VERTIGO

Summary

The veteran, who served from July 1970 to June 1974, including service in Vietnam and exposure to herbicides and asbestos, appeals the denial of service connection for postural dizziness, obstructive sleep apnea (OSA), and a compensable rating for hypertension. The Board found that the veteran's postural dizziness was a symptom of his service-connected hypertension and not a separate diagnosis. While the Board acknowledged the veteran's TERA exposure, the VA examiner opined that OSA is not scientifically linked to Agent Orange and that the veteran's condition was less likely than not caused by TERA. For hypertension, the Board reviewed numerous blood pressure readings and found that the veteran did not meet the criteria for a compensable rating, as his readings did not consistently meet the predominant diastolic pressure of 100 or more, or systolic pressure of 160 or more, particularly when considering the ameliorative effects of medication and outlier readings. The Board applied the benefit of the doubt doctrine but found the evidence weighed against the veteran's claims for all three issues. Service connection for postural dizziness, OSA, and a compensable rating for hypertension were all denied.

Rationale

Postural dizziness considered a symptom of hypertension; No diagnosis of postural dizziness found; No in-service complaints or treatment for postural dizziness; VA examiner opined less likely than not caused by TERA

Full Decision Text

Citation Nr: A26038376
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 250617-555673
DATE: April 23, 2026

ORDER

Entitlement to service connection for postural dizziness is denied.

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

Entitlement to a compensable rating for service connected hypertension is denied.

FINDINGS OF FACT

1. The Veteran does not have a diagnosis of postural dizziness, as it is considered a symptom of his service connected hypertension.

2. The Veterans currently diagnosed OSA was not shown to be causally or etiologically related to any event, injury, or disease during service.

3. The Veteran's hypertension did not result in systolic pressure readings predominantly 160 or more; or diastolic pressure predominantly 100 or more; or a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for postural dizziness have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

2. The criteria for entitlement to service connection for OSA have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

3. The criteria for entitlement to a compensable rating for service connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1970 to June 1974, and was honored with multiple decorations for their service, including the National Defense Service Medal; Predental Unit; Vietnam Campaign Medal; Vietnam Service Medal; and Citation Medal.

The matter comes before the Board on appeal from a rating decision issued in April 2025 by a Department of Veterans Affairs (VA) Regional Office. 

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. §?20.301.  

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.: see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

1. Entitlement to service connection for postural dizziness.

The Veteran contends that he is entitled to service connection for his postural dizziness. 

In the April 2025 rating decision on appeal, the AOJ favorably found the Veteran participated in toxic risk exposure activities (TERA) in service as it was confirmed service in Vietnam with exposure to herbicides and asbestos. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). As such, at issue in this case is whether there is a diagnosis of postural dizziness. 

After resolving all reasonable doubt in the Veteran's favor, the Board concluded the Veteran does not have a current diagnosis of postural dizziness. Although the Veteran's medical records note that the Veteran has suffered from postural dizziness, the medical records specifically consider this
 rating decision on appeal, the AOJ favorably found the Veteran participated in toxic risk exposure activities (TERA) in service as it was confirmed service in Vietnam with exposure to herbicides and asbestos. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). As such, at issue in this case is whether there is a diagnosis of postural dizziness. 

After resolving all reasonable doubt in the Veteran's favor, the Board concluded the Veteran does not have a current diagnosis of postural dizziness. Although the Veteran's medical records note that the Veteran has suffered from postural dizziness, the medical records specifically consider this a symptom of an underlying condition. The medical records have considered this to be a symptom of the Veteran's hypertension, which is already service connected. Efforts to identify other potential causes or diagnosis for the Veteran's postural dizziness have been unsuccessful, as there has been no diagnosis of any condition that that would cause such symptom during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Additionally, the Veteran's STRs and medical records are silent of any complaints or treatment for postural dizziness during his active duty service. 

The Veteran also was afforded a VA examination in March 2025 for his claimed ear conditions in order to assess whether the Veteran's dizziness could be related to an underlying ear condition. The VA examiner found no diagnosis of an ear condition. The VA examiner did note the Veteran's statements that his dizziness started in 2003 with sudden head movements when getting up from a chair and lasted for less than a minute. The Veteran also related that when he began experiencing feelings of imbalance when walking and he was diagnosed with postural imbalance. The VA examiner stated that initially it was felt that such condition might be due to the Veteran's blood pressure (BP) medication, amlodipine. However, the VA examiner noted the records reflect decreasing the dosage of amlodipine did not help the Veteran's symptoms. The VA examiner noted that the Veteran had undergone testing for carotid stenosis, MRI brain, and a cardiac evaluation, all of which did not reveal a cause for his symptoms. The VA examiner stated that the Veteran started having these issues a year prior to the exam and has had numerous evaluations over the last year with no underlying cause being established. Thus, VA examiner opined that given that this was a recent event and the Veteran's active duty service and exposure to Agent Orange was more than 50 years ago, the claimed condition of postural dizziness was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran.

In short, while appreciative of the Veteran's participation in the appeal, lay evidence cannot establish the presence of the claimed disability in this case.

In the absence of proof of the current disabilities, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 233 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists). Accordingly, the Board finds that the evidence persuasively is against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

2. Entitlement to service connection for OSA.

The Veteran contends that he is entitled to service connection for his diagnosed OSA. 

In the April 2025 rating decision on appeal, the AOJ favorably found the Veteran participated in toxic risk exposure activities (TERA) in service as it was confirmed service in Vietnam with exposure to herbicides and asbestos and was diagnosed with OSA in November 2024. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). As such, at issue in this case is whether there is a nexus between the currently diagnosed condition and in service event, injury, or disease. 

Here, the Veteran was afforded a VA examination in March 2025. The VA examiner noted that the Veteran was diagnosed with OSA. The VA examiner further noted that the Veteran stated his OSA had its onset in 2000 when he started snoring and was tired all day. The Veteran
 confirmed service in Vietnam with exposure to herbicides and asbestos and was diagnosed with OSA in November 2024. As the file is devoid of clear and unmistakable evidence to the contrary, the Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). As such, at issue in this case is whether there is a nexus between the currently diagnosed condition and in service event, injury, or disease. 

Here, the Veteran was afforded a VA examination in March 2025. The VA examiner noted that the Veteran was diagnosed with OSA. The VA examiner further noted that the Veteran stated his OSA had its onset in 2000 when he started snoring and was tired all day. The Veteran also stated he had received a sleep study that showed he had OSA, and that he was provided with a CPAP machine to help improve his symptoms. The VA examiner stated that since the Veteran began using CPAP his symptoms of snoring and daytime fatigue had improved. The VA examiner explained that OSA is characterized by episodes of complete airway collapse or a partial collapse with an associated decrease in oxygen saturation or around from sleep. The VA examiner also noted that OSA had other symptoms that included loud, disruptive snoring, witnessed apneas during sleep, and excessive daytime sleepiness. The VA examiner notes that the disturbances result in fragmented, nonrestorative sleep and the anatomic factors that promote pharyngeal narrowing include large neck circumference, soft tissue, bone, or vessels. Furthermore, many of these structures can lead to increased pressure surrounding the upper airway, resulting in pharyngeal collapsibility and insufficient space to accommodate airflow to a portion of the upper airway during sleep. It was also noted that the upper airway muscle tone plays a role, in that when this muscle decreases, a repetitive total or partial airway, collapse results. As such, the VA examiner noted that the most common cause of OSA in adults is obesity, male sex, and advancing age and that there is no scientific evidence that exposure to toxic substance such as Agent Orange causes OSA. Given the information, the VA examiner opined that the claimed condition of OSA was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran.

Based on the aforementioned, the Board finds that the March 2025 VA examination adequately concluded that the Veteran's currently diagnosed OSA was not related to his TERA in service. Specifically, the VA examiner addressed how the condition develops and the most likely causes of such condition, referring to literature that supports that OSA has not been linked to Agent Orange exposure. Thus, the Board finds the March 2025 VA examination provided adequate rationale for the conclusions reached and addressed the specifics of the Veteran's case thereof, giving it significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). 

For the foregoing reasons, service connection for OSA is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the probative evidence is not in approximate balance and weighs against the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable in such regard, and his service connection claim must be denied. 38?U.S.C. §?5107; 38 C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990).

3. Entitlement to a compensable rating for service connected hypertension.

The Veteran contends that he is entitled to a compensable rating for his service connected hypertension. 

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition, which should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. 

All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is
 be viewed in relation to its history and the limitation of activity imposed by the disabling condition, which should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. 

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

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

Under DC 7101, a 60 percent rating is warranted for hypertension if the diastolic pressure is predominantly 130 or more; a 40 percent rating is assigned if the diastolic pressure is predominantly 120 or more; a 20 percent rating is warranted when the diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more; and a 10 percent rating is assigned if the diastolic pressure is predominantly 100 or more or systolic pressure is predominantly 160 or more, or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.

Notes to DC 7101 provide that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic pressure of less than 90mm. Additionally, such direct that hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, should be evaluated as part of the condition causing it rather than by separate evaluation. Finally, hypertension should be evaluated separately from hypertensive heart disease and other types of heart disease.

Where the criteria for a compensable rating under a diagnostic code are not met, and the schedule does not provide for a noncompensable rating, as in Diagnostic Code 7101, a noncompensable rating will be assigned when the required symptomatology for a compensable rating is not shown. 38 C.F.R. § 4.31.

The Board may factor the ameliorative effects of blood pressure medication into its analysis of claims for increased ratings for hypertension because Diagnostic Code 7101 expressly mentions the effect of hypertension medications. See McCarroll v. McDonald, 28 Vet. App. 267, 276-77 (2016). 

Notably, the word "predominant" is not defined by the regulations. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant (last accessed April 10, 2026). 

As an initial matter, the Board notes that the Veteran has been taking medication for his hypertension since at least 2018. However, upon review of his medical records, they do not show that he has a history of diastolic pressure predominantly 100 or more prior to being placed on medication. In this regard, such reflect only one reading of diastolic pressure of over 100 in April 2006. Wilson v. McDonough, 35 Vet. App. 75 (2021) (under DC 7101, "a history of diastolic pressure predominantly 100 or more [that] requires continuous medication for control" refers to blood pressure readings taken before a veteran began medication to control hypertension).

Additionally, the Board finds the Veteran does not have a history of diastolic pressure predominantly 100 or more. In this regard, the Veteran's medical records reflect zero readings of diastolic pressure over 100, with the highest being 99. 

The Board further finds the Veteran does not have a history of systolic pressure predominantly 160 or more. However, the Board finds the Veteran does have a few readings of systolic pressure predominantly 160
ough, 35 Vet. App. 75 (2021) (under DC 7101, "a history of diastolic pressure predominantly 100 or more [that] requires continuous medication for control" refers to blood pressure readings taken before a veteran began medication to control hypertension).

Additionally, the Board finds the Veteran does not have a history of diastolic pressure predominantly 100 or more. In this regard, the Veteran's medical records reflect zero readings of diastolic pressure over 100, with the highest being 99. 

The Board further finds the Veteran does not have a history of systolic pressure predominantly 160 or more. However, the Board finds the Veteran does have a few readings of systolic pressure predominantly 160 or more. The relevant blood pressure (BP) readings from the Veteran's medical records are as follows: June 24, 2020: BP 179/99; March 15, 2023: BP 174/94; April 6, 2023: BP 177/96; August 12, 2024: BP 161/71; and October 21, 2024: BP 170/96. Although there are a few readings 160 or more for systolic pressure, such readings occurred due to specific situations, such as the June 2020 reading occurring after the Veteran was off of his blood pressure medication for a short period due to potentially switching and the new medication not working out; March 2023 during a pre-operative appointment regarding a surgery the Veteran would be undergoing in April; April 2023 during the Veteran's post-operative check-up after cataract surgery; and in August 2024 and October 2024 when the Veteran was experiencing postural dizziness and in the middle of his medication being adjusted to see if it was causing his postural dizziness. A review of the remainder of the Veteran's blood pressure readings indicate that such readings are outliers, and it is not shown that his hypertension results in diastolic pressure that is predominantly 100 or more or systolic pressure that is predominantly 160 or more.

Accordingly, the Board finds that a compensable rating for hypertension is not warranted at any time during the appeal period. Specifically, the evidence of record does not show diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more. The following blood pressure (BP) readings from the Veteran's medical records reflect his history of BP measurements: January 29, 2025: BP 142/89, 124/72; December 23, 2024: BP 152/95, 120/75, 138/83; December 2, 2024: BP 127/73, 155/80, 144/77; November 26, 2024: BP 150/95, 132/77, 137/70; November 13, 2024: BP 134/82, 149/90, 134/82; November 7, 2024: BP 157/86; 154/86; 154/85; October 29, 2024: BP 149/83, 156/89; October 21, 2024: BP 170/96; September 30, 2024: BP 152/82; August 12, 2024: BP 161/71; July 4, 2024: BP 157/88; July 3, 2024: BP 154/89; July 2, 2024: BP 148/90; July 1, 2024: BP 149/95, 148/84; June 31, 2024: BP 151/91; June 30, 2024: BP 144/89, 155/91; June 29, 2024: BP 141/84, 139/80; May 28, 2024: BP 146/92; April 23, 2024: BP 137/82, 118/73, 133/79; February 27, 2024: BP 147/83, 143/79; April 26, 2023: BP 155/85; April 20, 2023: BP 157/95; April 6, 2023: BP 177/96; March 15, 2023: BP 174/94; September 14, 2020: BP 158/81; August 19, 2020: BP 159/78; June 24, 2020: BP 179/99; April 1, 2020: BP 135/65; April 5, 2019: BP 133/73;
 133/79; February 27, 2024: BP 147/83, 143/79; April 26, 2023: BP 155/85; April 20, 2023: BP 157/95; April 6, 2023: BP 177/96; March 15, 2023: BP 174/94; September 14, 2020: BP 158/81; August 19, 2020: BP 159/78; June 24, 2020: BP 179/99; April 1, 2020: BP 135/65; April 5, 2019: BP 133/73; April 12, 2018: BP 125/72; April 10, 2017: BP 134/79; April 4, 2016: BP 150/90, 154/91; March 6, 2015: BP 133/77; April 15, 2014: BP 119/75; June 20, 2012: BP 140/85; May 24, 2011: BP 139/85; October 14, 2010: BP 119/80; October 6, 2010: BP 123/83; July 12, 2010: BP 130/83; January 5, 2010: BP 137/88; July 23, 2009: BP 133/81; January 27, 2009: BP 127/81; September 4, 2008: BP 147/91; June 4, 1974: BP 114/70; November 3, 1970: BP 102/82; May 18, 1971: BP 126/84; and January 16, 1970: BP 130/80. Thus, the Board finds a compensable rating is not warranted at any time. Fenderson, 12 Vet. App. 119; Hart, 21 Vet. App. 505.

Furthermore, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Accordingly, the Board finds an initial compensable rating for hypertension is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the probative evidence persuasively weighs against the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable, and the Veteran's increased rating claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

 

 

 

Melanie J. Mann

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Hageman Gaina, Samantha L.

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.