Case A26038060

J. PARKER · 2026 · Case ID: A26038060

MIXED

Summary

The veteran, who served from February 1987 to May 1989, appeals the denial of earlier effective dates for service connection for hypertension and tinnitus, and the initial disability ratings assigned for these conditions. The veteran also appeals the denial of service connection for erectile dysfunction and obstructive sleep apnea, claiming they are secondary to service-connected hypertension. The Board denied the appeal for earlier effective dates for hypertension and tinnitus, finding that no claim, formal or informal, was received prior to July 25, 2024, the date of intent to file. The Board granted a 10 percent disability rating for hypertension for the initial appeal period, resolving reasonable doubt in the veteran's favor due to evidence of continuous medication use and symptoms approximating a history of diastolic pressure predominantly 100 mmHg or more. However, the appeal for a higher rating for tinnitus was denied, as the maximum schedular rating for tinnitus is 10 percent. Service connection for erectile dysfunction and obstructive sleep apnea was granted as secondary to hypertension, with the Board finding the evidence in relative equipoise and resolving doubt in the veteran's favor. The issues of service connection for a kidney disorder and an acquired psychiatric disorder were remanded due to a duty to assist error, as VA failed to obtain necessary medical opinions for these conditions.

Rationale

Evidence in relative equipoise regarding 10% rating criteria; Continuous medication use for hypertension; Symptoms approximated history of diastolic pressure predominantly 100 mmHg or more

Special Benefit

EARLIER EFFECTIVE DATE

Docket No.

250805-568462

Full Decision Text

Citation Nr: A26038060
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 250805-568462
DATE: April 23, 2026

ORDER

An effective date prior to July 25, 2024, for service connection for hypertension is denied.

An effective date prior to July 25, 2024, for service connection for tinnitus is denied.

For the entire initial rating period on appeal, beginning July 25, 2024, a higher initial disability rating of 10 percent, but no higher, for the service-connected hypertension is granted.

A higher initial disability rating in excess of 10 percent for tinnitus, as a matter of law, is denied.

Service connection for erectile dysfunction, as secondary to service-connected hypertension, is granted.

Service connection for obstructive sleep apnea, as secondary to service-connected hypertension, is granted.

REMANDED

Service connection for a kidney disorder is remanded.

Service connection for an acquired psychiatric disorder, to include generalized anxiety disorder, major depressive disorder, insomnia disorder, and posttraumatic stress disorder, is remanded.

FINDINGS OF FACT

1. The Veteran separated from active service on May 3, 1989.

2. More than one year after service separation, on July 25, 2024, the Department of Veterans Affairs (VA) received the Veteran's intent to file for compensation benefits.

3. On the same day VA received the intent to file, VA also received the Veteran's claims for service connection for hypertension and tinnitus; no claim, formal or informal, for service connection for hypertension and/or tinnitus was received prior to that date.

4. Service connection for hypertension and tinnitus was granted in various November 2024 VA rating decisions, and an effective date of July 24, 2024, the date of receipt of intent to file, was assigned to both disabilities.

5. For the entire initial rating period on appeal, from July 25, 2024, the service connected hypertension has more nearly approximated the continuous use of medication with a history of diastolic pressure predominantly 100 mmHg or more.

6. For the entire initial rating period on appeal, from July 25, 2024, the service connected tinnitus has been assigned the maximum 10 percent schedular disability rating available, under Diagnostic Code 6260.

7. Currently diagnosed erectile dysfunction and obstructive sleep apnea are caused, at least in part, by the service-connected hypertension.

CONCLUSIONS OF LAW

1. The criteria for an effective date prior to July 25, 2024 for service connection for hypertension have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.156, 3.400, 3.2500.

2. The criteria for an effective date prior to July 25, 2024 for service connection for tinnitus have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.156, 3.400, 3.2500.

3. Resolving reasonable doubt in the Veteran's favor, for the entire initial rating period on appeal, from July 25, 2024, the criteria for a higher initial disability rating of 10 percent, but no higher, for service-connected hypertension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.21, 4.104, Diagnostic Code 7101.

4. There is no legal basis for the assignment of a disability rating in excess of 10 percent for tinnitus for any period. 38 U.S.C. § 1155; 38 C.F.R. § 4.87, Diagnostic Code 6260.

5. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for erectile dysfunction, as secondary to service connected hypertension, have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.326.

6. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for obstructive sleep apnea, as secondary to service connected hypertension, have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3
have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.326.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran, who is the appellant, had active service from February 1987 to May 1989.

The Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55, 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA), creates a new framework of review for veterans who disagree with an Agency of Original Jurisdiction's (AOJ) decision on their claim.

Following multiple VA Regional Office (RO) rating decisions, the Veteran submitted a VA Form 10182, Notice of Disagreement (NOD), in August 2025 requesting the AMA Hearing Review lane for a reevaluation of the evidence considered by the AOJ.

Subsequently, in August 2025, the Veteran requested a switch to the direct review lane. In a November 2025 letter, the Board of Veterans' Appeals (Board) informed the Veteran that the issues addressed in the instant decision had been placed on the direct review docket as requested; however, all issues related to the service-connected myocardial infarction would remain on the originally requested hearing docket, as such issue(s) were not included in the docket switch request form. As such, the Board does not address any issues related to the myocardial infarction in the instant decision, as any such issues remain on the hearing docket at this time.

Direct review is the appeal option to the Board in which a Board decision is issued based on evidence of record at the time of the prior decision. The Board cannot hold a hearing or accept into the record additional evidence in its direct review.

The Board is cognizant that in Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims (Court) held that, generally, the Board should not decide an appeal before the deadline for requesting an AMA docket switch has elapsed; however, in an August 2025 cover letter accompanying the docket switch request, the Veteran explicitly said that direct review was being sought and that no Board hearing was desired and no new evidence would be forthcoming. The Veteran also expressed a desire to have this decision expedited. As such, the Board finds it appropriate to proceed with adjudication of the instant matter at this time.

1. An Earlier Effective Date for Hypertension is Denied.

2. An Earlier Effective Date for Tinnitus is Denied.

Except as specifically provided, the effective date of an evaluation and award for pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Title 38 of the Code of Federal Regulations clarifies that an award of direct service connection will be effective on the day following separation from active military service or the date on which entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the appellant's claim or the date on which entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i).

As to what constitutes a claim, a specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). The term "claim" means a communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p).

Effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). This rulemaking also eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims for increase and revised 38 C.F.R. § 3.400(o)(2).

To preserve an effective date, an intent to file a claim may be submitted to VA. 38 C.F.R. § 3.155(b). Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, appropriate to the benefit sought within one-year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155. An intent to file a claim may be submitted in one of three ways, via saved electronic application, via written notice on a prescribed intent to file claim form, or via oral communication with designated VA personnel, who records the intent in writing.

Under the former regulations governing informal claims, any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant or representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the Veteran, it will be considered filed as of the date of receipt of the informal claim. When a claim has been filed which meets the requirements of 38 C.F.R. §§ 3.151 or 3.152, an informal request for increase or reopening will be accepted as a claim. 38 C.F.R. § 3.155 (2014).

Reports of examination or hospitalization from VA, private physicians, or state or other institutions, may be accepted in certain circumstances as claims for increase or claims to reopen. 38 C.F.R. § 3.157(a) (2014). Significantly, receipt of such reports of examination or hospitalization may only be accepted as an informal claim for increased benefits if a formal claim for compensation has been previously allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree. 38 C.F.R. § 3.157(b) (2014). With respect to evidence from a private physician or layman in particular, the date of receipt of such evidence will be accepted as the date of receipt of an informal claim when the evidence furnished by or on behalf of the claimant is within the competence of the physician or lay person and shows the reasonable probability of entitlement to benefits. 38 C.F.R. § 3.157(b)(2) (2014).

The applicable statutory and regulatory provisions require that VA look to all communications from a veteran which may be interpreted as applications or claims - formal and informal - for benefits. The Federal Circuit has emphasized that VA has a duty to fully and sympathetically develop a veteran's claim to its optimum, which includes determining all potential claims raised by the evidence and applying all relevant laws and regulations. See Harris v. Shinseki, 704 F.3d 946, 948-49 (Fed. Cir. 2013); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004); Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). The Board is required to adjudicate all issues reasonably raised by a liberal reading of the appeal, including all documents and oral testimony in the record prior to the Board's decision. See Brannon v.
seki, 704 F.3d 946, 948-49 (Fed. Cir. 2013); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004); Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). The Board is required to adjudicate all issues reasonably raised by a liberal reading of the appeal, including all documents and oral testimony in the record prior to the Board's decision. See Brannon v. West, 12 Vet. App. 32 (1998); Solomon v. Brown, 6 Vet. App. 396 (1994). However, in determining whether an informal claim has been made, VA is not required to read the minds of the veteran or representative. Cintron v. West, 13 Vet. App. 251, 259 (1999).

The essential elements for any claim, whether formal or informal, are: (1) an intent to apply for benefits; (2) an identification of the benefits sought; and (3) a communication in writing. Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); see also MacPhee v. Nicholson, 459 F.3d 1323, 1326-27 (Fed. Cir. 2006) (holding that the plain language of the regulations requires a claimant to have intent to file a claim for VA benefits).

The Veteran appeals for an effective date earlier than July 25, 2024 for the grant of service connection for hypertension and tinnitus. No argument has been provided as to why an earlier effective date might be warranted.

Review of the record reflects that the Veteran first filed a claim for benefits in September 1990, requesting service connection for an acquired psychiatric disorder. The issues of service connection for hypertension and/or tinnitus were not formally raised by the Veteran and/or reasonably raised by the record at that time. In May 2022, VA sent the Veteran a letter informing that an intent to file had been received on May 8, 2022. No formal claim was received within one year of receipt of the May 2022 intent to file.

Subsequently on July 25, 2024, which is more than one year after service separation, VA again sent the Veteran a letter informing that it had received a new intent to file for compensation benefits. On the same day VA received the intent to file, July 25, 2024, VA also received the Veteran's claim for service connection for hypertension and tinnitus. No claim, formal or informal, for service connection for hypertension and/or tinnitus was received prior to July 25, 2024. Service connection for hypertension and tinnitus was then granted in various November 2024 VA rating decisions. For both disabilities an effective date of July 25, 2024, the date of receipt of intent to file, was assigned.

Based upon the above discussed procedural history, and considering the lack of argument from the Veteran and/or the representative as to why earlier effective dates might be warranted, the Board finds that no claim, formal or informal, for service connection for hypertension and/or tinnitus was received or reasonably raised prior to July 25, 2024.

The pertinent legal authority governing effective dates is clear and specific, and the Board is bound by such authority. While entitlement to service connection may have arisen earlier than July 25, 2024, the date entitlement arose does not decide the effective date in this case; the later date of the claim for service connection controls the effective date. The controlling regulation clearly and specifically provides that the effective date shall be the date of receipt of the appellant's claim for service connection or the date on which entitlement arose, whichever is later. 38 C.F.R. § 3.400.

On these facts, the earliest effective date legally possible has been assigned under 38 C.F.R. § 3.400, the date of intent to file for service connection (July 25, 2024). As an effective date for service connection earlier than July 25, 2024 (date of receipt of intent to file for service connection) is not provided by law or regulation, the appeal for an earlier effective date as to the issues of service connection for hypertension and tinnitus is without legal merit, so must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law is dispositive, the claim must
.

Disability Rating Legal Authority

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment).

In Lyles, the Court explained that "entitlement to a separate evaluation in a given case depends on whether the manifestations of disability for which a separate evaluation is being sought have already been compensated by an assigned evaluation under a different DC." In Lyles, the Court also advised that "where a certain manifestation of a disability has not been compensated via an assigned evaluation under a particular DC, evaluation of that manifestation under another DC would not constitute pyramiding."

The Veteran has appealed from the initial ratings assigned for the service connected hypertension and tinnitus. In Fenderson v. West, 12 Vet. App. 119, 125 26 (1999), the Court addressed a similar appeal and directed that such appeal of the initial rating assigned following a grant of service connection was specifically not a claim for an increased disability rating. The Court also directed that separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings.

A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007).

The Board has thoroughly reviewed all the evidence in the Veteran's claims file and adequately addresses the relevant evidence in
The Court also directed that separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings.

The Board has thoroughly reviewed all the evidence in the Veteran's claims file and adequately addresses the relevant evidence in the instant decision. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, every piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence).

3. A Higher Initial Disability Rating for Hypertension is Granted.

VA assigned a 0 percent (noncompensable) initial disability rating for hypertension. The Veteran appeals for a higher initial disability rating.

Under Diagnostic Code 7101, a 10 percent rating is assigned for diastolic pressure predominately 100 or more, or; systolic pressure predominantly 160 or more, or is the minimum rating for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent disability rating is assigned for diastolic readings of predominantly 110 or more or systolic readings of 200 or more. A 40 percent disability rating is assigned for diastolic readings of predominantly 120 or more. A 60 percent disability rating is assigned for diastolic readings of predominantly of 130 or more. 38 C.F.R.

§ 4.104, Diagnostic Code 7101. The schedular criteria do not specifically outline any criteria for a noncompensable rating, which is assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31.

After a review of all the evidence, lay and medical, the Board finds that the evidence is at least in relative equipoise as to whether the criteria for a 10 percent rating for hypertension under Diagnostic Code 7101 have been met. For the entire initial rating period on appeal, beginning July 25, 2024, the hypertension has required the continuous use of medication. VA provided a VA hypertension examination in November 2024. Per the examination report the hypertension required taking continuous medication, specifically, Lisinopril, Metoprolol Tartrate, and Amlodipine, for control of the hypertension.

The Board next finds the evidence at least in relative equipoise on the question of whether the evidence more nearly approximates a history of diastolic pressure predominantly 100 mmHg or more. While available VA medical records do not reflect diastolic pressure readings of predominately 100 or more, numerous VA medical records prior to 2024 reflect diastolic blood pressure readings in the high 90s. Further, at the time of the VA examination in November 2024 the Veteran conveyed having symptoms of chest pain, dizziness, and shortness of breath related to the service-connected hypertension. The Board finds that such evidence reflects hypertension symptoms that more nearly approximate a finding of a history of diastolic pressure predominantly 100 mmHg or more.

For these reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that the hypertension more nearly approximates the criteria for a 10 percent disability rating for the entire initial rating period on appeal, beginning July 25, 2024. 38 C.F.R. §§ 4.21, 4.104.

The Board additionally finds that the criteria for a rating in excess of 10 percent have not been more nearly approximated at any time. The medical and lay evidence of record does not show diastolic blood pressure predominantly 110 mmHg or more, or systolic blood pressure predominantly 200 mmHg or more. It is only with application of reasonable doubt and 38 C.F.R. § 4.21 that even the criteria for a 10 percent disability rating are more nearly approximated, and not strictly met. 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code 7101. Further, the Veteran has not contended that the schedular rating criteria do not account for
for a rating in excess of 10 percent have not been more nearly approximated at any time. The medical and lay evidence of record does not show diastolic blood pressure predominantly 110 mmHg or more, or systolic blood pressure predominantly 200 mmHg or more. It is only with application of reasonable doubt and 38 C.F.R. § 4.21 that even the criteria for a 10 percent disability rating are more nearly approximated, and not strictly met. 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code 7101. Further, the Veteran has not contended that the schedular rating criteria do not account for all symptoms and functional impairments of the service-connected hypertension; thus, a claim for an extraschedular rating (38 C.F.R. § 3.321(b)) has not been raised by the evidence or by the Veteran. Accordingly, the Board will grant the appeal for a higher initial disability rating of 10 percent, but no higher, for the initial rating period on appeal from July 25, 2024.

4. A Higher Initial Disability Rating for Tinnitus is Denied.

For the entire initial rating period on appeal from July 25, 2024, the service connected tinnitus is rated at 10 percent under Diagnostic Code 6260. The Veteran generally requests a higher initial disability rating for the tinnitus.

Tinnitus is rated under Diagnostic 6260, which provides a 10 percent maximum disability rating for recurrent tinnitus. 38 C.F.R. § 4.87. Note (2) further explains that the Board must assign only a single rating for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head. The United States Court of Appeals for the Federal Circuit (Federal Circuit) affirmed VA's long-standing interpretation of Diagnostic Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral. Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). As the regulations preclude a rating in excess of a single 10 percent rating for tinnitus, the appeal for a disability rating greater than 10 percent for tinnitus must be denied as a matter of law. Further, the Veteran has not contended that the schedular rating criteria do not account for all symptoms and functional impairments of the service-connected tinnitus; thus, a claim for an extraschedular rating (38 C.F.R. § 3.321(b)) has not been raised by the evidence or by the Veteran.

5. Service Connection for Erectile Dysfunction is Granted.

6. Service Connection for Obstructive Sleep Apnea is Granted.

Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service.

Service connection may be granted for disability that is proximately due to or the result of a service-connected disability. An increase in severity of a non-service-connected disorder that is proximately due to or the result of a service connected disability, and not due to the natural progress of the non service connected condition, will be service connected. Aggravation will be established by determining the baseline level of severity of the non service connected condition and deducting that baseline level, as well as any increase due to the natural progress of the disease, from the current level. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether persuasive weight of the evidence is against a claim, in which case, the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuas
C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether persuasive weight of the evidence is against a claim, in which case, the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

The Veteran appeals for service connection for erectile dysfunction and obstructive sleep apnea as either directly related to an in-service toxic exposure risk activity (TERA), or as secondary (38 C.F.R. § 3.310) to the service-connected hypertension.

On the question of diagnosis, at the time of an April 2025 rating decision the AOJ made a favorable finding of a current diagnosis of obstructive sleep apnea. Under the AMA the Board is bound by such favorable finding. 38 C.F.R. §§ 3.104(c), 20.801.

As to the issue of erectile dysfunction, the available medical evidence of record is negative for a specific diagnosis of erectile dysfunction; however, per a July 2025 Higher-Level Review (HLR) Return, a VA decision review officer explained that, despite the lack of erectile dysfunction diagnosis, a veteran is competent to report symptoms of erectile dysfunction. As such, the VA decision review officer directed that a VA medical opinion be obtained as to the claimed/diagnosed erectile dysfunction. In other words, the VA decision review officer effectively made a favorable finding that there was a current disability of erectile dysfunction. The Board is bound by such favorable finding. Id.

Next, the Board finds the evidence at least in relative equipoise on the question of whether the current erectile dysfunction and obstructive sleep apnea were caused, at least in part, by the service-connected hypertension.

On the issue of erectile dysfunction, a VA examiner in May 2025 opined that it was more likely than not that the Veteran's metabolic syndrome, which included the service-connected hypertension, at least in part, was the cause of the erectile dysfunction. As to the obstructive sleep apnea, in a March 2025 TERA opinion a VA examiner opined it less likely than not that the obstructive sleep apnea was due to an in service TERA. In rendering this opinion, the VA examiner noted that the Veteran had the well-established obstructive sleep apnea risk factors of obesity, smoking, and hypertension. In other words, the VA examiner attributes, at least in part, the obstructive sleep apnea to the service-connected hypertension.

For these reasons, resolving all reasonable doubt in favor of the Veteran, the Board finds that the criteria for service connection for erectile dysfunction and obstructive sleep apnea, as secondary (38 C.F.R. § 3.310) to the service-connected hypertension, on a causation basis, have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82. As service connection is being granted on a secondary basis, there is no need to discuss entitlement to service connection on any other basis, as other theories of service connection have been rendered moot, leaving no question of law or fact to decide. See 38 U.S.C. § 7104.

REASONS FOR REMAND

The issues of service connection for a kidney disorder and an acquired psychiatric disorder are remanded to correct a duty to assist error that occurred prior to the rating decision on appeal. 38 C.F.R. § 20.802(a). VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006).

7. Service Connection for a Kidney Disorder is Remanded.

VA has not provided a VA kidney examination. In a March 2025 rating decision, the AOJ denied service connection for a kidney disorder based upon a finding of no current diagnosis. Available VA treatment records, however, reflect that in March 2020 there was a diagnosis of left kidney/renal cysts, and medical testing indicated
medical opinion when it is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006).

7. Service Connection for a Kidney Disorder is Remanded.

VA has not provided a VA kidney examination. In a March 2025 rating decision, the AOJ denied service connection for a kidney disorder based upon a finding of no current diagnosis. Available VA treatment records, however, reflect that in March 2020 there was a diagnosis of left kidney/renal cysts, and medical testing indicated the presence of chronic kidney disease. As there was an in-service TERA, which includes asbestos exposure, and there is some evidence substantiating a current kidney disorder, the Board finds remand for a VA kidney examination and opinion to be necessary.

8. Service Connection for an Acquired Psychiatric Disorder is Remanded.

VA provided a mental health examination in February 2025. At that time VA diagnosed generalized anxiety disorder, major depressive disorder, insomnia disorder, and posttraumatic stress disorder. Service personnel records show that during service the Veteran had a pattern of misconduct, including unauthorized absences, that culminated with a diagnosis of a personality disorder. As the VA examiner in February 2025 did not diagnose a personality disorder, the AOJ should have obtained a medical opinion on the question of whether the in-service behavioral problems were an early manifestation of a later (and currently) diagnosed acquired psychiatric disorder. The Board remands for such opinion.

The aforementioned matters are REMANDED for the following action:

1. Schedule the appropriate VA kidney/renal examination. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should provide the following opinions:

A) Is there a currently diagnosed kidney disorder?

B) For each kidney disorder diagnosed, is it at least as likely as not that the kidney disorder was caused by the synergistic, combined effect of all the Veteran's toxic exposures during service, to include asbestos exposure?

2. The AOJ should obtain an addendum medical opinion to the February 2025 VA mental health examination. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should provide the following opinion:

Is it at least as likely as not that the Veteran's in-service pattern of misconduct, including unauthorized absences, was an early manifestation of a currently diagnosed acquired psychiatric disorder?

J. PARKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Blowers, 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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