (quoting Brown v. Brown, 5 Vet. App. 413, 421 (1993)). Therefore, when conducting a de novo review of the evidence, the Board finds the reduction was improper and there is insufficient evidence to cure the AOJ's errors. See Lewis v. McDonough, 110 F.4th 1273, 1279 (2024) (de novo review of rating reduction). Accordingly, the rating will be restored to 10 percent, effective July 1, 2024.

2. Entitlement to service connection for loss of sense of taste

3. Entitlement to service connection for loss of sense of smell

Upon review of the evidence of record, the Board finds the Veteran's loss of sense of smell and loss of sense of taste are symptoms of his service-connected chronic sinusitis to include nasal polyps. Therefore, service connections are warranted on a secondary basis.

The agency of original jurisdiction denied service connection for loss of sense of taste and smell, finding the evidence does not show a diagnosed disability. See April 2025 rating decision. However, the evidence of record establishes the Veteran suffers from a loss of taste and smell. See July 2024 VA sinusitis examination report, July 2024 respiratory conditions examination report, September 2024 sinusitis examination report, and March 2025 loss of sense of smell and/or taste examination report (for February 2025 examination). Furthermore, these examination reports and other evidence of record support finding that these symptoms are associated with the Veteran's sinusitis, which the AOJ recognized when denying service connection for loss of sense of taste and smell.

During your VA medical contractor examination on February 24, 2025 the examiner provided the following rationale: For the claimant's claimed condition of Loss of Smell and Taste there is no diagnosis because Loss of smell and taste only occurs when veteran gets sinusitis; loss of smell and taste can be a normal symptom of sinusitis.

The AOJ erred in not granting service connection for the Veteran's loss of sense of smell and taste. Being a symptom of a disability does not preclude service connection on a secondary basis. See Morgan v. Wilkie, 31 Vet. App. 162, 167 (2019). Here the evidence establishes that the Veteran suffers from a loss of sense of taste and a loss of sense of smell. The Board need not determine whether there is a partial or complete loss of the senses, only that the loss was a disability resulting from his service-connected chronic sinusitis to include nasal polyps. The evidence of record repeatedly supports such a conclusion. Accordingly, the Board finds that service connection for loss of sense of smell and loss of sense of taste is warranted. 38 C.F.R. § 3.310.

4. Entitlement to service connection for pelvic condition

Upon review of the evidence of record, the Board finds service connection for a pelvic condition is not warranted.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of a pelvic disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). He likewise does not have symptoms of a pelvic disability. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018) ("pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity").

In his June 2024 claim for benefits, the Veteran sought service connection for a pelvic
recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). He likewise does not have symptoms of a pelvic disability. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018) ("pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity").

In his June 2024 claim for benefits, the Veteran sought service connection for a pelvic condition, but did not identify a diagnosis or symptoms of a disability. Nevertheless, the agency of original jurisdiction provided an examination, which the Veteran attended in September 2024. During the examination, the Veteran indicated there was an error and he denied having a pelvis condition. September 2024 hip and thigh conditions examination report, page 3 ("Veteran states that this is erroneous and he denies hip and pelvis condition"). On examination, the Veteran was found to have full range of motion of the hips, and no signs or symptoms of a disability were noted.

The agency of original jurisdiction denied the Veteran's claim in October 2024. Despite his contention of an error, the Veteran filed a supplemental claim in November 2024 and appealed the April 2025 denial of that claim. However, the Veteran again did not identify any signs or symptoms of disability. A review of the record reveals little in the way of a disability. There is no medical evidence of a pelvic disability. The closest is a June 2015 record noting left hip pain that reportedly started after the Veteran competed a physical training course in service in April 2015. On examination he had good range of motion and did not exhibit pain with straight leg raise or rotation of the hips. No edema, heat or tenderness to palpation was found. Nevertheless, he was assessed with sciatica neuralgia. However, there is no subsequent treatment or complaint related to the Veteran's left hip.

The Veteran seeks service connection for a pelvic condition; however, the most probative evidence of record does not support finding he has a current pelvic disability. There is no medical or lay evidence indicating a current pelvic disability, and when given the opportunity to describe such a disability to a VA examiner the Veteran denied having one. The Veteran has subsequently failed to identify any signs or symptoms of a current disability. Further, the evidence does not show pain manifesting in a functional impairment of earning capacity. Therefore, the evidence of record is against finding that the first element of service connection, a current disability, is met.

Accordingly, as there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection for a pelvic condition must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

5. Entitlement to service connection for a psychiatric disorder beyond unspecified trauma and stressor related disorder, to include PTSD and insomnia

The Veteran seeks service connection for an acquired psychiatric disorder. The Veteran is already service connected for unspecified trauma and stressor related disorder, and the evidence of record does not support finding he has another diagnosed psychiatric disorder. Therefore, his claim must be denied.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of an acquired psychiatric disorder, except for unspecified trauma and stressor related disorder, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294
and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of an acquired psychiatric disorder, except for unspecified trauma and stressor related disorder, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

A July 2024 VA examiner determined that the Veteran suffers from unspecified trauma and stressor related disorder, but no other psychiatric disorder. Furthermore, years of VA and private treatment records do not contain a diagnosis of a psychiatric disorder. A diagnosis that conforms with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is required to establish service connection for an acquired psychiatric disorder. Martinez-Bodon v. McDonough, 28 F.4th 1241, 1247 (Fed. Cir. 2022).

While the Veteran may believe he suffers from another psychiatric disorder, including PTSD and insomnia, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, which only shows one diagnosed psychiatric disorder, i.e., unspecified trauma and stressor related disorder.

In light of the above, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for an acquired psychiatric disorder beyond unspecified trauma and stressor related disorder. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection for an acquired psychiatric disorder beyond unspecified trauma and stressor related disorder is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Nothing in this decision precludes the Veteran from seeking a higher rating for his already service-connected unspecified trauma and stressor related disorder.

REASONS FOR REMAND

1. Evaluation of chronic sinusitis to include nasal polyps is remanded.

Upon review of the evidence of record, the Board finds remand is warranted for additional development, and proper consideration of the Veteran's disability, including consideration of all symptoms and the appropriate diagnostic code or codes.

Generally, an appeal regarding the reduction of a rating must address only the propriety of the reduction, and not whether a veteran is entitled to a higher rating. Dofflemyer v. Derwinski, 2 Vet. App. 277, 279-80 (1992). However, when filing a claim with VA, claimants are presumed to be seeking the maximum available benefit for their disability. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In situations where the reduction stems from an original claim for a higher rating, the appeal may encompass not only the propriety of the reduction, but also the underlying claim for a higher rating. Here, the agency of original jurisdiction (AOJ) sought to reduce the Veteran's rating in response to an increased rating claim. See June 4, 2024 claim for benefits. This fact distinguishes the Veteran's case from Dofflemyer, where VA sought to reduce a rating of its own volition. See Dofflemyer, 2 Vet. App. at 278.

Additionally, as noted above, the AOJ has evaluated the Veteran's disability under different diagnostic codes at different times. However, despite the Veteran's history of rhinitis, the AOJ has not sought clarification on whether the Veteran's historical polyps are related to rhinitis rather than sinusitis. Moreover, the VA examination reports of record contain potential internal inconsistencies that prevent adequate evaluation of the Veteran's disability. For example, the July and September 2024 VA examination reports include boxes for current findings, signs, or symptoms attributable to chronic sinusitis, and the examiners did not check the boxes for headaches, pain, purulent discharge, and crusting. However, immediately after, the examiners checked boxes indicating the Veteran experienced non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge or crusting within the prior twelve months. Furthermore, it is unclear what effect the Veteran's medication had on his disability. See Jones v. Shinseki,?26?Vet. App.?56?(2012) (holding that the?ameliorative effects of medication?may not be considered in assigning a disability rating where these effects are not explicitly contemplated by the rating criteria); 38 C.F.R. § 4.97, General Rating Formula for Sinusitis (relying on antibiotic treatment in part for a compensable rating, but not addressing other medications); but see McCarroll v. McDonald, 28 Vet. App. 267 (2016).

In light of the above and the lack of adjudication of the increased ratings claim, beyond the improper reduction in rating, remand is warranted to schedule an additional examination, and for adjudication and issuance of a proper decision. See 38 C.F.R. § 3.103(f).

2. Entitlement to a compensable rating for bilateral hearing loss disability is remanded.

Upon review of the evidence of record, the Board finds remand is warranted for additional examination.

As an initial matter, the Board will address the decision on appeal. The Veteran listed an October 2022 rating decision as the decision being appealed as it relates to his hearing loss disability. This is the decision that granted service connection for bilateral haring loss and assigned an initial noncompensable (zero percent) rating. However, he did not timely appeal the October 2022 rating decision. Nevertheless, the AOJ denied an increased rating in October 2024 and April 2025 rating decisions. Therefore, the Board considers the May 2025 Notice of Disagreement to be applicable to those decisions, and will consider evidence through the April 2025 decision and in the 90 days from the date of the Notice of Disagreement.

The Veteran attended a VA hearing loss examination in July 2024, the results of which supported a noncompensable rating. Accordingly, he was denied a compensable rating in an October 2024 rating decision. The Veteran filed a supplemental claim in November 2024, listing bilateral vision loss as an issue twice. The AOJ appears to have considered this an error and adjudicated bilateral hearing loss as well as deferring a decision on bilateral vision loss. See April 2025 rating decision.

Prior to issuing the April 2025 rating decision, the AOJ did not schedule an additional examination to evaluate the Veteran's hearing loss. While the mere passage of time does not necessitate the need for an additional examination, a review of the AOJ's Adjudication Procedures Manual, the M21-1, reveals the AOJ erred in not obtaining an examination.

When a claim for increase is received, review the evidence of record to determine if it is sufficient to assign the appropriate current evaluation, as discussed in M21-1, Part IV, Subpart i, 1.B.1.a. If the available evidence is insufficient to assign an evaluation, then request an examination for the claimed condition, regardless of whether a statement of worsening is received or whether an examination for the claimed condition was completed within the last year.

While the Board is not bound by the M21-1, it must consider relevant provisions contained within it. See Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). Here, there was insufficient evidence "to assign the appropriate current evaluation." The last VA hearing examination prior to the April 2025 rating decision was nine months prior, and there are no treatment records that show the Veteran's hearing loss was evaluated after the July 2024 VA examination. Notably, if the Veteran's right ear speech discrimination score was four percent lower during the July 2024 examination, a 10 percent rating would have been warranted. Moreover, when compared to an
year.

In light of the above, the Board finds the AOJ erred in not providing the Veteran with a hearing loss examination before adjudicating his claim. Therefore, remand is warranted to correct this error.

3. Entitlement to an initial compensable rating for chronic bronchitis is remanded.

Upon review of the evidence of record, the Board finds remand is warranted so an examination that complies with VA regulation is performed.

The Veteran attended a VA respiratory conditions examination on July 1, 2024. The examination report indicates pulmonary function testing (PFT) was not performed, but would be performed on July 8, 2024. Nevertheless, the examiner checked a box indicating Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO) was not completed because it was not indicated for the Veteran's condition. See July 1, 2024 VA respiratory conditions examination report, page 9. When pulmonary function testing was subsequently performed, DLCO testing was not performed. See July 2024 and November 2024 examination results. This is not sufficient to comply with VA regulation.

VA is required to evaluate bronchitis utilizing DLCO, with limited exception. "If the DLCO (SB) (Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method) test is not of record, evaluate based on alternative criteria as long as the examiner states why the test would not be useful or valid in a particular case." 38 C.F.R. § 4.96(d)(2).

While the July 1, 2024 examination report indicates such testing was not indicated, no examiner specified "why the test would not be useful or valid" in this particular case. 38 C.F.R. § 4.96(d)(2). "Indicated" does not mean the same thing as "valid," as the examiner had the opportunity to check the box stating the test was "[n]ot valid for veteran's particular case." July 1, 2024 examination report, page 9. Furthermore, merely checking a box would not have provided the examiner's reasoning for checking the box.

The AOJ erred in not providing DLCO testing for the Veteran before adjudicating his claim, or obtaining an opinion on why such testing would not be useful or valid in this case. Accordingly, remand is warranted to correct this error.

4. Entitlement to service connection for erectile dysfunction is remanded.

Upon review of the evidence of record, the Board finds remand is warranted to obtain additional medical opinions.

In February 2025, the AOJ obtain a report and opinion regarding the Veteran's erectile dysfunction claim. The opinion report was limited to whether the Veteran's erectile dysfunction was caused by in-service toxic exposure risk activities (TERAs), and the opinion provided was negative. In support of this opinion, the examiner explained:

Review of VA website and medical literature shows no evidence of a causal relationship between the toxins exposed the veteran during service and erectile dysfunction. Additionally, at the time of erectile dysfunction the veteran notably had hypogonadism, weight gain and was prediabetic all of which are significant risk factors for erectile dysfunction. For these reasons, it is less likely that current erectile dysfunction is the result of toxic exposure during service.

The report only cites one of the Veteran's treatment records. "Evidence comments: 12/29/17 notes history of the diagnosis of erectile dysfunction with treatment for sildenafil. Notes history of hypogonadism, prediabetes and weight gain." However, after testing was performed subsequent to that December 2017 treatment record, it was found that it was unlikely the Veteran had hypogonadism. See February 16, 2018 treatment record. Furthermore, while the examiner relied on VA's website to support the opinion provided, VA's website raises the possibility of erectile dysfunction being caused by service-connected disabilities,
reasons, it is less likely that current erectile dysfunction is the result of toxic exposure during service.

VA's website identifies causes of erectile dysfunction including hardening of arteries, high blood pressure, heart disease, chronic kidney disease, emotional issues, depression and side effects from medicines. Notably, the Veteran is service connected for chronic kidney disease, unspecified trauma and stressor related disorder, hypertension, atherosclerotic cardiovascular disease and unstable angina, and he takes medication for other service-connected disabilities.

In light of the above, the AOJ erred in not obtaining an addendum opinion that adequately considered the evidence of record and addressed reasonably raised theories of entitlement for service connection. Therefore, remand is warranted to correct this error.

5. Entitlement to service connection for left ankle disability is remanded.

6. Entitlement to service connection for left foot disability is remanded.

Upon review of the evidence of record, the Board finds remand is warranted to obtain an additional examination and medical opinion.

i. Left Ankle

The record contains VA medical opinions in support of and against the Veteran's left ankle disability claim. The Veteran attended a VA ankle examination in September 2024 and reported spraining his ankles playing basketball. The examiner noted a June 2003 diagnosis of "acuate ankle sprain, resolved." The examiner did not provide any other diagnosis and went on to provide a positive nexus opinion, stating the "[c]urrent diagnosis of acute left ankle sprain, resolved is related to the left ankle sprain secondary to basketball [June 2003]." In support of this, the examiner stated there is evidence of chronicity, and cited literature that indicates 40 percent of ankle sprains go on to develop chronic conditions. Nevertheless, the agency of original jurisdiction sought an addendum opinion.

The AOJ sought clarification because the September 2024 examiner "suggests acute injury is resolved but [positive] direct medical opinion was provided despite remark 'objective evidence does not correlate well with subjective deficits.'" In response, the September 2024 examiner stated:

There is a history of left ankle sprain resolved in 2003 as outlined in opinion with dates. Subsequent medical examination and medical history in 2016 does not support a chronic left ankle condition. This begs the question of what could have happened to ankles from 2016 to current date since records indicate normal ankles per veteran and examination in 2016. The current subjective claimed deficiencies do not correlate with claimed medical history. Normal xray obtained at time of injury is normal, thus not correlating with the claimed deficiencies. Additionally, this provider checked that range of motion was not to be considered for rating purposes as veteran efforts were suboptimal and he had highly questionable effort and cooperation.

The AOJ obtained an additional medical opinion from a different medical professional in March 2025, noting "[t]he prior medical opinion was positive, however the diagnosis suggests the claimed condition has resolved. The recent addendum is unclear as to whether the positive opinion requires revision." March 1, 2025 opinion report, page 1. The March 2025 examiner, based on a review of service treatment records and post-service medical records including the September 2024 examination report, provided a negative nexus opinion. In support of this, the examiner explained:

Veteran's [service treatment records] and medical records reviewed. Veteran was given a diagnosis of acute ankle sprain of the left ankle, resolved on C&P exam dated 9/9/2024. According to the exam, the Veteran had subjective reports of intermittent ankle pain and on clinical exam, had objective findings of limited ROM [(range of motion)] and active ROM but normal passive ROM. These clinical exam findings along with subjective reports of ongoing symptoms would indicate that there is a left ankle sprain present. It was noted that the Veteran was seen 6/2003 with complaints of ankle sprain during basketball game. There are no records indicating that the Veteran required ongoing care or treatment for this condition while in service. There are no records to support chronicity of the condition and it is highly unlikely that a minor, acute spr
of the left ankle, resolved on C&P exam dated 9/9/2024. According to the exam, the Veteran had subjective reports of intermittent ankle pain and on clinical exam, had objective findings of limited ROM [(range of motion)] and active ROM but normal passive ROM. These clinical exam findings along with subjective reports of ongoing symptoms would indicate that there is a left ankle sprain present. It was noted that the Veteran was seen 6/2003 with complaints of ankle sprain during basketball game. There are no records indicating that the Veteran required ongoing care or treatment for this condition while in service. There are no records to support chronicity of the condition and it is highly unlikely that a minor, acute sprain would cause issues over 20 years in the future without requiring ongoing care. Veteran went on to have routine exam 12/2016 and Report of Medical History of the same date indicated no subjective or objective findings or complaints of ankle conditions. The claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness.

Both examiners focus on the Veteran's medical history, and particularly rely on a December 2016 report of medical history. The Board recognizes that the Veteran's service records reveal that on multiple occasions the Veteran declined to report ankle issues when given the opportunity. See, e.g., November 15, 2009 and November 2, 2015 Period Health Assessments (denied history of joint pain and chronic pain). However, the examiners appear to have overlooked relevant information.

Notably, the Veteran's service treatment records from after December 2016 indicate the Veteran may have injured his left ankle while on active duty in 2016. A January 2017 service treatment record notes the Veteran "has been having some swelling in his ankles and his right big toe. This has been happening since last year as well." Furthermore, the Veteran reported in an April 2014 Post Deployment Health Assessment that he twisted his ankle while deployed to Kuwait, though he did not state which ankle. See April 9, 2014 service treatment record. Given that neither examiner addressed these potential additional ankle injuries, and that these treatment records may contradict the rationales provided, the Board cannot conclude the opinions provided were based on an accurate medical history. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) ("An opinion is adequate where it is based upon consideration of the veteran's prior medical history and examinations..."). "Without a medical opinion that clearly addresses the relevant facts and medical science, the Board is left to rely on its own lay opinion, which it is forbidden from doing." Stefl, 21 Vet. App. at 124 (emphasis added). Accordingly, the Board finds the September 2024 and March 2025 examiners' opinions to be inadequate. The AOJ erred in not obtaining an adequate opinion.

During his September 2024 examination, the Veteran reported his symptoms were stable since onset and are occasional, with intermittent pain and ache when walking for longer periods of time. Given this, the Board recognizes that this occasional pain may not have come to mind when the Veteran filled out annual assessment and post-deployment forms. However, it would be premature to make such an inference at this juncture. Accordingly, and in light of the above, remand is warranted to schedule an examination where the Veteran will be able to provide a complete history of symptoms and injuries. In turn, a medical opinion based on the Veteran's complete medical history, including lay statements, will be able to be obtained.

ii. Left Foot

The January 19, 2017 service treatment record discussed above also noted swelling of the left foot. Given the Veteran's history of left ankle injury or injuries in service, combined with a history of concurrent left ankle and foot swelling, the possibility that his claimed left foot disability is related to his claimed left ankle disability has been raised by the record. Therefore, the Veteran's left ankle and left foot claims are inextricably intertwined, and the left foot claim must be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other).

In this regard, 38 C.F.R. § 20.802(a) does not prohibit remanding claims as inextricably intertwined. See Green v. McDonough, 37 Vet. App. 127, 136 (2024); see also Phillips v. McDonough, 37 Vet. App. 394
, the Veteran's left ankle and left foot claims are inextricably intertwined, and the left foot claim must be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other).

7. Entitlement to service connection for sleep apnea is remanded.

In his May 2025 Notice of Disagreement to the Board, the Veteran identified sleep apnea as an issue and cited an October 2022 rating decision that denied service connection. The Veteran does not appear to have timely appealed this decision. Nevertheless, upon review of the evidence of record, the Board finds that the Veteran's claim of service connection for an acquired psychiatric disorder encompassed a claim of service connection for sleep apnea, and remand is warranted to adjudicate this claim.

The scope of the Veteran's claim for service connection for an acquired psychiatric disorder includes any disability that reasonably may be encompassed by his description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

Here, when the Veteran filed his June 2024 service connection claim for an acquired psychiatric disorder, he listed two psychiatric disabilities: "PTSD w/Anxiety" and "Insomnia." Similarly, in his November 2024 supplemental claim he characterized the issue as "posttraumatic stress disorder (claimed with insomnia)." The inclusion of insomnia suggests a sleep issue. However, a July 2024 VA examiner did not identify sleep disturbance as a criterion met for PTSD, and did not list chronic sleep impairment as a symptom of the Veteran's service connected unspecified trauma and stressor related disorder. See July 2024 VA PTSD examination report, pages 7-8. The examiner did note the Veteran has a history of "some sleep issues and was diagnosed sleep apnea." Id. at page 4. Furthermore, the Veteran also attended a VA sleep apnea examination in September 2024, but the examiner did not provide an opinion on the etiology of the Veteran's sleep apnea. In essence, the AOJ appears to have been properly developing a claim for service connection for sleep apnea that was encompassed by the claim of service connection for insomnia. However, the AOJ did not adjudicate this claim.

In light of the above, under Clemons, the Board finds that the Veteran's claim for service connection for an acquired psychiatric disorder, namely insomnia, reasonably encompassed a claim of service connection for sleep apnea. It appears the AOJ may have come to the same conclusion, but did not adjudicate this issue. This was an error. See 38 C.F.R. § 3.103(f). Accordingly, remand is warranted to correct this error and allow the AOJ the opportunity to adjudicate this issue in the first instance, thus preserving the Veteran's right to "one review on appeal." 38 U.S.C. § 7104(a).

In other words, given the AOJ's error in not adjudicating the Veteran's sleep apnea claim, the Board will remand the claim to allow the AOJ the opportunity to fulfill its duty to adjudicate it in the first instance, which in turn preserves the Veteran's right to appeal any future adverse AOJ decision. See 38 U.S.C. § 7104(a); 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current and historical severity of the Veteran's service connected chronic sinusitis to include nasal polyps disability. The examiner should provide a full historical description of the disability and report all historical signs and symptoms necessary for evaluating the Veteran's disability under all applicable rating criteria throughout the period on appeal, including any changes in signs or symptoms (including their severity, frequency, or duration) and when such changes occurred.

The examiner must discount the ameliorative effects of non-antibiotic medication. In other words, opine on the historical severity of the Veteran's disability, if he had
.802(a).

The matters are REMANDED for the following action:

The examiner must discount the ameliorative effects of non-antibiotic medication. In other words, opine on the historical severity of the Veteran's disability, if he had not taken non-antibiotic medication.

The examiner must also discuss the Veteran's nasal polyps and whether they are related to rhinitis or sinusitis.

2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected hearing loss disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

3. Schedule the Veteran for an examination by an appropriate clinician to determine the current and historical severity of the Veteran's service-connected bronchitis disability. The examiner should provide a full historical description of the disability and report all historical signs and symptoms necessary for evaluating the Veteran's disability under all applicable rating criteria throughout the period on appeal, including any changes in signs or symptoms (including their severity, frequency, or duration) and when such changes occurred.

DLCO (SB) (Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method) testing must be performed, unless the examiner states why the test would not be useful or valid in this case, or unsafe for the Veteran. 38 C.F.R. § 4.96(d)(2).

4. Obtain opinions from an appropriate clinician regarding whether it is at least as likely as not that:

5. The Veteran's erectile dysfunction disability is related to service. When providing this opinion, the examiner must consider:

" the total potential exposure through all applicable deployments; and

" the synergistic, combined effect of all toxic exposure risk activities of the Veteran;

6. But for a service-connected disease or injury, the Veteran would not have developed erectile disfunction;

7. The Veteran's erectile dysfunction has been aggravated by service-connected disease or injury.

Provide rationale for any opinion given. In doing so, the examiner should address VA's website that identifies causes of erectile dysfunction including hardening of arteries, high blood pressure, heart disease, chronic kidney disease, emotional issues, depression and side effects from medicines. The Veteran is service connected for chronic kidney disease, unspecified trauma and stressor related disorder, hypertension, atherosclerotic cardiovascular disease and unstable angina, and he takes medication for other service connected disabilities.

8. Schedule the Veteran for a VA examination for the left ankle claim. The examiner must review the claims file. The examiner should solicit details on in-service injuries and subsequent symptoms, including potential injuries in 2003, 2014, 2016 and 2017. See service records dated:

" June 2, 2003 (basketball injury);

" April 9, 2014 (Post Deployment Health Assessment - twisted his ankle while deployed to Kuwait, though he did not state which ankle);

" January 18, 2017 (record notes the Veteran "has been having some swelling in his ankles and his right big toe. This has been happening since last year as well."); and

" February 24, 2017 service treatment record (trace left ankle edema)

The examiner is asked to provide a response to the following:

Identify each of the Veteran's left ankle disabilities.

For each disability identified, is it at least as likely as not related to service, including potential in-service injuries noted above?

For each disability identified, does it affect the Veteran's left foot?

Provide rationale to support the opinions. In doing so, the examiner must address relevant medical evidence and lay statements of record, including that the Veteran reported his symptoms were stable since onset and are occasional, with intermittent pain and ache when walking for longer periods of time. See September 2024 VA ankle examination report; January 18, 2017 service treatment record (left ankle and foot swelling). If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

9. Adjudicate the Veteran's encompassed sleep apnea claim, and readjudicate his other claims. In doing so, evaluate polyps (potentially from rhinitis) and sinusitis separately if applicable. See 38 C

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