HEARING LOSS

KRISTIN HADDOCK · 2026 · Case ID: A26038475

MIXED

Summary

The Veteran, an air service member from April 1989 to August 1989, appeals the denial of service connection for PTSD, GERD, gout (right toes), hypertension, and sleep apnea, as well as an increased rating for bilateral hearing loss prior to April 21, 2023. The Board denied the increased rating for hearing loss, finding the audiometric results and the Veteran's lay testimony did not meet the criteria for a compensable rating prior to April 21, 2023. The Board noted that a subsequent increase to 50% effective April 21, 2023, was based on evidence outside the current appeal record. The Board remanded the claims for PTSD, GERD, gout, hypertension, and sleep apnea. For PTSD, the Board found the VA examination inadequate, as it did not properly address the Veteran's claimed bootcamp stressors or provide sufficient rationale for the diagnosis. For GERD, the VA examination was also found inadequate for failing to adequately address the Veteran's lay statements regarding onset and continuity of symptoms and providing insufficient rationale for a negative nexus opinion. The claims for gout, hypertension, and sleep apnea were remanded as inextricably intertwined with the granted service connection for a psychiatric disability and back condition, requiring adjudication based on those prior grants. The Veteran's assertion of headaches secondary to hearing loss was noted but not addressed as it was part of a separate, unappealed claim.

Rationale

Audiometric testing results indicated Level I in the right ear and Level II in the left ear.; These results fall within the criteria for a noncompensable rating.; Veteran's lay testimony was less probative than objective audiology studies.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210812-179082

Full Decision Text

Citation Nr: A26038475
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 210812-179082
DATE: April 24, 2026

ORDER

Entitlement to a compensable rating for a bilateral hearing loss disability prior to April 21, 2023, is denied.

REMANDED

Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded.

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

Entitlement to service connection for gout, right toes, is remanded.

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for sleep apnea is remanded.

FINDING OF FACT

Prior to April 21, 2023, the Veteran's bilateral hearing loss disability has been manifested by hearing acuity of no worse than Level I in the right ear, and no worse than Level II in the left ear.

CONCLUSION OF LAW

The criteria for a rating in excess of 0 percent for a bilateral hearing loss disability prior to April 21, 2023, have not been met. 38 U.S.C. §§ 1155, 5107 (2024); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.85, Diagnostic Code 6100, 4.86 (2025).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active air service from April 1989 to August 1989.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2021 and July 2021 Higher-Level Review (HLR) rating decisions issued by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). Originally, in an October 2020 rating decision, the Veteran's claim for service connection for PTSD was denied. In November 2020, the Veteran submitted a supplemental claim requesting review of the October 2020 rating decision. A November 2020 rating decision, which confirmed and continued the denial of service connection for PTSD, was issued in response to that claim. Following the November 2020 rating decision, the Veteran submitted a request for HLR. The June 2021 rating decision on appeal was issued in response to that request. In a May 2021 rating decision, the Veteran's claims for service connection for gout, right toes, GERD, hypertension, and sleep apnea and an increased rating for service-connected hearing loss were denied. Following the May 2021 rating decision, the Veteran submitted a request for HLR. The July 2021 HLR rating decision on appeal was issued in response to that claim.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On April 7, 2025, the Veteran testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record in the claims file. Therefore, the Board may only consider the evidence of record at the time of the November 2020 AOJ decision on appeal, which was subsequently subject to HLR, with regard to the claim for service connection for PTSD and the May 2021 AOJ decision on appeal, which was subsequently subject to HLR, with regard to the claims for service connection for gout, right toes, GERD, hypertension, and sleep apnea, and an increased rating for a bilateral hearing loss disability, as well as any evidence submitted by the Veteran or his representative at the April 2025 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 decisions on appeal, which were subsequently subject to HLR, 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.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claim for an increased rating for a bilateral hearing loss disability, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered.
the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claim for an increased rating for a bilateral hearing loss disability, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims for service connection for PTSD, GERD, gout, right toes, hypertension, and sleep apnea, any evidence the Board could not consider will be considered by the AOJ in the adjudication of these claims. 38 C.F.R. § 3.103(c)(2)(ii).

In a July 2023 rating decision, the AOJ increased the rating for the Veteran's bilateral hearing loss disability from 0 percent to 50 percent, effective April 21, 2023. The evidence used to support that increase was added to the record outside the evidentiary record before the Board. Accordingly, the Board may not review that evidence. 38 U.S.C. §7113(c); 38 C.F.R. § 20.303. Further, the issue of entitlement to a rating in excess of 50 percent for a bilateral hearing loss disability is not an issue that has been appealed for Board consideration under this appeal stream. Therefore, the Board does not have either the authority or the discretion to review the evidence supporting that increase. As such, the Board is compelled to limit its consideration of this appeal to the issue noted above, that is, entitlement to a compensable rating for the Veteran's hearing loss disability prior to April 21, 2023. The Board also acknowledges that at the April 2025 hearing, the Veteran testified that his hearing loss and tinnitus caused headaches. The Board notes that the Veteran filed a separate claim for migraines secondary to his service-connected tinnitus and hearing loss that was denied in a November 2022 rating decision. As the Veteran has filed a separate claim for this disability that is not part of the current appeal, the Board finds this issue is not properly before the Board with regard to the issue of a higher rating for the Veteran's service-connected hearing loss disability.

Increased Rating - Bilateral Hearing Loss Disability prior to April 21, 2023

The Veteran asserts that his bilateral hearing loss disability is worse than accounted for by the currently assigned ratings. The Veteran's bilateral hearing loss disability is rated at 0 percent prior to April 21, 2023, and 50 percent thereafter pursuant to 38 C.F.R. § 4.85, Diagnostic Code 6100.

Initially, the Board notes that the Veteran has been service connected for a bilateral hearing loss disability since December 2020, and that the current appeal stems from a new claim for increase received by VA in April 2021.

In January 2021, the Veteran was afforded a VA hearing loss and tinnitus examination. The Veteran reported that his hearing impairment made it difficult to hear conversational speech in the presence of background noise and from a distance, and that he constantly had to ask people what they had said. Audiometric testing results at that time were as follows:

HERTZ

1000 2000 3000 4000 Average

RIGHT 15 20 15 25 19

LEFT 20 25 25 20 23

Speech recognition ability was measured at 92 in the right ear and 88 in the left ear. Application of the above results to 38 C.F.R. § 4.85, Table VI compels a numeric designation of Level I in the right ear and Level II in the left ear. When those values are applied to Table VII, it is apparent that a 0 percent rating is accurate. 38 C.F.R. § 4.85. Further, neither ear presented an exceptional pattern of hearing loss; therefore, Table VIA is not for application.

In May 2021, the Veteran was afforded another VA hearing loss and tinnitus examination. The Veteran reported that he had some difficulty hearing and understanding. Audiometric testing results at that time were as follows:

HERTZ

1000 2000 3000 4000 Average

RIGHT 20 25 25 25 23.75

LEFT 25 30
ear and Level II in the left ear. When those values are applied to Table VII, it is apparent that a 0 percent rating is accurate. 38 C.F.R. § 4.85. Further, neither ear presented an exceptional pattern of hearing loss; therefore, Table VIA is not for application.

HERTZ

1000 2000 3000 4000 Average

RIGHT 20 25 25 25 23.75

LEFT 25 30 25 25 26.25

Speech recognition ability was measured at 94 in both ears. Application of the above results to 38 C.F.R. § 4.85, Table VI compels a numeric designation of Level I in the right ear and Level I in the left ear. When those values are applied to Table VII, it is apparent that a 0 percent rating is accurate. 38 C.F.R. § 4.85. Further, neither ear presented an exceptional pattern of hearing loss; therefore, Table VIA is not for application.

During the April 2025 Board hearing, the Veteran testified that his hearing had gotten worse, and that the ringing in his ears sometimes gave him headaches. He reported that if it was too quiet, it would bother him, and that he never knew what to expect. He reported that sometimes he had to lay down and cover his head with a pillow. He testified that he had played basketball in college, and that he was no longer able to do things like that. He stated that he had difficulty hearing his wife when she spoke to him, and that he had to turn his television up so loud, even his neighbor had come to ask him to turn it down.

Based on the foregoing, the Board finds that the Veteran is not entitled to a compensable rating for his bilateral hearing loss disability prior to April 21, 2023. As noted, the Veteran's hearing impairment is, at worst, measured at Level I in the right ear and Level II in the left ear. Those results fall squarely within the criteria for a noncompensable rating. As such, a higher rating is not warranted. 38 C.F.R. § 4.85, Diagnostic Code 6100.

Consideration has been given to assigning staged ratings. However, at no time during the period in question prior to April 21, 2023, has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007).

The Board in no way discounts the difficulties that the Veteran experiences as a result of his bilateral hearing loss; however, because hearing loss is a disability requiring a "mechanical application of the rating schedule," the Board cannot find a basis in law or regulation to support a compensable disability rating. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Additionally, the Veteran's reports as to the severity of his bilateral hearing loss disability and its impact on his daily life though competent and credible, are less probative than the objective audiology studies of record, prepared by skilled professionals. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, the VA examination reports considered the Veteran's reported impact of his hearing loss on his ordinary conditions of life, including his ability to work. Martinak v. Nicholson, 21 Vet. App. 447 (2007).

Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to a rating in excess of 0 percent for a bilateral hearing loss disability prior to April 21, 2023, is not warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

REASONS FOR REMAND

Service Connection - PTSD

The Veteran asserts he has a diagnosis of PTSD that had its onset during active service or is otherwise etiologically related to an in-service stressor. Specifically, the Veteran claims his PTSD is due to the trauma he experienced during bootcamp.

In June 2020, the Veteran submitted a private medical opinion in support of his claim for service connection for an acquired psychiatric disability. The provider, a licensed psychologist, noted diagnoses of PTSD, major depressive disorder, insomnia, and unspecified anxiety disorder, and opined that the Veteran's diagnosed conditions were based
(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

REASONS FOR REMAND

Service Connection - PTSD

In June 2020, the Veteran submitted a private medical opinion in support of his claim for service connection for an acquired psychiatric disability. The provider, a licensed psychologist, noted diagnoses of PTSD, major depressive disorder, insomnia, and unspecified anxiety disorder, and opined that the Veteran's diagnosed conditions were based on fear and more likely than not caused or related to the constant harassment he experienced during bootcamp.

The Veteran's private and VA treatment records also note diagnosis of PTSD and reflect that the Veteran reported the condition was related to his experiences during active service.

In an April 2024 decision, the Board granted entitlement to service connection for an acquired psychiatric disability, diagnosed as major depressive disorder and anxiety disorder, not otherwise specified. In the decision, the Board found that although the June 2020 private psychologist had provided that the Veteran's current psychiatric disability included PTSD, there was no indication that the Veteran had psychiatric symptoms clearly attributable to a psychiatric disorder other than major depressive disorder and anxiety disorder, for which service connection was being granted; therefore, it found there was no need to separately address the issue of service connection for PTSD. The Board notes that separately diagnosed psychiatric disorders may be service connected as distinct disabilities subject to the provisions of 38 C.F.R. § 4.14. Therefore, despite the grant of service connection for an acquired psychiatric disability, diagnosed as major depressive disorder and anxiety disorder, the Veteran's claim of entitlement to service connection for PTSD remains on appeal. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009); see also November 2020 and June 2021 rating decisions (denying service connection for PTSD), August 2021 VA Form 10182 (appealing the denial of service connection for PTSD).

The Board notes that there are particular requirements for establishing entitlement to service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Those requirements are: (1) a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. 38 C.F.R. § 3.304(f).

Although the June 2020 private medical opinion and the Veteran's VA and private treatment records note a diagnosis of PTSD, the evidence of record is insufficient to determine the information and diagnostic criteria used to support the diagnosis. Further, the Veteran has not been afforded a VA examination to determine the nature and etiology of his claimed PTSD.

In light of the Veteran's treatment records noting a diagnosis of PTSD and evidence indicating a potential relationship to service, the Board finds that the failure to afford the Veteran a VA examination to determine the nature and etiology of any currently present PTSD constitutes a duty to assist error on the part of the AOJ. Accordingly, remand is necessary to afford the Veteran a VA examination to determine the nature and etiology of any currently present PTSD. 38 C.F.R. § 20.802(a); McLendon v. Nicholson, 20 Vet. App. 79 (2006).

Service Connection - GERD

The Veteran asserts that his GERD had its onset during active service or is otherwise etiologically related to active service. In the alternative, the Veteran claims that his GERD was caused and/or aggravated by medication used to treat his now service-connected back disability.

The Board further notes that the Veteran's private and VA treatment records indicate that the Veteran has abused/used alcohol and drugs to self-medicate his now service-connected acquired psychiatric disability. A March 2021 VA treatment record reflects that the Veteran reported that following his discharge from service he had started using alcohol for comfort due to the betrayal he felt over the way he had been treated during service. The Veteran reported that when he could no longer receive the desired effect from alcohol, he had started using marijuana and cocaine.

In April 2021, the Veteran was afforded a VA esophageal conditions examination. The Veteran reported the onset of his GERD as 1989 when he had started taking Tylenol and Advil frequently to treat his back pain
The Board further notes that the Veteran's private and VA treatment records indicate that the Veteran has abused/used alcohol and drugs to self-medicate his now service-connected acquired psychiatric disability. A March 2021 VA treatment record reflects that the Veteran reported that following his discharge from service he had started using alcohol for comfort due to the betrayal he felt over the way he had been treated during service. The Veteran reported that when he could no longer receive the desired effect from alcohol, he had started using marijuana and cocaine.

In April 2021, the Veteran was afforded a VA esophageal conditions examination. The Veteran reported the onset of his GERD as 1989 when he had started taking Tylenol and Advil frequently to treat his back pain following a back injury. He stated that due to the medications, he had started experiencing acid reflux especially at night. He reported that his symptoms had progressively worsened since service, and that he now experienced acid reflux symptoms every day. He stated that his symptoms decreased his appetite and caused him to be nauseous and throw up. The examiner diagnosed GERD with 1989 as the date of diagnosis and opined that the condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner stated that no records could be located showing a diagnosis of acid reflux while in service or records indicating the symptoms of acid reflux.

The Board finds that the April 2021 VA examination is inadequate for adjudication purposes. In this regard, the examiner noted the date of diagnosis as during active service but provided a negative nexus opinion without adequately addressing the Veteran's lay statements regarding the onset and continuity of his symptoms and relying primarily on the lack of contemporaneous medical documentation. Further, the VA examiner's rationale lacks a sufficient level of detail to adequately support the negative conclusion reached. As the examination is inadequate, it cannot serve as the basis of a denial of entitlement to service connection.

As the VA examination obtained prior to the rating decision on appeal is inadequate for consideration of the Veteran's claim, and the other evidence of record is insufficient to support the Veteran's claim, remand for corrective action is necessary. 38 C.F.R. § 20.802(a); see also Barr v. Nicholson, 21 Vet. App. 303 (2007).

Service Connection - Gout, Right Toes, Hypertension, and Sleep Apnea

The Veteran asserts his gout, right toes, hypertension, and sleep apnea are etiologically related to active service. Specifically, the Veteran has claimed that his gout is due to being forced to wear boots that were too small during bootcamp, that his hypertension is caused and/or aggravated by the stress and anxiety caused by his service-connected tinnitus, hearing loss, and acquired psychiatric disability, and that his sleep apnea is caused and/or aggravated by his service-connected acquired psychiatric disability.

At the time the AOJ issued the rating decision on appeal, the Veteran was only service connected for hearing loss and tinnitus. However, as noted above, in an April 2024 decision, the Board granted entitlement to service connection for an acquired psychiatric disability, diagnosed as major depressive disorder and anxiety disorder, not otherwise specified. In the April 2024 decision, the Board also granted entitlement to service connection for a back disability. See April 2024 Board decision and April 2024 rating decision.

During the post April 2025 hearing evidence submission window, the Veteran submitted a November 2021 private medical opinion in support of his claim for service connection for sleep apnea. The provider, a medical doctor, opined that it was more likely than not that a nexus existed between the Veteran's active military service and the development of obstructive sleep apnea, that it was more likely than not, notwithstanding the fact that the Veteran had yet to be approved for service connection for PTSD, that there was a strong scientific association between obstructive sleep apnea and PTSD (refer to "research" section), that it was more likely than not that this type of nexus was most accurately termed a hybrid primary-constructive secondary nexus given the Veteran's psychological history and the fact that he had PTSD although not currently service connected, and that it was more likely than not, in like kind, that the obverse scenario was also true, that was that the same logic could be utilized as an argument to prove that the Veteran's obstructive sleep apnea should be service-connected. As rationale, the provider noted the claim history, diagnostic criteria for PTSD, and medical literature that indicated a relationship between sleep apnea and PTSD.

The Board finds the November 2021 private medical opinion is inadequate to support the Veteran's claim for service connection for sleep apnea. In this regard, the provider failed to give sufficient rationale specific to the Veteran to support the medical opinions.

While the Veteran's VA treatment records note diagnosis and treatment for g
had PTSD although not currently service connected, and that it was more likely than not, in like kind, that the obverse scenario was also true, that was that the same logic could be utilized as an argument to prove that the Veteran's obstructive sleep apnea should be service-connected. As rationale, the provider noted the claim history, diagnostic criteria for PTSD, and medical literature that indicated a relationship between sleep apnea and PTSD.

While the Veteran's VA treatment records note diagnosis and treatment for gout, hypertension, and sleep apnea as well as the use of pain medication to treat his now service-connected back disability and the use of alcohol and drugs to self-medicate his now service-connected acquired psychiatric disability, the records do not contain any information regarding the etiology of these conditions. Further, the Veteran was not afforded VA examinations in response to his claims.

As the evidence of record indicates that the Veteran's claimed conditions could be related to his now service connected acquired psychiatric and back disabilities, the Board finds the issues of entitlement to service connection for gout, right toes, hypertension, and sleep apnea are inextricably intertwined with the issues of entitlement to service connection for an acquired psychiatric disability and back disability, which were granted in an April 2024 Board decision. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, the Board finds these issues should be remanded for adjudication based on the findings in the April 2024 Board decision and the April 2024 rating decision, which implemented the April 2024 Board decision.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an examiner with appropriate expertise to determine the nature and etiology of the claimed PTSD. The claims file must be made available to and reviewed by the examiner. Any indicated tests and studies must be performed.

Based on review of the record and examination of the Veteran, the examiner must first determine whether the Veteran meets the diagnostic criteria for a diagnosis of PTSD, and if so, identify the stressor upon which that diagnosis is based on. Then, the examiner must provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the claimed PTSD is etiologically related to the Veteran's active service.

A complete and detailed rationale must be provided for all opinions expressed.

2. Schedule the Veteran for an examination by an examiner with appropriate expertise to determine the nature and etiology of the claimed GERD. The claims file must be made available to and reviewed by the examiner. Any indicated tests and studies must be performed.

Based on the examination results and review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the claimed GERD had its onset during the Veteran's active service or is otherwise etiologically related to such service. In forming the opinion, the examiner must consider the Veteran's statements regarding the onset and continuity of his symptoms.

The examiner must also provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the claimed GERD was caused by, aggravated by, or would not have occurred but for a service-connected disability.

A complete and detailed rationale must be provided for all opinions expressed.

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3. Conduct the appropriate action to develop and adjudicate the inextricably intertwined claims of entitlement to service connection for gout, right toes, hypertension, and sleep apnea.

Kristin Haddock

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E.J. Woodward, Associate 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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