MAJOR DEPRESSIVE DISORDER

A. S. CARACCIOLO · 2026 · Case ID: A26037105

MIXED

Summary

The Veteran, an Air Force Veteran who served from July 2007 to June 2008, appeals the denial of an increased rating for an acquired psychiatric disorder, denial of service connection for pseudofolliculitis barbae and bilateral hearing loss, and the grant of service connection for tinnitus, headaches, and obstructive sleep apnea (OSA). The Board denied the increased rating for the acquired psychiatric disorder, finding the Veteran's symptoms, while present, did not meet the criteria for a rating higher than 30 percent. The Veteran's pseudofolliculitis barbae was also denied a compensable rating, as it affected less than five percent of the body and received only topical treatment. Bilateral hearing loss was denied due to normal audiometric results for VA purposes, despite the Veteran's subjective complaints. Service connection for tinnitus was granted, with the Board resolving doubt in the Veteran's favor after conflicting medical opinions, finding the lay evidence credible and consistent with service. Headaches and OSA were granted secondary service connection to the acquired psychiatric disorder, based on a private medical opinion that found a link between the conditions, despite a VA examiner's negative opinion on headaches and no VA exam for OSA.

Rationale

Symptoms did not meet criteria for 50% or higher rating.; Veteran maintained employment and relationships.; No cognitive impairments noted.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

9413

Docket No.

210408-152761

Full Decision Text

Citation Nr: A26037105
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 210408-152761
DATE: April 21, 2026

ORDER

Entitlement to a rating in excess of 30 percent for an acquired psychiatric disorder is denied.

Entitlement to an initial compensable rating for pseudofolliculitis barbae is denied.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for headaches, to include as secondary to service-connected acquired psychiatric disorder, is granted.

Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected acquired psychiatric disorder, is granted.

FINDINGS OF FACT

1. For the entire appeal period, the Veteran's acquired psychiatric disorder was characterized, at worst, by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.

2. For the entire appeal period, the Veteran's pseudofolliculitis barbae affected less than 5 percent of his exposed and total body area.

3. The evidence persuasively weighs against finding that the Veteran has had hearing loss for VA purposes at any time during the pendency of the claim.

4. The Veteran's tinnitus began in and etiologically related to his active duty service.

5. The Veteran's headaches is caused by his service-connected acquired psychiatric disorder.

6. The Veteran's OSA is caused by his service-connected acquired psychiatric disorder.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating in excess of 30 percent for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9413.

2. The criteria for entitlement to an initial compensable rating for pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.118, DC 7806.

3. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385.

4. The criteria for entitlement to service connection for tinnitus have been met. 38?U.S.C. §§?1101, 5107;?38?C.F.R. §§?3.102, 3.159, 3.303, 3.304, 3.309.

5. The criteria for entitlement to service connection for headaches, to include as secondary to service-connected acquired psychiatric disorder, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for entitlement to service connection for OSA, to include as secondary to service-connected acquired psychiatric disorder, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Air Force from July 2007 to June 2008.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision by a Department of Veterans Affairs (VA) regional office (RO). The Veteran timely appealed the rating decision by submitting a VA Form 10182 and requested the hearing docket, which allows the submission of additional evidence within 90 days after a hearing is held pursuant to the Veterans Appeals Improvement Modernization Act of 2017 (AMA). 38 C.F.R. § 20.303 (2019). In October 2024, the Veteran testified at a virtual hearing before the undersigned. A transcript of the hearing is associated with the claims file. Therefore, the Board will consider the evidence of record as of February 25, 2021, the date of the notification letter for the rating decision on appeal, as well as between October 22, 204, to January 21, 2025. Id.

Increased Rating

Disability ratings?are determined by applying the
, which allows the submission of additional evidence within 90 days after a hearing is held pursuant to the Veterans Appeals Improvement Modernization Act of 2017 (AMA). 38 C.F.R. § 20.303 (2019). In October 2024, the Veteran testified at a virtual hearing before the undersigned. A transcript of the hearing is associated with the claims file. Therefore, the Board will consider the evidence of record as of February 25, 2021, the date of the notification letter for the rating decision on appeal, as well as between October 22, 204, to January 21, 2025. Id.

Increased Rating

Disability ratings?are determined by applying the criteria set forth in the VA Schedule for Rating?Disabilities (Rating?Schedule). ?38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disabilities resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. §?1155; 38?C.F.R. §?4.1.

VA should interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability.? 38?C.F.R. §?4.2. Any reasonable doubt regarding the degree of disability shall be resolved in favor of the claimant. 38?C.F.R. §?4.3. Where there is a question as to which of two evaluations apply, the higher of the two should be assigned where the disability picture more nearly approximates the criteria for the next higher rating.? 38?C.F.R. §?4.7.

1. Entitlement to a rating in excess of 30 percent for an acquired psychiatric disorder is denied.

As an initial matter, the Board notes that the relevant temporal focus for this matter begins November 2019, one year prior to the date VA received the increased rating application. See 38 C.F.R. § 3.400. The Board further notes that the Veteran is currently in receipt of a 30 percent rating for his service-connected acquired psychiatric disorder. He contended that a higher rating is warranted.

The Veteran's acquired psychiatric disorder has been rated under DC 9413, which provides that a 30 percent rating is warranted where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

A 50 percent rating is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect, circumstantial, circumlocutory, or stereo-typed speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Id.

A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and the inability to establish and maintain effective relationships. Id.

A 100 percent rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

When evaluating an acquired psychiatric disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment.? 38?C.F.R. §?4.126.

The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Analysis should not be limited to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the rating criteria in determining the level of occupational and social impairment. Mauerhan v. Principi, 16?Vet. App.?436?(2002).

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria.? Bankhead v. Shulkin, 29?Vet. App.?10, 22 (2017); 38?C.F.R. §?4.130.? The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages.? Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating.? Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).?

The Board has thoroughly reviewed the evidence of record and finds that a rating in excess of 30 percent for the Veteran's acquired psychiatric disorder is not warranted for the entire appeal period.

A February 2020 sleep medicine consult shows that the Veteran was alert and oriented times four, with normal mood and effect. He was dressed appropriately with no history of depression or suicidal or homicidal ideation. The Veteran reported he was not being followed for mental health. An August 2020 sleep clinic note revealed no depression, anxiety, crying spells, or suicidal/homicidal ideation.

The Veteran underwent a VA examination in February 2021. The examiner found the Veteran's psychiatric symptoms included anxiety and chronic sleep impairment. The symptoms manifested as occupational and social impairment due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported he had been married to his current spouse since 2018 and had two children, ages seven and nine, who resided in the home. He was employed as director of process improvement for business practices for the state government, working remotely since March 2020 due to COVID. However, his current job did not afford him much time for personal activities or hobbies. He spent most of his time seeking further training for his career and starting up his own business. He had recently interviewed for a promotion in the same job field and expressed confidence that he would be offered the job. He was eager to take on new responsibilities. He further reported that he earned his "Lean Six Sigma Black Belt" and was toward his "Master" black belt. However, he described that "worrying" kept him from being able to fall asleep, but he had not participated in therapy or counseling for his anxiety. The examiner noted that the Veteran had a diagnosis of OSA, which likely contributed to further inference with his sleep maintenance and daytime fatigue.

Upon mental status examination, the Veteran was oriented to person, place, time, and the reason for the evaluation. He was appropriately dressed and responded appropriately throughout the examination. There were no obvious difficulties with speech, concentration, gait, orientation, or fund of knowledge.

The Veteran testified in October 2024 that he was always on high alert, vigilant and that he extended himself to make sure he was doing the best possible job, even in his current job as a consultant.
" kept him from being able to fall asleep, but he had not participated in therapy or counseling for his anxiety. The examiner noted that the Veteran had a diagnosis of OSA, which likely contributed to further inference with his sleep maintenance and daytime fatigue.

The Veteran testified in October 2024 that he was always on high alert, vigilant and that he extended himself to make sure he was doing the best possible job, even in his current job as a consultant. He experienced panic attacks at least three to four times per month. He had difficulty with sleep and experienced headaches. His acquired psychiatric disorder affected his concentration, as well as his relationship with his spouse.

For the entire appeal period, the Board finds that the Veteran's symptoms waxed and waned, but the overall severity of the symptoms persuasively weighed against a rating in excess of 30 percent. The Veteran's reported anxiety - while no doubt causing the Veteran difficulty - were the type of disturbance in motivation and mood contemplated by the 30 percent rating criteria. The Veteran was not noted to have any cognitive impairments. While the Veteran testified that his acquired psychiatric disorder affected his relationships, the record does not reflect that he had difficulty maintaining effective work or social relationships. He still had a relationship with his wife and children. Additionally, the Veteran has continued working, despite asserting that his job did not leave him much time for personal activities and hobbies. In fact, he spent time and energy working to further his career and take on new responsibilities. Though he testified his concentration was affected, there was no evidence that the Veteran experienced such difficulties in understanding complex commands or impairment to his memory. The Veteran's suspiciousness, less than weekly panic attacks, and chronic sleep impairment are contemplated by the 30 percent rating criteria. The Veteran's symptoms overall did not demonstrate occupational and social impairment with reduced reliability and productivity for a 50 percent rating, deficiencies in most areas for a 70 percent rating, or the "total" occupational and social impairment required for a 100 percent rating. See Vazquez-Claudio, 713 F.3d at 118.

The Board emphasizes that having one or more symptoms within the identified criteria for a higher rating does not automatically trigger the granting of a higher rating; it is the overall disability picture that the Board must consider. See 38 C.F.R. § 4.7.

For all the foregoing reasons, the Board finds that a rating in excess of 30 percent for the Veteran's acquired psychiatric disorder is not warranted for the entire period. The evidence weighs persuasively against a higher rating, and as such, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). An increased rating for the Veteran's acquired psychiatric disorder is denied.

2. Entitlement to an initial compensable rating for pseudofolliculitis barbae is denied.

The Veteran's pseudofolliculitis barbae has been assigned a noncompensable rating pursuant to 38 C.F.R. § 4.118, DC 7806. The Veteran contends that his symptomatology warrants a higher rating.

As an initial matter, the Board notes that the relevant temporal focus for this matter begins June 20, 2020, the date entitlement to service connection arose. See 38 C.F.R. § 3.400.

Effective August 13, 2018, changes were made to the rating criteria for skin disabilities (38?C.F.R. §?4.118). See?83 Fed. Reg. 32,592?(July 13, 2018). As the Veteran's claim was filed after August 13, 2018, the new rating criteria will apply.

Any condition under Diagnostic Code 7806 is to be evaluated under the General Rating Formula for the Skin. A noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected.

A 10 percent rating contemplates at least five percent, but less than 20 percent, of the entire body; or at least five percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy
the Veteran's claim was filed after August 13, 2018, the new rating criteria will apply.

A 10 percent rating contemplates at least five percent, but less than 20 percent, of the entire body; or at least five percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immuno-suppressive drugs required for a total duration of less than six weeks during the past 12-month period.

A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.

A 60 percent rating contemplates more than 40 percent of the entire body, or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806.

The Federal Circuit Court has held that systemic therapy means "treatment pertaining to or affecting the body as a whole," whereas topical therapy means treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied, and that nothing in Diagnostic Code 7806 displaces the accepted understandings of systemic therapy and topical therapy to permit a topical therapy that affects "only the area to which it is applied" to count as a systemic therapy under the Code. However, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case and does not automatically mean systemic therapy because Diagnostic Code 7806 distinguishes between systemic and topical therapy. Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017).

The Federal Circuit also held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Burton v. Wilkie, 30 Vet. App. 286 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects.

The Board finds that the evidence persuasively weighs against the assignment of a compensable rating for the Veteran's pseudofolliculitis barbae under the regulations for the entire appeal period.

The Veteran appeared for a VA examination in February 2021. The Veteran reported pain and itchiness associated with pseudofolliculitis barbae but no treatment or medication. The examiner found that the Veteran's pseudofolliculitis barbae affected less than 5 percent of his total body and exposed area.

In January 2025, the Veteran submitted a private disability benefits questionnaire (DBQ) provided by Dr. E.W. Dr. E.W. noted that the Veteran had two separate dermatologic diagnoses of pseudofolliculitis barbae and hidradenitis suppurativa. The Veteran had not been treated with medication in the past 12 months. The pseudofolliculitis barbae affected less than 5 percent of his total body and exposed area, which was his face, neck, and head. The examiner found that none of the Veteran's pseudofolliculitis barbae caused scarring or disfigurement of the head, face, or neck.

The Board finds that a compensable rating is not warranted for the Veteran's pseudofolliculitis barbae. The Veteran's condition affected less than 5 percent of his total body area, as well as less than 5 percent of exposed area. He only used topical cream or ointment for his pseudofolliculitis barbae. Without systemic therapy for less than six weeks or lesions involving at least 5 percent, but less than 20 percent, of the total body or exposed area, a higher rating cannot be awarded under DC 7806 or the General Rating Formula for the Skin. Though the Veteran says that he has bumps on his sides, legs, and groin, he also testified that it may be eczema. See October 2024 Hearing Transcript. Dr. E.W. provided that the Veteran has two different skin-condition diagnoses, pseudofolliculitis barbae and hidradenitis suppurativa; however, only his pseudofolliculitis barbae is service connected. The Board acknowledges that the Veteran's pseudofolliculitis barbae causes him pain and discomfort, and may require dressing changes, but the General Rating Formula for the Skin has specific criteria for each rating. Finally, the Veteran has not had scars associated with his pseudofolliculitis barbae.

Given the record before it, the Board finds that the evidence persuasively weighs against the Veteran's claim for an increased rating for pseudofolliculitis barbae at any time during the appeal period. In denying such rating, the Board finds the benefit of the doubt doctrine is not applicable.? 38?U.S.C. §?5107;?38?C.F.R. §§?3.102, 4.3, 4.7.

Service Connection

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). Service connection may also be granted for any disease diagnosed after discharged, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

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). For certain chronic conditions, an alternative method of establishing the third Shedden element is through a demonstration of?continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331?(Fed. Cir. 2013); Fountain v. McDonald,?27?Vet. App. 258 (2015); 38?C.F.R. §?3.309.

In determining whether?service connection?is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the claimant prevailing in either event. See?38?U.S.C. §?5107(b);?38?C.F.R. §?3.102.

3. Entitlement to service connection for bilateral hearing loss is denied.

The Veteran contends his bilateral hearing loss is related to his service.

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time, he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim
ain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time, he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

Service connection for impaired hearing shall only be established when hearing status as determined by audiometric testing meets specified pure tone and speech recognition criteria. Audiometric testing measures threshold hearing levels (in decibels) over a range of frequencies (in Hertz), and the threshold for normal hearing is from 0 to 20 decibels. Higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 156 (1993).

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

Audiometric testing results from a December 2020 VA examination shows normal hearing for VA purposes under the provisions of 38 C.F.R. § 3.385. Specifically, the pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 5 5 5 5 0

LEFT 5 5 10 10 10

The audiometric testing results did not show an auditory threshold of 40 decibels or higher at any of the above-referenced frequencies or auditory thresholds of 26 decibels or greater for at least three of the above-referenced frequencies in either ear. Additionally, the reported Maryland CNC Test scores of 96 percent for both ears do not meet the VA definition of a hearing loss disability.

As evidence during the claim period reflects that the Veteran has not met the criteria for a hearing loss disability, the current disability requirement has not been met. Moreover, neither the Veteran nor his representative has asserted that the December 2020 VA examination was inadequate. In fact, they concede that the Veteran does not have hearing loss for VA purposes. See October 2024 Hearing Transcript, p. 4.

The Board acknowledges that the Veteran is competent to say that he has decreased hearing in both ears. However, hearing loss for VA compensation purposes must be established by audiometric and/or speech recognition scores. The Board in no way calls into question the Veteran's own observation of diminished hearing acuity, but the Board is unable to find at this time that the Veteran's bilateral hearing loss is of such severity to qualify as a disability for VA purposes, as defined by regulation.

The Board is grateful for the Veteran's honorable service, and this decision is not meant to detract from that service. However, the Board finds that the claim of entitlement to service connection for bilateral hearing loss must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. As the evidence is persuasively against the Veteran's claim of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

4. Entitlement to service connection for tinnitus is granted.

The Veteran asserts that his tinnitus began in service.

Favorable findings in the February 2021 rating decision include a diagnosis of tinnitus from the December 2020 VA examination. Thus, the current disability has been shown. Shedden, 381 F.3d at 1166-67.

4. Entitlement to service connection for tinnitus is granted.

The Veteran asserts that his tinnitus began in service.

Next, the Board finds that the Veteran was exposed to loud noise while in service. The Veteran's military occupation specialty (MOS) was a traffic management apprentice. See March 2009 Certificate of Release or Discharge from Active Duty. The Veteran testified at his October 2024 Board hearing that he worked around heavy machine and equipment and that aircraft and B1s flew over their shops every day. The Veteran further testified that he heard ringing in his ears during service. The Board finds the Veteran's statements credible and consistent with service. Thus, the second element of service is also established. See Shedden,?supra.

The remaining issue is whether there is a medical nexus between the Veteran's currently diagnosed tinnitus and his service. As to this matter, the evidence conflicts.

The Veteran appeared for a VA examination in December 2020, in which he reported his tinnitus began in 2007. The examiner opined that the Veteran's tinnitus was less likely than not related to service because the Veteran's MOS of transportation had a low probability of hazardous noise exposure. The Veteran had normal hearing at entrance and exit from service, and there was no report of tinnitus or hearing loss in military records.

As previously discussed, however the Veteran contends that he was exposed to loud noises during service, and that he began hearing ringing in his ears during service. He further testified at his Board hearing that he has continued to experience tinnitus since his active duty service. Tinnitus is a rare type of disability that, in the vast majority of cases, may be established on the basis of lay evidence alone. See Charles v. Principi,?16?Vet. App.?370?(2002). The Veteran is competent to report experiencing the symptom of tinnitus in the ears. See Jandreau v. Nicholson,?492 F.3d 1372, 1376-77?(Fed. Cir. 2007). His lay statements are credible and consistent with the circumstances of his service.

After careful consideration, the Board finds that the evidence regarding nexus is in approximate balance. When the evidence for and against a claim is in approximate balance, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See?38?U.S.C. §?5107;?38?C.F.R. §?3.102; see also Gilbert v. Derwinski, 1?Vet. App. 49 (1990). Resolving all reasonable doubt in the Veteran's favor, the Board finds that the third element of service connection is established. See Shedden, 381 F.3d at 1166-67. As all three elements of service connection are met, service connection for tinnitus is warranted.

5. Entitlement to service connection for headaches, to include as secondary to service-connected acquired psychiatric disorder, is granted.

6. Entitlement to service connection for OSA, to include as secondary to service-connected acquired psychiatric disorder, is granted.

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

As will be addressed below, the Board finds that service connection for headaches and OSA is warranted on a secondary basis so the Board will not address direct service connection.

Favorable findings from the February 2021 rating decision include diagnoses of tension headaches and OSA. The Veteran
. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

As will be addressed below, the Board finds that service connection for headaches and OSA is warranted on a secondary basis so the Board will not address direct service connection.

Favorable findings from the February 2021 rating decision include diagnoses of tension headaches and OSA. The Veteran is also service connected for an acquired psychiatric disorder. See February 2021 Rating Decision - Codesheet. Therefore, the Board finds that the first and second elements of service connection are satisfied. Wallin, 11 Vet. App. at 512.

The remaining question is whether there is a medical nexus between the Veteran's currently diagnosed headaches and OSA and his service-connected acquired psychiatric disorder. As to this matter, the evidence persuasively weighs in favor of nexus.

The Veteran underwent a headaches VA examination in February 2021, and the examiner opined that the Veteran's headaches were less likely than not related to his service. She explained that the Veteran's service treatment records (STRs) showed no complaint or treatment of migraine headaches. However, she did not provide an opinion as to whether the Veteran's headaches could be related to his acquired psychiatric disorder. The RO did not provide the Veteran with an OSA VA examination.

In January 2025, the Veteran submitted two December 2024 private DBQs and medical opinions pertaining to his headaches and OSA provided by Dr. E.W. Citing an article indicating that depression can cause symptoms like headaches, and an additional article reporting a significant association between depression and sleep apnea, Dr. E.W. concluded that it was at least as likely as not that the Veteran's headaches and OSA were a result of his service-connected mental health condition.

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Athough Dr. E.W.'s explanation could have been more robust, after careful review of the record, and particularly in the absence of no conflicting evidence, the Board finds that the favorable evidence of record supports secondary service connection between the Veteran's headaches and OSA to his service-connected acquired psychiatric disorder. Based on the above, the Board finds that the evidence persuasively supports the Veteran's claims, and the Board resolves all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection for headaches and OSA will be granted.

A. S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. L. Park, 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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