Case A26033594

CYNTHIA M. BRUCE · 2026 · Case ID: A26033594

MIXED

Summary

The Veteran, who served in the U.S. Navy from September 1965 to September 1970, appeals the denial of service connection for chronic sinusitis, type II diabetes mellitus with erectile dysfunction, hypertension, and bilateral sensorineural hearing loss. The Veteran also sought an increased rating for migraine headaches and type II diabetes mellitus with erectile dysfunction, and hypertension. The Board granted service connection for migraine headaches, finding an earlier effective date of October 18, 2022, was warranted. Service connection was also granted for benign lung nodules, calluses of both feet, flat feet, and hepatitis C. The Board found the evidence in approximate balance for these conditions, resolving doubt in the Veteran's favor. The Veteran's claim for chronic sinusitis was denied due to insufficient evidence. The claims for increased ratings for type II diabetes mellitus with erectile dysfunction and hypertension were denied as the criteria were not met. The claim for a compensable rating for bilateral sensorineural hearing loss was also denied due to a lack of audiometric testing and the Veteran's failure to attend a scheduled VA examination. The Board remanded claims for a heart murmur, obstructive sleep apnea (OSA), and obesity. The remand for the heart murmur was due to an inadequate VA examination that failed to provide a nexus opinion despite documented evidence of a murmur. The remand for OSA and obesity is to determine if obesity is an intermediate step in the development of OSA, considering recent case law on obesity as a disability.

Rationale

Resolving reasonable doubt in favor of the Veteran; Criteria for 30 percent rating met; Migraine headaches manifested characteristic prostrating attacks

Service Branch

NAVY

Special Benefit

EARLIER EFFECTIVE DATE

Docket No.

250517-546865

Full Decision Text

Citation Nr: A26033594
Decision Date: 04/10/26 Archive Date: 04/10/26

DOCKET NO. 250517-546865
DATE: April 10, 2026

ORDER

An earlier effective date of October 18, 2022, for the award of service connection for migraine headaches is granted.

Service connection for benign lung nodules (claimed as lung condition) is granted.

Service connection for calluses of both feet is granted.

Service connection for flat feet is granted.

Service connection for hepatitis C is granted.

Service connection for chronic sinusitis is denied.

A 30 percent disability rating for migraine headaches is granted.

A disability rating in excess of 10 percent for type II diabetes mellitus with erectile dysfunction is denied.

A disability rating in excess of 10 percent for hypertension is denied.

A compensable disability rating for bilateral sensorineural hearing loss is denied.

REMANDED

Entitlement to service connection for a heart murmur is remanded.

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

Entitlement to service connection for obesity is remanded.

FINDINGS OF FACT

1. On October 18, 2022, the Veteran submitted an Intent to File, and in July 2023, he submitted a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, seeking service connection for hypertension.

2. The issue of entitlement to service connection for migraine headaches as secondary to hypertension was raised by the evidence of record at the time the Veteran filed his July 2023 hypertension claim.

3. The evidence is at least in approximate balance as to whether there is a medical nexus between the Veteran's lung nodules, calluses, flat feet, and hepatitis C and his active military service.

4. The most persuasive evidence of record does not demonstrate a sinus condition.

5. Throughout the rating period on appeal, the Veteran's migraine headaches have manifested characteristic prostrating attacks occurring on average once a month over the last several months.

6. Throughout the rating period on appeal, the Veteran's diabetes mellitus with erectile dysfunction has been manageable by restricted diet only, has not required an oral hypoglycemic agent or insulin or regulation of activities, nor has it manifested any other complications, including diabetic neuropathy.

7. Throughout the rating period on appeal, the Veteran's hypertension has required continuous medication for control and has not manifested diastolic pressure predominantly at 110 or more or systolic pressure at predominantly 200 or more.

8. There are no audiometric test results available during the rating period on appeal; a VA audiological examination was scheduled, but the Veteran did not report for that examination nor offer good cause as to why he did not appear.

CONCLUSIONS OF LAW

1. The criteria for an effective date of October 18, 2022, for the grant of service connection for migraine headaches have been met. 38 U.S.C. §§ 5103(a), 5103A, 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.159, 3.160, 3.400.

2. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for lung nodules have been met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for calluses have been met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

4. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for flat feet have been met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

5. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for hepatitis C have been met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R.
doubt in favor of the Veteran, the criteria for service connection for flat feet have been met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

6. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

7. Resolving reasonable doubt in favor of the Veteran, the criteria for a 30 percent disability rating for migraines have been met for the entire rating period on appeal. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code (DC) 8100.

8. The criteria for a disability rating in excess of 10 percent for type II diabetes mellitus with erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.119, Diagnostic Code (DC) 7913.

9. The criteria for a disability rating in excess of 10 percent for hypertension have not been met for any part of the rating period on appeal. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.104, Diagnostic Code (DC) 7101.

10. The criteria for a compensable disability rating for bilateral hearing loss have not been met for any part of the rating period on appeal. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code (DC) 6100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran, who is the appellant in this case, had active service in the U.S. Navy from September 1965 to September 1970.

This matter comes before the Board of Veterans' Appeals (BVA or Board) from December 2024, January 2025, February 2025, and April 2025 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO); the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On September 23, 2025, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the December 2024, January 2025, February 2025, and April 2025 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his attorney within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the
Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On September 23, 2025, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the December 2024, January 2025, February 2025, and April 2025 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his attorney within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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 claim[s], 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, because the Board is remanding the claims of entitlement to service connection for a heart murmur and sinusitis, 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).

Effective Date

1. An earlier effective date of October 18, 2022, for the award of service connection for migraine headaches is granted.

The Veteran seeks an earlier effective date for the award of service connection for migraine headaches. For the reasons discussed below, the Board finds that an earlier effective date of October 18, 2022, is warranted.

38 U.S.C. § 5110, which governs the assignment of an effective date for an award of benefits, provides:

Unless specifically provided otherwise in this chapter, the effective date of an award based on an initial claim, or a supplemental claim, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a)(1).

The implementing regulation similarly provides that the effective date of an award based on an original claim, or a claim reopened after final adjudication of compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of the receipt of the application. 38 C.F.R. § 3.400. "Date of receipt" means the date on which a claim, information, or evidence was received by VA. 38 C.F.R. § 3.1(r). The date of receipt of an application can be deemed the date VA received an "intent to file" a claim from a claimant so long as a complete claim application is submitted within a year of receipt of the intent-to-file form. 38 C.F.R. § 3.155(b).

However, 38 C.F.R. § 3.155 also provides that only one complete claim for a benefit (e.g., compensation, pension) may be associated with each intent to file a claim for that benefit, though multiple issues may be contained within a complete claim. In the event multiple complete claims for a benefit are filed within 1 year of an intent to file a claim for that benefit, only the first claim filed will be associated with the intent to file a claim. 38 C.F.R. § 3.155(d)(1)(ii).

In this case, on October 18, 2022, the Veteran submitted an Intent to File form. On July 6, 2023, he submitted a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, requesting service connection for hypertension. An August 2023 rating decision granted service connection for hypertension, effective from August 10, 2022. The Veteran appealed the initial rating assigned for hypertension to the Board. In a November 2024 decision, the Board determined that the issue of entitlement to migraine headaches secondary to hypertension had been raised by the evidence of record prior to the August 2023 rating decision. Specifically, the Board cited to a March 2011 VA treatment record noting headaches
on October 18, 2022, the Veteran submitted an Intent to File form. On July 6, 2023, he submitted a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, requesting service connection for hypertension. An August 2023 rating decision granted service connection for hypertension, effective from August 10, 2022. The Veteran appealed the initial rating assigned for hypertension to the Board. In a November 2024 decision, the Board determined that the issue of entitlement to migraine headaches secondary to hypertension had been raised by the evidence of record prior to the August 2023 rating decision. Specifically, the Board cited to a March 2011 VA treatment record noting headaches in the setting of a hypertensive emergency and a September 2021 VA treatment record in which the Veteran's treating clinician questioned whether his headaches were caused by elevated blood pressure. The Board, in the November 2024 decision, remanded the issue of entitlement to service connection for migraine headaches to obtain a VA nexus opinion.

Subsequently, based on a favorable nexus opinion, the January 2025 rating decision on appeal granted service connection for migraine headaches, assigning an effective date of April 2, 2024.

Based on the foregoing procedural history, the Board finds that an earlier effective date of October 18, 2022, is warranted for the award of service connection for migraine headaches, as the issue of entitlement to service connection for migraine headaches was raised by the record in the context of the Veteran's July 2023 claim of entitlement to service connection for hypertension, as noted by the Board in its November 2024 decision. Thus, because the Veteran submitted a complete application for service connection for hypertension with one year of the October 18, 2022, Intent to File form, and because the issue of service connection for migraine headaches was raised by the evidence of record at that time, the Board finds that an earlier effective date of October 18, 2022, is warranted for the award of service connection for migraine headaches. 38 C.F.R. § 3.155(b).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. 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).

The United States Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992).

1. Service connection for benign lung nodules (claimed as lung condition) is granted.

2. Service connection for calluses of both feet is granted.

3. Service connection for flat feet is granted.

4. Service connection for hepatitis C is granted.

The December 2024 rating decision on appeal denied service connection for lung nodules, and the January 2025 rating decision on appeal denied readjudication of the claims of entitlement to service connection for calluses, flat feet, and hepatitis C, finding that no new and relevant evidence had been received. At the outset, the Board finds that the September 2025 report of Dr. R.P., discussed in detail below, constitutes new and relevant evidence such that the petition to readjudicate the claims of entitlement to service connection for calluses, flat feet, and hepatitis C is granted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156, 3.2501.

Turning to the merits of the claims, the Veteran contends that his lung nodules, calluses, flat feet, and hepatitis C were incurred in or caused by his active service. Resolving reasonable doubt in his favor, the Board finds that the
finding that no new and relevant evidence had been received. At the outset, the Board finds that the September 2025 report of Dr. R.P., discussed in detail below, constitutes new and relevant evidence such that the petition to readjudicate the claims of entitlement to service connection for calluses, flat feet, and hepatitis C is granted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156, 3.2501.

Turning to the merits of the claims, the Veteran contends that his lung nodules, calluses, flat feet, and hepatitis C were incurred in or caused by his active service. Resolving reasonable doubt in his favor, the Board finds that the evidence is at least in approximate balance as to whether the claimed lung nodules, calluses, flat feet, and hepatitis C are etiologically related to the Veteran's active service, and that service connection is warranted.

Service treatment records show multiple episodes of treatment for calluses and plantar warts, including in February 1967, April 1967, May 1968, February 1969, June 1969, August 1969, and January 1970. The Veteran also reported foot trouble at his September 1970 separation examination.

Following separation from active service in 1970, a December 1996 VA treatment record indicates that the Veteran had bilateral bunion repair in the 1970s. Subsequent VA treatment records show ongoing treatment for calluses as early as March 1999.

A February 1997 VA treatment record indicates a diagnosis of mild to moderate restrictive lung disease of unknown etiology, with symptoms of shortness of breath and dyspnea on exertion, and a positive occupational exposure to paint fumes, asbestos, and fiberglass. A March 14, 1997, pulmonary function test (PFT) was consistent with mild restrictive lung disease. An October 2013 CT scan showed benign lung nodules.

A March 2011 VA treatment record notes a history of hepatitis C. An October 2015 treatment note indicates the Veteran believed he acquired hepatitis C while in the military. He had received treatment for it over 10 years ago by a private physician. In a September 2017 statement, the Veteran stated that in 1972 or 1973, he donated blood for a surgery for his youngest child. Shortly after, he was contacted by the city's health department and was tested and informed that he had hepatitis C.

In December 2025, the Veteran submitted a report from a private physician, R.P., DO. The doctor opined that the Veteran's calluses, flat feet, hepatitis C, and lung nodules were all related to active service. With regard to the calluses and flat feet, she explained that the Veteran's military duties, which involved sustained marching, prolonged standing, and heavy weight-bearing tasks, subjected his feet to repetitive loading beyond normal physiological thresholds, and this was exacerbated by his military footwear. Over time, this caused calluses and the collapse of the arches in his feet (flat feet).

With regard to the hepatitis C, Dr. R.P. noted the Veteran's report that he was diagnosed with the condition in the early 1970s after donating blood, and explained that hepatitis C was not identified until the late 1980s, and as such, the absence of an earlier diagnosis in the medical records should not be interpreted as evidence that the condition was not present at the time. The doctor stated that the Veteran credibly reported that he lived with the condition untreated for decades until approximately 2014. The doctor further noted that he reported that he received mass immunizations via jet injector in the military, which she stated were recognized as a key vector for hepatitis C transmission, citing to medical literature and explaining the process by which such transmission occurs.

Regarding the Veteran's lung nodules, Dr. R.P. noted that the Veteran reported being berthed in close proximity to an air vent located near a boiler room, a setting historically recognized as a high-risk area for airborne asbestos fibers aboard Navy vessels. She discussed the Veteran's history of cigar use, noting that it was limited to a few cigars per week, and stating that, given this history, the development of the benign lung nodules was more plausibly attributable to his in-service asbestos exposure.

Dr. R.P.'s nexus opinions regarding the claimed calluses, flat feet, hepatitis C, and lung nodules are accompanied by very thorough rationale, citations to medical literature and medical records, and discussion of the Veteran's specific history. The Board finds that the report is highly probative, and, while there are negative VA opinions of record, has resolved any doubt in favor of the Veteran in finding that service connection for calluses,
for airborne asbestos fibers aboard Navy vessels. She discussed the Veteran's history of cigar use, noting that it was limited to a few cigars per week, and stating that, given this history, the development of the benign lung nodules was more plausibly attributable to his in-service asbestos exposure.

Dr. R.P.'s nexus opinions regarding the claimed calluses, flat feet, hepatitis C, and lung nodules are accompanied by very thorough rationale, citations to medical literature and medical records, and discussion of the Veteran's specific history. The Board finds that the report is highly probative, and, while there are negative VA opinions of record, has resolved any doubt in favor of the Veteran in finding that service connection for calluses, flat feet, hepatitis C, and lung nodules is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).

5. Service connection for chronic sinusitis is denied.

The Veteran contends that he has sinusitis that was caused by active service. However, the Board finds that the weight of the evidence is against a finding that the Veteran has sinusitis.

Reviewing the most relevant evidence of record, service treatment records are silent as to any reports, finding, signs, symptoms, treatment, or diagnosis of sinusitis. Indeed, the Veteran specifically denied sinusitis at the September 1970 separation examination, and clinical evaluation of the sinuses was marked as normal.

Following separation from service in 1970, a March 1997 x-ray of the sinuses showed no evidence of acute sinusitis.

In March 2011, the Veteran sought treatment for high blood pressure and reported sinus pain and sneezing.

In August 2016, he reported sinus trouble on the left side.

In April 2018, the Veteran reported that his coworker had had the flu, and several days later, he started feeling fatigued with fever and chills. He took Tylenol and started feeling better, and the clinician seemed to indicate that it may have been an episode of sinusitis.

In September 2021, the Veteran reported that he believed that his sinus congestion may be causing his headaches. He had been taking Fluticasone, which helped with both his sinus congestion and headaches.

In August 2023, the Veteran reported sinus congestion with productive cough and headaches for one day. He was diagnosed with an upper respiratory infection.

The Veteran was afforded a VA examination in September 2024. The examiner stated he did not now have nor had he ever had a sinus condition. The Veteran reported that a sinus condition began in 1977 (7 years after service separation) with persistent nasal congestion, sinus pressure and tenderness, and postnasal drip. He had taken Sudafed to treat the condition and also used Flonase and Vicks vapor rub. An x-ray of the sinuses was negative. The examiner concluded there were no findings, signs, or symptoms to support a diagnosis of a sinus condition, and thus, the claimed condition was less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran, reasoning that there was no pathology to warrant a diagnosis or condition that can be related to the claimed toxic exposure.

After a review of all of the evidence, lay and medical, the Board finds that the weight of the evidence is against a finding of a current disability of the sinuses. In this regard, the Board finds the September 2024 VA opinion of record to be the most probative and persuasive on the question of whether there is or has been a sinus condition. The examiner's opinion is supported by the other medical evidence of record, which is silent for a chronic sinus condition. Rather, the evidence indicates that the Veteran has experienced infrequent episodes of sinus congestion and pain, often accompanied by other symptoms. Moreover, x-rays have been consistently negative, and no clinician has diagnosed sinusitis.

Without a showing of a current disability, the claim for service connection must be denied. "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no claim." Brammer, 3 Vet. App. at 225. The Board recognizes that the Court has held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However,
. Moreover, x-rays have been consistently negative, and no clinician has diagnosed sinusitis.

Without a showing of a current disability, the claim for service connection must be denied. "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no claim." Brammer, 3 Vet. App. at 225. The Board recognizes that the Court has held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, where the overall record fails to support a disability, as is the case here, that holding would not apply. The weight of the evidence does not demonstrate sinusitis.

Regarding the Veteran's statements that he has sinusitis, the Board recognizes that lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. Sept. 14, 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007)). However, while the Veteran is competent to provide his lay description of symptoms or events, he is not competent to diagnose or opine on medical etiology for complex medical questions requiring specific medical knowledge and training. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (stating that a lay person is not competent to diagnose or make a competent nexus opinion about a disorder as complex as cancer). The question of whether the Veteran has sinusitis requires evaluation and assessment by a professional, and, in this case, the most persuasive evidence does not demonstrate that the criteria for a finding of a diagnosis of a sinus condition are met.

Accordingly, the Board finds that the most probative evidence is against finding that the Veteran has a current sinus condition. Thus, the Board reiterates that in the absence of proof of a present disability there can be no valid claim. See Brammer. As a result, the claim for service connection for sinusitis is denied. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for sinusitis is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Disability Ratings

Disability evaluations (ratings) are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.

In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3.

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21.

Staged ratings are appropriate for an initial or increased rating claim when the
lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3.

Staged ratings are appropriate for an initial or increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

1. A 30 percent disability rating for migraine headaches is granted.

The Veteran is in receipt of a noncompensable, or zero percent, disability rating for migraine headaches throughout the rating period on appeal. For the reasons discussed below, the Board finds that a 30 percent disability rating is warranted for the entire rating period on appeal.

The Veteran's headaches have been evaluated under the provisions of 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, a 10 percent disability rating is warranted for headaches with characteristic prostrating attacks occurring on an average of once every two months over the last several months, while a 30 percent disability rating is warranted for prostrating attacks occurring once every month. Headaches manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant the highest, 50 percent, disability rating. Id.

The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252.

The rating criteria under DC 8100 contain several undefined words and phrases, including "prostrating." However, the Court held that "characteristic prostrating attacks" means "migraine attacks that typically produce powerlessness or a lack of vitality." Johnson, 30 Vet. App. at 252. The phrase "completely prostrating" generally means that the migraine attack must render the veteran entirely powerless. Johnson at 253. The completely prostrating attacks must also be "prolonged," where "prolong" is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Id. Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

The Board also notes that according to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "prostration" is defined as "complete physical or mental exhaustion." A similar definition is found in DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1554 (31st Ed. 2007), in which "prostration" is defined as "extreme exhaustion or powerlessness."

In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Reviewing the most relevant evidence of record, in a July 2022 statement, the Veteran said that he experienced migraines ranging from mild to severe periodically - 2 to 3 times per month.

At a July 2022 VA examination, the Veteran reported headaches occurring 2 to 4 times
LLUSTRATED MEDICAL DICTIONARY 1554 (31st Ed. 2007), in which "prostration" is defined as "extreme exhaustion or powerlessness."

In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Reviewing the most relevant evidence of record, in a July 2022 statement, the Veteran said that he experienced migraines ranging from mild to severe periodically - 2 to 3 times per month.

At a July 2022 VA examination, the Veteran reported headaches occurring 2 to 4 times per week, lasting less than one day. He took Excedrin as needed. He also experienced sensitivity to sound. The Veteran did not have characteristic prostrating attacks of migraine headache pain or very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability, and the headaches did not impact his ability to work.

At an October 2024 VA examination, the Veteran reported experiencing migraines once every six months, lasting one to two days. He denied any current use of medication. He also reported sensitivity to light. The examiner stated that the Veteran experienced characteristic prostrating attacks of migraine head pain, with less frequent attacks, and did not experience completely prostrating and prolonged attacks. He would have difficulty with concentration during a migraine episode.

In the September 2025 report, Dr. R.P. stated that the Veteran's headaches were true migraine attacks of one to two days' duration and with associated photophobia. She said that the documented duration, functional incapacitation, and occupational impact demonstrated that these episodes rose to the level of characteristic prostrating attacks occurring about once per month, consistent with the 30 percent rating criteria under DC 8100. During these migraine episodes, she noted that he was unable to tolerate light exposure or maintain productivity, forcing cessation of activities and resulting in substantial functional loss.

Based on the lay and medical evidence of record and resolving any reasonable doubt in favor of the Veteran, the Board finds that a 30 percent disability rating for headaches is warranted for the entire rating period on appeal as the evidence is in approximate balance as to whether the Veteran's migraines are manifested by characteristic prostrating attacks occurring on average once a month over the last several months. The Board finds the September 2025 report from Dr. R.P. to be highly probative in this regard.

The Board also finds that the weight of the evidence is against the assignment of a 50 percent rating throughout the rating period on appeal. Namely, as discussed above, the July 2022 VA examiner stated that the Veteran did not have characteristic prostrating attacks of migraine headache pain or very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability, and the headaches did not impact his ability to work. The October 2024 VA examiner also stated that the Veteran had less frequent prostrating attacks, and did not experience completely prostrating and prolonged attacks, nor does any other evidence of record indicate that he experiences prolonged migraine attacks resulting in severe economic inadaptability. While there is certainly evidence of functional impact (e.g., difficulty concentrating), the evidence does not demonstrate that the Veteran's migraine attacks have been very frequent, completely prostrating, or prolonged in terms of producing lack of vitality. The Veteran has reported that his headaches last one to two days and has not indicated that he has missed work frequently due to his migraines. Moreover, the evidence does not demonstrate that the frequency and severity of the Veteran's migraines have been productive or are capable of producing severe economic inadaptability. As noted above, the VA examiner stated that the headaches would create difficulty concentrating, and, while Dr. R.P. stated that he would need to cease all activities during migraines, they only occur on average once per month. While, certainly, the evidence demonstrates that the Veteran's migraines impact his work activities, he has not described his migraines as causing extreme exhaustion, powerlessness, debilitation, or incapacitation with substantial inability to engage in ordinary activities, nor does the evidence demonstrate that the Veteran has experienced substantial work impairment.

In sum, resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence is at least in approximate balance as to whether a 30 percent disability rating is warranted for the Veteran's migraines for the entire rating period on appeal. To the extent any higher level of compensation is sought, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as there is not an approximate balance of positive and negative evidence with regard to an even higher rating, that doctrine is not applicable.
not described his migraines as causing extreme exhaustion, powerlessness, debilitation, or incapacitation with substantial inability to engage in ordinary activities, nor does the evidence demonstrate that the Veteran has experienced substantial work impairment.

In sum, resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence is at least in approximate balance as to whether a 30 percent disability rating is warranted for the Veteran's migraines for the entire rating period on appeal. To the extent any higher level of compensation is sought, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as there is not an approximate balance of positive and negative evidence with regard to an even higher rating, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert at 53-56.

2. A disability rating in excess of 10 percent for type II diabetes mellitus with erectile dysfunction is denied.

The Veteran is in receipt of a 10 percent disability rating for his diabetes mellitus with erectile dysfunction for the entire rating period on appeal. For the reasons discussed below, the Board finds that the weight of the evidence is against a rating in excess of 10 percent.

The Veteran's diabetes has been evaluated under DC 7913, which falls under the Schedule of Ratings for the Endocrine System, found in 38 C.F.R. § 4.119. Under DC 7913, which specifically addresses evaluation of diabetes mellitus, a 10 percent evaluation is assigned where the disorder is manageable by a restricted diet only. A 20 percent evaluation is assigned where diabetes requires insulin and restricted diet, or an oral hypoglycemic agent and a restricted diet. A 40 percent evaluation is assigned where diabetes requires insulin, a restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities). A 60 percent evaluation is assigned where the disease requires insulin, a restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent evaluation is assigned where diabetes requires more than one daily injection of insulin, a restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring at least 3 hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119.

Note (1) to DC 7913 instructs that compensable complications of diabetes are to be evaluated separately unless they are a part of the criteria used to support a 100 percent disability rating. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913. 38 C.F.R. § 4.119.

In this regard, the Veteran's erectile dysfunction is currently rated as noncompensably disabling as part of the diabetic process. Under 38 C.F.R. § 4.115b, DC 7522 provides that a noncompensable rating is warranted for erectile dysfunction, with or without penile deformity. The term deformity means either an internal or external distortion of the penis. Williams v. Wilkie, 30 Vet. App. 134, 138 (2018).

A footnote to DC 7522 also indicates the disability is to be reviewed for entitlement to special monthly compensation (SMC) for loss of use of a creative organ under 38 C.F.R. § 3.350(a). At the outset, the Board notes that the Veteran is also in receipt of SMC for loss of use of a creative organ under the provisions of 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a) throughout the rating period on appeal.

Reviewing the most relevant evidence, medical treatment records do not show that the Veteran has been prescribed insulin or any oral hypoglycemic agents to treat his diabetes. For instance, a February 2024 VA treatment record lists an assessment of "diet-controlled diabetes mellitus."

At a September 2024 VA examination, the examiner assessed diabetes mellitus that was managed by restricted diet and did not require regulation of activities. The Veteran visited a diabetic care provider for episodes of ketoacidosis and/or hypoglycemia less than two times per month and had no hospitalizations for such episodes. He had progressive unintentional weight loss attributable to diabetes mellitus, reporting that he had lost 15 percent of his baseline weight. He had erectile dysfunction that was due to the diabetes mellitus. The Veteran denied any impact on his occupational function or ordinary activities. Peripheral pulses examination findings were within normal limits. Motor and sensory examination was within normal limits to include gait, balance, and cranial and peripheral nerves. There was no urinary or bowel incontinence.

At a separate September 2024 VA examination for erectile dysfunction, the Veteran reported difficulty with having and maintaining an erection, stating that he took medication for the condition with slight improvement. Physical examination of the penis, testes, and epididymis were normal.

After a review of all the evidence, lay and medical, the Board concludes that the weight of the evidence is against the assignment of a disability rating in excess of 10 percent for diabetes mellitus for the entire rating period on appeal. Namely, throughout the rating period on appeal, the Veteran's diabetes has only required a restricted diet and has not required either an oral hypoglycemic agent or insulin or regulation of activities. Moreover, he has not been hospitalized for episodes of ketoacidosis or hypoglycemia.

In addition, the Board observes that the Veteran's erectile dysfunction, which is noncompensably disabling under DC 7522, is appropriately rated as part of the diabetic process.

The Board acknowledges the September 2025 report of Dr. R.P., in which the doctor opines that the Veteran has diabetic neuropathy. However, she bases this conclusion on an incorrect premise, which is that the Veteran has long-term prescriptions for Gabapentin. However, a review of the extensive medical records associated with the claims file reveals no prescription of Gabapentin or any other medication for diabetic neuropathy, nor has any clinician diagnosed diabetic neuropathy. Further, as noted above, the September 2024 VA examination was negative for any condition of the peripheral nerves. The Board therefore finds that the weight of the evidence is against a separate or increased rating for diabetic neuropathy.

In denying a disability rating in excess of 10 percent for diabetes mellitus, the Board has considered the Veteran's statements that his diabetes is worse. While he is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions regarding whether his symptoms meet the next higher rating criteria under VA regulations.

Such competent evidence concerning the nature and extent of the Veteran's diabetes has been provided by the medical personnel who have examined him during the current appeal. The medical findings (as provided in the examination reports and clinical records) directly address the criteria under which this disability is evaluated, and such findings are of more probative value in determining the severity of the diabetes than are general histories or general descriptions of symptoms such as described by this Veteran.

Despite the Veteran's contention of debilitating diabetes, the 10 percent disability rating for diabetes indicates a significant impact on his functional ability. Such a disability evaluation assigned by VA recognizes his functional limitations, indicating very generally a 10 percent reduction in his ability to function due to his diabetes mellitus. The critical question in this case, however, is whether the problems he has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not.

For these reasons, the claim for a disability rating in excess of 10 percent for diabetes mellitus with erectile dysfunction is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as there is not an approximate balance of positive and negative evidence, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, 1 Vet. App. at 53-56.

3. A disability rating in excess of 10 percent for hypertension is denied.

The Veteran is in receipt of a 10 percent disability rating for the entire rating period on appeal. For the reasons discussed below, the Board finds that
mellitus with erectile dysfunction is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as there is not an approximate balance of positive and negative evidence, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, 1 Vet. App. at 53-56.

3. A disability rating in excess of 10 percent for hypertension is denied.

The Veteran is in receipt of a 10 percent disability rating for the entire rating period on appeal. For the reasons discussed below, the Board finds that a rating in excess of 10 percent is not warranted at any time during the rating period on appeal.

The Veteran's hypertension has been evaluated under 38 C.F.R. § 4.104, DC 7101, which addresses hypertensive vascular disease, including hypertension and isolated systolic hypertension. Under this diagnostic code, a 10 percent evaluation is assigned when diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or is the minimum evaluation assigned for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent evaluation is assigned when diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more. A 40 percent evaluation is assigned when diastolic pressure is predominantly 120 or more, and a 60 percent evaluation is assigned when diastolic pressure is predominantly 130 or more. Id.

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.

The record clearly shows that the Veteran has been on continuous medication for his hypertension throughout the rating period on appeal.

In Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), the Court held that, when assigning a disability rating, the Board may not consider the ameliorative effects of medication where those effects are not explicitly contemplated by the rating criteria. "Thus, if [the applicable diagnostic code] does not specifically contemplate the effects of medication, the Board is required, pursuant to Jones, to discount the ameliorative effects of medication when evaluating [the disability]. Conversely, if [the applicable diagnostic code] does specifically contemplate the effects of medication, then Jones is inapplicable." McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (en banc).

The rating criteria for hypertension specifically contemplates the use of medication to ameliorate symptoms. Indeed, in McCarroll, the Court specifically held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication, as the plain language of DC 7101 contemplates the effects of medication.

Regarding the last criteria, the Court also explained in McCarroll that a compensable rating under DC 7101 may be warranted for a veteran whose blood pressure is currently controlled by medication, i.e., whose blood pressure does not otherwise meet the criteria for a compensable evaluation, but who has a history of diastolic pressure predominantly 100 or more. The Board also notes that a precedential Court decision, Wilson v. McDonough, 35 Vet. App. 75 (2021), similarly held that when analyzing the evidence under DC 7101, the Board should have considered pre-medication blood pressure readings to determine if the veteran has a history of diastolic pressure at 100 or above, regardless of whether such readings were taken during the period on appeal. However, the requirement to consider blood pressure readings outside of the appeal period is only applicable when a noncompensable rating is in effect. As the Veteran's service-connected hypertension is rated at 10 percent disabling throughout the appeal period, these holdings in McCarroll and Wilson are not for application.

Reviewing the most relevant evidence, blood pressure readings during the period on appeal included 177/84 (January 29, 2025), and 176/90 (January 29, 2025). In January 2025, the Veteran reported that his home blood pressure readings had been around 170/90. In sum, the evidence does not reflect diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more.

After a review of all of the evidence, lay and medical, the Board finds that
in effect. As the Veteran's service-connected hypertension is rated at 10 percent disabling throughout the appeal period, these holdings in McCarroll and Wilson are not for application.

After a review of all of the evidence, lay and medical, the Board finds that the weight of the evidence is against a disability rating in excess of 10 percent for hypertension for the entire rating period on appeal. Namely, the evidence demonstrates that continuous medication was required, but diastolic pressure has not been predominantly 110 or more, nor has systolic pressure been predominantly 200 or more.

The Board acknowledges the Veteran's contention that he has to take medication to control his hypertension, the implication being that without medication, his readings would meet the criteria for an even higher rating. However, as noted above, the rating criteria for hypertension specifically contemplates the use of medication to ameliorate symptoms, and, therefore, the Board need not discount the ameliorative effects of blood pressure medication in determining the appropriate rating.

Accordingly, the Board concludes that a disability rating in excess of 10 percent for the service-connected hypertension is not warranted for any part of the rating period on appeal. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as there is not an approximate balance of positive and negative evidence, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, 1 Vet. App. at 53-56.

4. A compensable disability rating for bilateral sensorineural hearing loss is denied.

The Veteran is in receipt of a noncompensable, or zero percent, disability rating for his service-connected bilateral hearing loss throughout the rating period on appeal. He contends that he is entitled to a higher rating. For the reasons discussed below, the Board finds that the weight of the evidence is against the assignment of a compensable disability rating throughout the rating period on appeal.

The Veteran's hearing loss has been evaluated under 38 C.F.R. § 4.85, DC 6100. This diagnostic code sets out the criteria for evaluating hearing impairment using pure tone threshold averages and speech discrimination scores. Numeric designations are assigned based upon a mechanical use of tables found in 38 C.F.R. § 4.85, and there is no room for subjective interpretation. See Acevedo-Escobar v. West, 12 Vet. App. 9, 10 (1998); Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability evaluations range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, and as measured by puretone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second, or hertz (Hz).

The rating criteria for hearing loss establish 11 auditory acuity levels designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. The rows in Table VI (38 C.F.R. § 4.85) represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. The columns in Table VI represent nine categories of decibel loss based on the pure tone audiometry test.

The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the row appropriate for the percentage of discrimination and the column appropriate to the puretone decibel loss.

The percentage disability evaluation is found from Table VII (38 C.F.R. § 4.85) by intersecting the row appropriate for the numeric designation for the ear having the better hearing acuity and the column appropriate to the numeric designation level for the ear having the poorer hearing acuity. For example, if the better ear has a numeric designation Level of "V" and the poorer ear has a numeric designation Level of "VII," the percentage evaluation is 30 percent. 38 C.F.R. §§ 4.85(b), 4.87.

In addition, under 38 C.F.R. § 4.86
appropriate for the percentage of discrimination and the column appropriate to the puretone decibel loss.

In addition, under 38 C.F.R. § 4.86(a), when the puretone threshold at each of the four specified frequencies, 1000, 2000, 3000, and 4000 Hz, is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Under 38 C.F.R. § 4.86(b), when the pure tone 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 VIa, whichever results is the higher numeral. That numeral will then be elevated to the next higher Roman numeral.

Reviewing the evidence most relevant to the rating period on appeal, the Veteran has not undergone any audiological testing during the rating period on appeal. A VA audiological examination was scheduled for October 9, 2024, but the Veteran did not report for that examination, nor has he offered good cause for his failure to appear. 38 C.F.R. § 3.655. The duty to assist a veteran in developing evidence is not always a "one-way street." Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). A veteran must cooperate when he is asked for information that is essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Otherwise, he denies VA evidence which might have helped establish his claim.

Thus, as there is no audiological testing during the rating period on appeal upon which to base a grant of an increased rating for bilateral hearing loss, the Board finds that the weight of the evidence is against a compensable disability rating for the Veteran's bilateral hearing loss disability.

The Board acknowledges the statements of the Veteran that his hearing loss is worse than reflected by the assigned noncompensable rating. However, the Board finds that these statements alone do not warrant a higher disability rating. As noted above, the rating of hearing loss disability involves the mechanical application of the rating schedule to numeric designations assigned to official audiometric results, which are unavailable in this case. See Lendenmann, 3 Vet. App. at 345.

For these reasons, the claim for a compensable disability rating for bilateral hearing loss is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as there is not an approximate balance of positive and negative evidence, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, 1 Vet. App. at 53-56.

REASONS FOR REMAND

A remand of the following claims is necessary to correct a pre-decisional error in VA's duty to assist or to satisfy a regulatory or statutory duty. 38 C.F.R. § 20.802(a).

1. Entitlement to service connection for a heart murmur is remanded.

A March 2011 VA treatment note indicates the presence of a systolic murmur loudest over the second right intercostal area.

The Veteran was afforded a VA examination in October 2024. The examiner noted the Veteran's self-report that he had been in the hospital and that an EKG detected a heart murmur. However, the examiner declined to provide a nexus opinion regarding the heart murmur, as the examiner stated that the Veteran was unable to attend diagnostics to confirm the claimed murmur condition, despite the March 2011 documentation of same.

The Board therefore finds that the October 2024 VA examination is inadequate, and that a remand is necessary to obtain a new VA examination and nexus opinion in light of the March 2011 diagnosis of a heart murmur.

2. Entitlement to service
the second right intercostal area.

2. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

3. Entitlement to service connection for obesity is remanded.

A July 2012 sleep study confirmed a diagnosis of OSA. In an October 2024 report, a private physician, Dr. R.T., noted that in July 2012, the Veteran's BMI was 50.7, indicating that he was obese, and stated that obesity is a major risk factor for developing OSA. Further, Dr. R.T. opined that the Veteran had credibly stated that his service-connected migraine headaches had led him to abstain from physical activity, which led to his weight gain to the point of obesity, which in turn led to the development of OSA.

In order to determine if obesity is an "intermediate step," an adjudicator must resolve the following issues: (1) whether the service-connected disability caused the Veteran to become obese; (2) if so, whether the obesity was a substantial factor in causing the claimed disability; and (3) whether the claimed disability would not have occurred but for obesity. If these questions are answered in the affirmative, the claimed disability may be service connected on a secondary basis. See VAOPGCPREC 1-2017.

Further, in the recent precedential case of Adams v. Collins, 38 Vet. App. 273 (2025), the Court noted that obesity is a disability if it results in a functional impairment of earning capacity, invalidating the portion of VA's General Counsel Opinion VAOPGCPREC 1-17 to the extent it determined obesity per se is not a disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, the finding in VAOPGCPREC 1-17 that obesity is not a "disease" for purposes of 38 U.S.C. §§ 1110 and 1131, and therefore not entitled to service connection on a direct basis, remains valid.

Based on the foregoing, the Board finds that a remand is necessary to determine: (1) whether obesity is an "intermediate step" in the development of the Veteran's OSA, and (2) whether obesity is secondary to his service-connected disabilities.

The matters are REMANDED for the following action:

1. Afford the Veteran the opportunity to attend a VA examination with an appropriate specialist addressing the nature and etiology of his heart murmur. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished, and a rationale for any opinion expressed should be provided. The claims file must be made available to the examiner for review of the history in conjunction with the examination, and the examination report should reflect that such review was accomplished.

(a.) The examiner should offer the following opinion: Is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's heart murmur was incurred during or caused by active service? In rendering the opinion, the examiner should specifically discuss the Veteran's March 2011 diagnosis of a heart murmur.

Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is approximately balanced such that it is as medically sound to find in favor of causation as it is to find against it.

All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question.

2. Afford the Veteran the opportunity to attend a VA
approximately balanced such that it is as medically sound to find in favor of causation as it is to find against it.

2. Afford the Veteran the opportunity to attend a VA examination with an appropriate specialist to address the nature and etiology of his obesity and obstructive sleep apnea. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished, and a rationale for any opinion expressed should be provided. The claims file must be made available to the examiner for review of the history in conjunction with the examination, and the examination report should reflect that such review was accomplished.

(b.) The examiner should offer the following opinion: Is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's service-connected disabilities caused his obesity?

(c.) The examiner should offer the following opinion: Is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that any increase in functional impairment of earning capacity associated with his obesity was proximately due to or the result of a service-connected disability (i.e., aggravated by a service-connected disability)?

(d.) Next, the examiner should offer the following opinion: Is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's obesity was a substantial factor in causing his obstructive sleep apnea?

(e.) Next, the examiner should offer the following opinion: Is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's obstructive sleep apnea would not have occurred but for his obesity?

Note: The term "aggravated" in the above context refers to a worsening of the pre-existing or underlying condition; "permanent worsening" is not required to establish service connection.

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Sherrard, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

Analyze in VA Law Explorer