Case A26037763

JOHN J. CROWLEY · 2026 · Case ID: A26037763

MIXED

Summary

The veteran served from March 1986 to March 1990 and again from January 1991 to March 1991. The veteran appealed the denial of service connection for GERD and sought service connection for bilateral knee disabilities, hypertension, erectile dysfunction secondary to a back disability, left lower extremity sciatic nerve pain secondary to a back disability, right lower extremity sciatic nerve pain secondary to a back disability, and insomnia secondary to tinnitus. The issues of right ear hearing loss and left ear hearing loss were withdrawn by the appellant's representative. The Board granted service connection for the left knee disability, finding it at least as likely as not related to service, resolving doubt in the veteran's favor due to equipoise and credible lay statements. Service connection for hypertension was also granted, with the Board giving weight to in-service elevated blood pressure readings and credible lay statements, despite a gap between service and diagnosis and no VA examination. The Board granted service connection for erectile dysfunction and bilateral lower extremity sciatic nerve pain secondary to the service-connected back disability, finding the evidence in equipoise and resolving doubt in the veteran's favor, supported by private medical opinions and treatment records. Service connection for insomnia secondary to tinnitus was granted, with the Board finding the private medical opinion persuasive that tinnitus was the proximate cause of the insomnia. Service connection for GERD was denied, as the Board found the evidence weighed against service connection, and no VA examination was deemed necessary due to lack of credible evidence linking GERD to service.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210419-153691

Full Decision Text

Citation Nr: A26037763
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 210419-153691
DATE: April 22, 2026

ORDER

Entitlement to service connection for right ear hearing loss has been withdrawn.

Entitlement to a compensable rating for left ear hearing loss has been withdrawn.

Entitlement to service connection for a left knee disability is granted.

Entitlement to service connection for a right knee disability is granted.

Entitlement to service connection for hypertension is granted.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.

Entitlement to service connection for erectile dysfunction, secondary to a back disability, is granted.

Entitlement to service connection for left lower extremity sciatic nerve pain, secondary to a back disability, is granted.

Entitlement to service connection for right lower extremity sciatic nerve pain, secondary to a back disability, is granted.

Entitlement to service connection for a sleep condition, including insomnia, secondary to tinnitus, is granted.

FINDINGS OF FACT

1. On March 25, 2025, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant, through the authorized representative, that a withdrawal of the issue of service connection for right ear hearing loss was requested.

2. On March 25, 2025, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant, through the authorized representative, that a withdrawal of the issue of an increased rating for left ear hearing loss was requested.

3. Resolving reasonable doubt in the Veteran's favor, his left knee disability is at least as likely as not related to service.

4. Resolving reasonable doubt in the Veteran's favor, his right knee disability is at least as likely as not related to service.

5. Resolving reasonable doubt in the Veteran's favor, his hypertension is at least as likely as not related to service.

6. The evidence of record persuasively weighs against finding that GERD began during active service or is otherwise related to an in-service injury or disease.

7. The Veteran's erectile dysfunction is at least as likely as not due to or aggravated by the service-connected back disability.

8. The Veteran's left lower extremity sciatic nerve pain is at least as likely as not due to or aggravated by the service-connected back disability.

9. The Veteran's right lower extremity sciatic nerve pain is at least as likely as not due to or aggravated by the service-connected back disability.

10. The Veteran's insomnia is due to his service-connected tinnitus.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of entitlement to service connection for right ear hearing loss by his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for withdrawal of entitlement to a compensable rating for left ear hearing loss by his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

3. The criteria for entitlement to service connection for a left knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for a right knee disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

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

7. The criteria for entitlement to service connection for erectile dysfunction, secondary to a back disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

8. The criteria for entitlement to service connection for left lower extremity sciatic nerve pain, secondary to a back disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§
1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for entitlement to service connection for erectile dysfunction, secondary to a back disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

9. The criteria for entitlement to service connection for right lower extremity sciatic nerve pain, secondary to a back disability, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

10. The criteria for entitlement to service connection for insomnia, secondary to tinnitus, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1986 to March 1990 and from January 1991 to March 1991.

In the April 19, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on March 25, 2025.

Therefore, the Board may only consider the evidence of record at the time of the February 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302 (a), 20.801.

The Board notes that the March 2025 Board Hearing addressed two dockets stemming from separate Notices of Disagreement. Therefore, the current decision will only address the claims subject of the April 2021 AMA Notice of Disagreement.

1. Entitlement to service connection for right ear hearing loss.

2. Entitlement to a compensable rating for left ear hearing loss.

The Board may dismiss any appeal which fails to identify the specific determination with which the claimant disagrees. 38 U.S.C. § 7105 (d). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by an appellant or an appellant's authorized representative. Id.

An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the appellant. Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018); DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011).

On March 25, 2025, the Veteran's authorized representative withdrew the issues of entitlement to service connection for right ear hearing loss and a compensable rating for left ear hearing loss orally at the hearing. All of the aforementioned requirements have been met. Accordingly, the Board does not have jurisdiction to review the appeal as to these issues and are dismissed.

3. Entitlement to service connection for a left knee disability.

4. Entitlement to service connection for a right knee disability.

The Veteran contends that his bilateral knee disability began during service and has progressively worsened since. See March 2025 Hearing Transcript. Specifically, he attributes his bilateral knee disability to his time in Air Assault School, where they taught him how to rappel from helicopters and off of buildings. Id.

To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of
hearing loss orally at the hearing. All of the aforementioned requirements have been met. Accordingly, the Board does not have jurisdiction to review the appeal as to these issues and are dismissed.

3. Entitlement to service connection for a left knee disability.

4. Entitlement to service connection for a right knee disability.

To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or "nexus" between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3d 1391, 1395 (Fed. Cir. 2021).

Treatment records show the Veteran has a current bilateral knee disability, as the Veteran has bilateral knee pain and a right knee meniscus injury sufficient to cause functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (2018); August 2012 Private Treatment Records; June 2025 Letter, Kensington Medical Services. While the service treatment records are silent regarding a specific knee injury, the Veteran reported cramps in his legs with overuse on his March 1991 Separation examination.

The Veteran has provided a June 2025 private medical opinion in support of his claims that will be addressed throughout this appeal. See June 2025 Letter, Kensington Medical Services. Beginning with the knees, they wrote that the Veteran reported bilateral knee pain, worse on the right, with onset during Air Assault School involving rappelling, forced marches, and heavy equipment carriage. The Veteran's spouse corroborated continuous symptoms since 1992, including locking, difficulty rising, and worsening symptoms. No specific diagnosis is noted, but symptoms suggest chronic strain. The Veteran's Air Assault School and combat engineer duties caused microtrauma to knee joints, leading to chronic pain and potential cartilage degradation, as evidenced by ongoing symptoms since service. Therefore, it is at least as likely as not that the Veteran's bilateral knee disability is a direct result of his service as a combat engineer.

As with multiple other disabilities discussed below, the Veteran has not been provided with a VA examination. However, the Board finds that the balance of positive and negative evidence is in relative equipoise, and a remand to obtain additional medical opinions is not necessary. With a current bilateral knee disability and credible lay statements of record that a qualifying event, injury, or disease had onset during service, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for a bilateral knee disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to service connection for hypertension.

The Veteran contends, in substance, that his hypertension is related to or began during active service. See March 2025 Board Hearing.

As an initial matter, the February 2021 rating decision favorably found that the Veteran has been diagnosed with hypertension. Furthermore, the evidence shows that a qualifying event, injury,
a current bilateral knee disability and credible lay statements of record that a qualifying event, injury, or disease had onset during service, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for a bilateral knee disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to service connection for hypertension.

The Veteran contends, in substance, that his hypertension is related to or began during active service. See March 2025 Board Hearing.

As an initial matter, the February 2021 rating decision favorably found that the Veteran has been diagnosed with hypertension. Furthermore, the evidence shows that a qualifying event, injury, or disease has its onset during service. Service treatment records, dated March 1, 1990, note mild diastolic elevation. Lasty, hypertension is a chronic disease which may be presumptively linked to military service under 38 C.F.R. § 3.309.

In the June 2025 private medical opinion, the examiner noted that hypertension was diagnosed on October 28, 2014, with stable management by 2021. The Veteran reported elevated blood pressure readings in the service records, with chronic hypertension requiring medication beginning in 2000. They note that the gap between service (1991) and diagnosis in (2014) is consistent with literature showing that toxic exposures and stress-related hypertension may manifest years after initial exposure. Overall, they opined that it is at least as likely as not that the Veteran's hypertension is a direct result of his in-service toxic exposure.

Despite the Veteran's in-service diastolic elevation and other blood pressure readings that appear elevated, no VA examination has been obtained.

The Board notes that the verification of any toxic exposures regarding the Veteran's military occupational specialty of combat engineer has not been completed. During the March 2025 Board Hearing, the Veteran's representative expressed that there might be an argument to remand the issues of hypertension, GERD, and erectile dysfunction for toxic exposure due to the Veteran's combat engineer military occupational specialty. While further development is necessary in general to assess the Veteran's claim of toxic exposure, the Board finds sufficient evidence is already of record to decide on these issues.

Here, the Board places greater probative weight in the elevated blood pressure readings and mild diastolic elevation that was noted during service and the Veteran's credible lay statements of record. Therefore, the Board resolves all reasonable doubt in favor of the Veteran and finds that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

6. Entitlement to service connection for GERD.

The Veteran contends that his GERD is due to or related to active service. See March 2025 Board Hearing. However, in his May 2020 claim, the Veteran did not provide how his GERD relates to an in-service event or exposure. See May 2020 Fully Developed Claim.

The February 2021 rating decision favorably found that the Veteran has been diagnosed with GERD. During the March 2025 Board Hearing, the Veteran reported that his GERD symptoms have increased within the last couple of years. His symptoms include burning, choking, and difficulty swallowing.

Service treatment records show the Veteran reported symptoms such as a sore throat and difficulty swallowing. See e.g., September 1986, October 1989, and December 1989 Service Treatment Records. However, these symptoms were associated with pharyngitis, tonsillitis, or a cold. Id.

The June 2025 private medical opinion noted that the Veteran reported daily acid reflux with burning, choking, and difficulty swallowing. They further note that the Veteran's spouse corroborated chronic symptoms, particularly choking, and cited page 13 of the March 2025 Board Hearing Transcript. However, the Veteran's spouse did not provide testimony regarding the Veteran's GERD symptoms. See March 2025 Board Hearing. While she did provide testimony for some of the Veteran's disabilities, there is no testimony from his spouse on page 13. This error and reliance on nonexistent lay statements undermines the probative weight of the June 2025 private medical opinion as a whole.

The Veteran has not provided any evidence to support that his GERD is due to active service in any way.

The Board acknowledges that a VA examination or medical opinion has not been obtained. Here, the Board finds that no VA examination is required because there is no credible evidence suggesting a link between the Veteran's active service and his GERD. Therefore, the Board finds no VA examination or opinion is required. McLendon v. Nicholson, 20 Vet. App. 79 (
provide testimony for some of the Veteran's disabilities, there is no testimony from his spouse on page 13. This error and reliance on nonexistent lay statements undermines the probative weight of the June 2025 private medical opinion as a whole.

The Veteran has not provided any evidence to support that his GERD is due to active service in any way.

The Board acknowledges that a VA examination or medical opinion has not been obtained. Here, the Board finds that no VA examination is required because there is no credible evidence suggesting a link between the Veteran's active service and his GERD. Therefore, the Board finds no VA examination or opinion is required. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see Bardwell v. Shinseki, 24 Vet. App. 36 (2010); see also 38 U.S.C. § 5103 (d)(2), 38 C.F.R. § 3.159 (c)(4)(i).

Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the evidence is against service connection for GERD. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

7. Entitlement to service connection for erectile dysfunction, secondary to a back disability.

8. Entitlement to service connection for left lower extremity sciatic nerve pain, secondary to a back disability.

9. Entitlement to service connection for right lower extremity sciatic nerve pain, secondary to a back disability.

The Veteran contends that his erectile dysfunction is secondary to the medication he takes for hypertension. See March 2025 Board Hearing. The Veteran's representative also suggested that the erectile dysfunction could be secondary to the back disability. Id. Lastly, the Veteran contends that his bilateral lower extremity nerve pain is secondary to his back disability. Id.

Service connection may be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995).

As to a current disability, the February 2021 rating decision favorably found that the Veteran has erectile dysfunction. Furthermore, private treatment records show that the Veteran has chronic lumbar back pain that radiates to the left posterior thigh and right posterior thigh. See April 2016 CareMed, Encounter 6. These private treatment records also show that the back pain radiates to the lateral aspect of the left leg and right leg. See May 2015 CareMed, Encounter 4. Therefore, the Board finds a current disability of bilateral lower extremity sciatic nerve pain.

The June 2025 private medical opinion noted that the L5-S1 bulging disc can impair sacral nerve roots (S2-S4), critical for erectile function, especially with numbness during prolonged sitting, indicating potential neurogenic erectile dysfunction. Furthermore, hydrochlorothiazide, used for hypertension and prescribed to the Veteran, is well-established to increase erectile dysfunction risk. Overall, erectile dysfunction is a secondary consequence to the Veteran's back disability or hypertension.

For bilateral lower extremity sciatica, the private examiner noted that no formal sciatica diagnosis is documented, but symptoms suggest radiculopathy secondary to the L5-S1 bulging disc. The L5-S1 bulging disc can compress or irritate nerve roots, causing radicular symptoms such as numbness and pain in the lower extremities, particularly during prolonged sitting, which increases nerve root tension. Military activities, including heavy lifting and load carriage, increase the risk of lumbar disc herniation, a known cause of sciatica, with symptoms often appearing years later as degeneration progresses. The examiner found that the Veteran's back disability, linked to in-service trauma, is the primary cause, with no alternative causes documented. Furthermore, sciatica is a secondary consequence of the service-related disc pathology.

The Veteran has not been provided with a VA examination for his erectile dysfunction or bilateral lower extremity sciatic nerve pain. A July 2021 VA examination noted current back pain symptoms of pain and numbness when sitting for prolonged periods. However, the examiner did not note that the Veteran had radicular pain or any other signs or symptoms due to radiculopathy.

In this case, the Board finds the evidence to at least be in equipoise as to whether the Veteran
years later as degeneration progresses. The examiner found that the Veteran's back disability, linked to in-service trauma, is the primary cause, with no alternative causes documented. Furthermore, sciatica is a secondary consequence of the service-related disc pathology.

In this case, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current erectile dysfunction and bilateral lower extremity sciatic pain is secondary to a back disability. Therefore, after resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for erectile dysfunction and bilateral lower extremity sciatic pain, secondary to the service-connected back disability, is granted. 38 U.S.C. § 5107; 38 U.S.C. § 3.310 (a).

10. Entitlement to service connection for a sleep condition, including insomnia, secondary to tinnitus.

The Veteran contends, in substance, that he experiences severe insomnia due to his service-connected tinnitus. See March 2025 Board Hearing.

The June 2025 private medical opinion noted that insomnia is a chronic sleep disorder characterized by difficulty falling asleep, staying asleep, or achieving restorative sleep, leading to daytime fatigue and impaired functioning. The Veteran reports severe insomnia, achieving only 4 to 5 hours of sleep nightly with daytime fatigue, linked to constant tinnitus noise, particularly disruptive when lying down. No formal insomnia diagnosis is documented, but symptoms align with chronic insomnia secondary to tinnitus. Chronic tinnitus, as experienced by the Veteran, disrupts sleep by increasing sleep latency and maintenance difficulties due to the constant perception of ringing, especially in quiet environments at bedtime. Hyperarousal, a shared feature of tinnitus and insomnia, amplifies sleep disturbances, with studies showing a strong association between tinnitus severity and insomnia, independent of loudness. The absence of documented sleep apnea or primary psychological disorders supports tinnitus as the primary cause. Overall, the Veteran's service-connected tinnitus, caused by military noise exposure, is thus the proximate cause of his insomnia.

Generally, insomnia is identified as a symptom of another underlying disability. However, secondary service connection has been established in this case for insomnia as secondary to tinnitus and the evidence of record does not indicate that insomnia is a symptom of his service-connected tinnitus but rather is a separate diagnosed disability with separate symptoms and functional impairments. Furthermore, Diagnostic Code 6260 for tinnitus does not include any reference to insomnia or other sleeping issues for rating purposes.

(Continued on the next page)

For the foregoing reasons, service connection for a sleep condition, including insomnia, as secondary to service-connected tinnitus is granted. 38 U.S.C. § 5107; 38 U.S.C. § 3.310 (a).

John J. Crowley

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Cochran, Laura

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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