TRAUMATIC BRAIN INJURY

HARVEY P. ROBERTS · 2026 · Case ID: A26036425

MIXED

Summary

The Veteran served from May 1976 to May 1980. The Veteran appeals the denial of service connection for TBI residuals secondary to Alzheimer's disease, depression secondary to Alzheimer's disease, and a low back disability. The Veteran also sought an increased rating for bilateral hearing loss. The Board granted service connection for TBI residuals secondary to Alzheimer's disease, finding that a private examiner's opinion, which linked the September 2021 fall and subsequent concussion to the Veteran's documented balance issues from Alzheimer's disease, was persuasive. The Board resolved reasonable doubt in the Veteran's favor for this claim. Service connection for depression, also secondary to Alzheimer's disease, was granted based on a VA treatment record from June 2023, which noted depression related to increasing Alzheimer's symptoms, and resolving doubt in the Veteran's favor. The claim for a low back disability was denied. The Board found the evidence weighed against service connection, noting the absence of in-service treatment records for back issues, a normal separation examination report, and the Veteran's own indication of symptom onset in 2014. A VA examiner's opinion that the low back disability was not related to service was given significant weight. The claim for an increased rating for bilateral hearing loss was denied. A May 2024 VA examination resulted in a 30 percent rating based on specific audiometric thresholds. A private hearing test was deemed inadequate for rating purposes as it lacked speech recognition scores and did not meet criteria for an exceptional pattern of hearing impairment. The Board found the VA examination to be the most probative evidence, denying the claim for a higher rating.

Rationale

Private examiner opinion linked fall to Alzheimer's disease; Resolved reasonable doubt in Veteran's favor; Established causal relationship between Alzheimer's and TBI

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250424-537965

Full Decision Text

Citation Nr: A26036425
Decision Date: 04/20/26 Archive Date: 04/20/26

DOCKET NO. 250424-537965
DATE: April 20, 2026

ORDER

Entitlement to service connection for traumatic brain injury (TBI) residuals, secondary to Alzheimer's disease, is granted.

Entitlement to service connection for depression, secondary to Alzheimer's disease, is granted.

Entitlement to service connection for a low back disability is denied.

Entitlement to an initial rating in excess of 30 percent for bilateral hearing loss is denied.

FINDINGS OF FACT

1. Resolving all reasonable doubt in the Veteran's favor, a falling incident which resulted in TBI residuals as caused by balance problems related to Alzheimer's disease.

2. Resolving all reasonable doubt in the Veteran's favor, the Veteran's depression is related to Alzheimer's disease.

3. The evidence for the period under review persuasively weighed against finding that a low back disability began during service, or is otherwise related to an event, injury, or disease in service or any service-connected disability.

4. During the period under review, the Veteran's bilateral hearing has been manifested by hearing acuity of no worse than Level VI in the right ear and no worse than Level VII in the left ear.

CONCLUSIONS OF LAW

1. The criteria for service connection for TBI, secondary to Alzheimer's disease, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for depression, secondary to Alzheimer's disease, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for an initial rating in excess of 30 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1976 to May 1980.

This appeal comes before the Board of Veterans' Appeals (Board) from an August 2024 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On December 15, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the August 2024 AOJ decision on appeal, and any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or more than 90 days following receipt of the withdrawal, the Board did not consider that evidence in this decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801.

If the Veteran wants VA to consider any evidence that was submitted that the Board cannot consider, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify that evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be established 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. To establish service connection requires evidence of: (1) a current disability; (2) incurrence or aggravation in service of a
and submit or identify that evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be established 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. To establish service connection requires evidence of: (1) a current disability; (2) incurrence or aggravation in service of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be established for a disability that is proximately due to, the result of, or aggravated by, service-connected disability. 38 C.F.R. § 3.310.

In reviewing the evidence for all of the Veteran's claims, the Board notes that the Veteran, due to service-connected Alzheimer's disease symptomatology, was unable to fully participate in the development of the claim. Specifically, the Veteran was not able to fully participate in the May 2024 VA examinations provided to determine the etiology of TBI residuals and psychiatric disabilities, due to memory loss and cognitive difficulties arising from the Alzheimer's disease. Having reviewed the evidence, the Board will resolve reasonable doubt in the Veteran's favor.

1. Entitlement to service connection for TBI, secondary to Alzheimer's disease

Reviewing the evidence, the service medical records did not contain any notation indicating diagnosis or treatment for TBI-related symptoms.

Private treatment records note that the Veteran was treated for balance issues which caused the Veteran to fall accidentally beginning in August 2021. At that time, private examiners diagnosed symptoms associated with dementia which caused problems with orientation.

Subsequent treatment records indicate treatment for a September 2021 incident in which the Veteran fell and incurred a concussion. In a November 2021 private treatment record, an examiner indicated that the Veteran had early symptoms of Alzheimer's disease which had resulted in muscle twitching in the legs, weakness in both feet and hips, and significant loss of muscle bulk.

In a May 2024 VA TBI examination, the examiner noted that that the Veteran could not participate fully in the examination due to the Veteran's Alzheimer's symptoms. The examiner noted that the Veteran fell in September 2021, resulting in a concussion. The examiner also noted that the Veteran's mental state had deteriorated since the concussion. The examiner found that the Veteran had TBI related to the September 2021 falling incident.

In a January 2026 letter, after a review of the evidence from the period under review, a private examiner indicated that the September 2021 fall was caused by documented balance issues related to the Veteran's Alzheimer's disease. The examiner noted that the Veteran's Alzheimer's disease caused spatial disorientation which resulted in the Veteran's inability to understand the Veteran's body's position relative to the rest of the environment. Therefore, the examiner found that the service-connected Alzheimer's disease caused the Veteran diagnosed TBI.

Resolving all reasonable doubt in the Veteran's favor, the Board finds the diagnosed TBI was caused by the Veteran's service-connected Alzheimer's disease. Accordingly, the Board finds that service connection for TBI residuals is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for depression, secondary to Alzheimer's disease

The Veteran contends that the Veteran experienced psychiatric disability symptomatology either due to service or due to a service-connected disability.

2. Entitlement to service connection for depression, secondary to Alzheimer's disease

The Veteran contends that the Veteran experienced psychiatric disability symptomatology either due to service or due to a service-connected disability.

Having reviewed the evidence for the period under review, the Board finds that experienced a psychiatric disability, specifically depression, related to Alzheimer's disease. The record for the period under review indicated treatment for diagnosed depressive disorder. However, during that period, the Veteran's Alzheimer's disease increased in severity. As that disability affected the Veteran's cognitive functioning and ability to recall past events, the Veteran was increasingly unable to cooperate with VA examiners who were attempting to treat the Veteran for psychiatric disability symptomatology. In the May 2024 VA examination report, the VA examiner, who attempted to examine the Veteran to determine the nature and etiology of any current psychiatric disability, indicated that the Veteran was unable to discuss psychiatric symptoms due to Alzheimer's disease symptoms.

Therefore, in deciding this claim, the Board must consider the few records written during the period under review when the Veteran could still cooperate with examiners. Specifically, in a June 2023 VA treatment record, the provider reported treating the Veteran for depression and apathy related to the increasing severity of Alzheimer's disease. Based on the evidence, the Board finds that the Veteran experienced depression related to the increasing Alzheimer's symptoms.

Resolving all reasonable doubt in the Veteran's favor, the Board finds the diagnosed depression was caused by service-connected Alzheimer's disease. Accordingly, the Board finds that service connection for depression, secondary to Alzheimer's disease, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102

3. Entitlement to service connection for a low back disability

The Veteran contends that a low back disability is related to service.

The service medical records do not contain any notation indicating diagnosis or treatment for low back disability symptomatology. In an April 1980 service separation examination report, a service examiner indicated that the spine and other musculoskeletal systems were normal. In a contemporaneous report of medical history prior to separation, the Veteran specifically denied having ever experienced recurrent back pain.

The post-service treatment records included in evidence indicate treatment for low back disability symptomatology beginning in 2014. In a July 2019 private treatment record, when asked about the onset of the current back pain, the Veteran indicated having an accident at work in August 2014 that resulted in a back injury.

In an April 2024 VA examination report, the Veteran reported having experienced mild back pain in service. The Veteran stated that the back pain progressed in 2013, resulting in back surgery in 2015. After an examination, the examiner diagnosed degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome, spinal stenosis, spondylolisthesis, and bilateral lower extremity radiculopathy.

In a June 2024 VA medical opinion, the April 2024 VA examiner opined that the Veteran's diagnosed low back disability was not at least as likely as not related to service or any incident of service. The examiner noted that the treatment records in evidence did not contain any notation indicating treatment or diagnosis for a low back disability until 2014, many years after the Veteran's separation from service. Despite the Veteran's statements indicating onset of low back pain during service, the examiner noted that, in the July 2019 private treatment record, the Veteran stated that the low back disability symptomatology began after an accident in 2014. Therefore, the examiner found that the low back disability was not related to service.

The Board concludes that, while a VA examiner diagnosed several low back disabilities the period under review, the evidence weighed against a finding that the disabilities were related to service. The service medical records did not contain any notation indicating treatment or diagnosis for low back disability symptomatology during service. In an April 1980 service separation examination report, a service examiner indicated that the spine and other musculoskeletal systems were normal. In a contemporaneous report of medical history prior to separation, the Veteran specifically denied having recurrent back pain. Post-service treatment records did not contain any notation indicating diagnosis or treatment for a low back disability until 2014. In a subsequent July 2019 private treatment record, the Veteran, in describing the onset of current low back disability symptoms, indicated experiencing such symptoms following an August 2014 back injury. In the
against a finding that the disabilities were related to service. The service medical records did not contain any notation indicating treatment or diagnosis for low back disability symptomatology during service. In an April 1980 service separation examination report, a service examiner indicated that the spine and other musculoskeletal systems were normal. In a contemporaneous report of medical history prior to separation, the Veteran specifically denied having recurrent back pain. Post-service treatment records did not contain any notation indicating diagnosis or treatment for a low back disability until 2014. In a subsequent July 2019 private treatment record, the Veteran, in describing the onset of current low back disability symptoms, indicated experiencing such symptoms following an August 2014 back injury. In the June 2024 VA medical opinion, the April 2024 VA examiner, having reviewed this record, opined that the Veteran's low back disability was not at least as likely as not related to service. The Board finds that the VA examiner's opinion, based on a review of the entirety of this evidence, has great probative value in this matter. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

The Board has considered the lay evidence in this matter. In the April 2024 VA examination report, the Veteran reported experiencing mild back pain during service. However, in the April 1980 report of medical history provided prior to separation from service, the Veteran specifically denied having ever experienced recurrent back pain. Moreover, in the July 2019 private treatment record, the Veteran indicated having experienced low back disability symptoms since August 2014, over three decades after separation from service. Therefore, the Board finds that the lay evidence weighed against a finding that the Veteran's low back disability began during service or was related to any incident in service.

Certain chronic diseases, such as arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service, such as one year for arthritic conditions; or, if they were noted in service or within an applicable presumptive period, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In this instance, the service medical records contained no notation suggesting onset of low back disability symptomatology during service. The post-service treatment records did not contain any notation indicating diagnosis or treatment for low back disability symptomatology until over three decades after service separation. The Board has found that the lay evidence weighed against a finding that the low back disability began during service. Therefore, because the evidence weighed against a finding that low back disability symptomatology began during service or within one year of separation from service, service connection cannot be established for the disability on a presumptive basis.

Accordingly, having reviewed the evidence, the Board finds that the Veteran's low back disability is not related to service or any incident of service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board finds that the evidence is not in approximate balance and that there is no reasonable doubt to resolve in the Veteran's favor. Therefore, the claim must be denied.

4. Entitlement to an initial rating in excess of 30 percent for bilateral hearing loss

The Veteran is seeking a higher rating because the Veteran contends that bilateral hearing loss was of greater severity during the period under review than contemplated by the assigned 30 percent rating during the period under review.

Ratings for defective hearing range from 0 percent to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies of 1000, 2000, 3000, and 4000
level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies of 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, 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. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, 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, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

At a May 2024 VA examination, the Veteran reported having difficulty hearing in all situations. On testing, the examiner noted that the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were:

HERTZ

1000 2000 3000 4000 Avg CNC

RIGHT 30 55 65 75 56 60

LEFT 40 60 65 65 58 56

Applying the results to Table VI, the findings yield a numeric designation of Level VI in the right ear and Level VII in the left ear. Entering the resulting bilateral numeric designation of Level VI for the right ear and Level VII for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a 30 percent rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown.

In support of the claim, the Veteran submitted a July 2024 private hearing test. On testing, the examiner noted that the Veteran's pure tone thresholds, in decibels, were:

HERTZ

1000 2000 3000 4000 Avg

RIGHT 25 30 40 60 46

LEFT 30 30 60 50 43

Private audiology reports may be used as evidence if all the required information is present, and Board attorneys can convert findings to numerical charts. The July 2024 VA examiner did not provide any speech recognition scores, to specifically include any using the Maryland CNC speech discrimination test. Moreover, the pure tone thresholds found on testing were not of sufficient severity to be considered an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86. Therefore, the audiometric evaluation is not adequate for VA rating purposes under § 4.85(a) and cannot be used to rate the Veteran's hearing loss disability.

Based on the evidence above, a rating in excess of 30 percent for bilateral hearing loss is not warranted. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran's reports of difficulty hearing. The Veteran is competent to report such symptoms; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. Lendenmann v. Principi, 3 Vet. App. 345 (1992).

The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran described is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran reported experiencing difficulties with hearing which is what is contemplated in the rating assigned. Rossy v. Shulkin, 29 Vet. App. 142 (2017).

Accordingly, the Board finds that the most probative evidence of record persuasively weighs against the claim of entitlement to a rating in excess of 30 percent for bilateral hearing loss. The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim for a rating in excess of 30 percent for bilateral hearing
Veteran described is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran reported experiencing difficulties with hearing which is what is contemplated in the rating assigned. Rossy v. Shulkin, 29 Vet. App. 142 (2017).

Accordingly, the Board finds that the most probative evidence of record persuasively weighs against the claim of entitlement to a rating in excess of 30 percent for bilateral hearing loss. The Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim for a rating in excess of 30 percent for bilateral hearing loss must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Harvey P. Roberts

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T.M. Gillett, 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.

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