TINNITUS

JOHN R. DOOLITTLE, II · 2026 · Case ID: A26038751

MIXED

Summary

The veteran, who served from January 1985 to May 1985, appeals the denial of service connection for tinnitus, hearing loss, and hypertension. The Board granted service connection for tinnitus, finding the evidence in equipoise and resolving doubt in the veteran's favor. The veteran testified to noticing ringing in his ears eight to twelve months after discharge, which has continued, and reported exposure to machine fire during basic training and AIT with ineffective earplugs. While service treatment records were silent on hearing complaints, VA treatment records from March 2019 noted tinnitus. The Board found the veteran's testimony credible and applied the benefit of the doubt to establish the existence of a current disability and an in-service event related to noise exposure. The claims for hearing loss and hypertension were remanded. For hearing loss, the Board found the evidence of a current ear condition and in-service noise exposure sufficient to warrant a VA examination to determine the nexus to service, noting the inadequacy of the existing evidence and the duty to assist. For hypertension, the Board found the January 2016 VA examination inadequate, as it failed to address the veteran's in-service diagnosis and treatment for hypertension, and did not adequately consider the potential link to service-connected PTSD. A remand was ordered for a new examination to determine the etiology of hypertension and its relationship to PTSD.

Rationale

Evidence in equipoise regarding current disability; Benefit of the doubt applied for current disability; Evidence minimally indicates in-service noise exposure; Benefit of the doubt applied for in-service event; Veteran's testimony regarding onset and continuation of symptoms is competent and credible

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210105-140328

Full Decision Text

Citation Nr: A26038751
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 210105-140328
DATE: April 27, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

REMANDED

Entitlement to service connection for hearing loss (including an ear disability) is remanded.

Entitlement to service connection for hypertension is remanded.

FINDING OF FACT

Resolving any doubt in favor of the Veteran, his tinnitus manifested within one year of his separation from service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1985 to May 1985.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2020 rating decision issued by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

In the January 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on August 27, 2024.

Therefore, the Board may only consider the evidence of record at the time of the December 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran [or representative] 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.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) 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 of hypertension and hearing loss any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

As a preliminary matter, the Board notes that the instant VA Form 10182 included appeals of claims for an increased rating for service-connected post-traumatic stress disorder (PTSD) and entitlement to a total disability rating based upon individual unemployability (TDIU) and, incorrectly in part, cited to the December 2020 rating. The TDIU claim stemmed from a December 9, 2019, rating decision. However, review of the claims file shows the Veteran appealed the PTSD and TDIU claims to the Board on multiple occasions: three Board appeals were filed in September 2020 before instant appeal along with one in July 2021 seeking an increased rating and earlier effective date for PTSD. These claims were assigned to Legacy Docket No. 2003288 and Docket No. 200326-78596; and on May 5, 2021, a Board hearing was held. Next, in a January 26, 2022, decision (the Board granted the Veteran a temporary total rating due to hospital treatment more than 21 days (March 5- through March 31, 2019) for the service-connected PTSD; an initial 70 percent rating for PTSD, aside from the periods of temporary total rating; and a TDIU due to service-connected PTSD. The Board advised the Veteran on the proper course to express any disagreement. On January 28, 2022, the AOJ implemented the Board's decision. The Veteran did not motion the Board for reconsideration and did not appeal.

At the August 27, 2024, Board hearing for the instant appeal, the Veteran testified that he was satisfied with the outcome of the current PTSD rating and TDIU and withdrew the claims from the instant appeal. Accordingly, the PTSD and TDIU claims are not currently before the Board and will not be addressed.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred
from the periods of temporary total rating; and a TDIU due to service-connected PTSD. The Board advised the Veteran on the proper course to express any disagreement. On January 28, 2022, the AOJ implemented the Board's decision. The Veteran did not motion the Board for reconsideration and did not appeal.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

Lay evidence may be competent evidence to establish incurrence. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Certain chronic diseases, including organic diseases of the nervous system like tinnitus, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of the same symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). For the showing of a chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time.

In adjudicating an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (discussing the Board's inherent authority "to discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence"). To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

1. Entitlement to service connection for tinnitus is granted.

The Veteran contends his tinnitus is due to active service. See September 2020 VA Form 21-526EZ,
the light of its own inherent characteristics and its relationship to other items of evidence"). To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

1. Entitlement to service connection for tinnitus is granted.

The Veteran contends his tinnitus is due to active service. See September 2020 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

In the December 2020 rating decision on appeal, the AOJ denied the claim because the evidence did not show a current diagnosed disability. No favorable findings were made. The primary question before the Board is whether the Veteran has a current diagnosed disability that was incurred in or due to active service.

Turning to the evidence, the Veteran's service treatment records (STRs) do not reflect hearing loss or related complaints.

A September 2014 private treatment record shows that the Veteran denied any hearing loss, earaches, ear discharge, or ringing in the ears.

VA treatment records show that, in March 2019, the Veteran reported tinnitus and a problem with the right ear. An October 2024 VA treatment record shows the Veteran's medical history includes tinnitus.

At the August 2024 Board hearing, the Veteran testified that about eight- to twelve months after discharge he noticed ringing in his ears that comes and goes; it continues to the present.

The Board finds the evidence is in equipoise in regard to the Veteran's statements that he has a current disability of tinnitus. As noted above, in September 2014 the Veteran denied having ringing in the ears. However, in August 2024 during his Board testimony the Veteran testified that he has had ringing in his ears continuously since eight to twelve months after service. Therefore, as stated, the evidence is in conflict; and the Board will find that the evidence is in equipoise on the issue as the Board is without evidence to find that the Veteran's statements in regard to his symptoms lack credibility. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Thus, affording the Veteran the benefit of the doubt, the first prong of service connection, existence of a present disability, is satisfied. Shedden, supra.

Regarding an in-service event, while the Veteran's service treatment records do not reflect hearing loss or related complaints, military personnel records indicate that the Veteran was on active duty for a few months and was assigned to basic combat training (BCT) at Fort Dix and advanced individual training (AIT) at Fort Lee. One document notes an M16 qualification badge; however, the record also indicates the Veteran was administratively separated from active duty while in training and did not earn an MOS, which typically requires the meeting of various soldier skills and qualifications.

At the Board hearing, the Veteran testified that during basic training and AIT, he was exposed to loud noises, specifically, machine fire; and the earplugs were not effective on the shooting range. Although the evidence in regard to an in-service event of noise exposure is not substantial, the evidence minimally indicates that the Veteran was exposed to some measure or modicum of noise while in service. Therefore, the Board will find the evidence sufficient on the issue of an in-service event as the Board is without evidence to find that the Veteran's statements in regard to his in service noise exposure lacks credibility. Buchanan, 451 F.3d at 1336-37. Thus, affording the Veteran the benefit of the doubt, the second prong of service connection, an in-service event or occurrence, is satisfied. Shedden, supra.

The remaining question, then, is whether the claimed tinnitus is related to service, to include noise exposure therein. At the August 2024 Board hearing, the Veteran testified that about eight- to twelve months after discharge he noticed the ringing in his ears; it has been a continuous issue since that time; he was exposed to machine fire; the ear plugs supplied were not effective on the shooting range; and he did not have a job post-service with noise levels near to what he was exposed to in the military. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (citing Dorland's Illustrated Medical Dictionary 1714 (28th Ed. 1994)). Generally, tinnitus is a disorder with symptoms that can be identified through lay observation alone. Id. Thus, the Veteran is competent to identify his
2024 Board hearing, the Veteran testified that about eight- to twelve months after discharge he noticed the ringing in his ears; it has been a continuous issue since that time; he was exposed to machine fire; the ear plugs supplied were not effective on the shooting range; and he did not have a job post-service with noise levels near to what he was exposed to in the military. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (citing Dorland's Illustrated Medical Dictionary 1714 (28th Ed. 1994)). Generally, tinnitus is a disorder with symptoms that can be identified through lay observation alone. Id. Thus, the Veteran is competent to identify his symptoms of tinnitus (ringing sounds) began within eight to twelve months after discharge and continued afterward. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has no reason to doubt the Veteran's statements regarding the onset and continuation of symptoms. Buchanan, supra; Gardin, supra.

The Veteran was not afforded a VA examination. Regardless, as noted above, the Veteran's statements regarding onset and continuation of symptoms is competent and credible evidence that his tinnitus manifested to a compensable degree within the one-year presumptive period for tinnitus, following his separation from service and has continued ever since.

Resolving any doubt in favor of the Veteran, service connection is warranted for tinnitus on a presumptive basis as a chronic disease; and the claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra.

REASONS FOR REMAND

1. Entitlement to service connection for hearing loss (including an ear disability) is remanded.

The Veteran contends that his hearing loss is due to active service.

In the December 2020 rating decision currently on appeal, the AOJ denied the claim finding no current diagnosed disability. No favorable findings were made. The primary question before the Board is whether the Veteran has a current diagnosed hearing disability that was incurred in or due to active service or is due to or aggravated by a service-connected disability.

Next, the Veteran originally styled his claim for a hearing loss or impairment disability. See August 2020, VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. The record demonstrates that, throughout the period on appeal, the Veteran complained of ear pain and was treated for a red ear canal and white fluid in the ear. Accordingly, the Board has recharacterized the issue as a claim for a hearing loss disability to include an ear disability to better reflect the scope of the claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Turning to the evidence, the STRs show that, at entrance, in January 1985, the Veteran's puretone thresholds, in decibels, were as follows:

HERTZ

1000 2000 3000 4000

RIGHT 10 15 10 0

LEFT 10 10 5 0

There does not appear to be a separation exam within the STRs. The sole audiogram in the record is the January 1985.

A September 2014 private treatment record shows that the Veteran denied any hearing loss, earaches, ear discharge, or ringing in the ears.

VA treatment records contain emergency room notes from August 2016, and a December 2022 indicated the Veteran's hearing was grossly intact. However, in February 2019, the Veteran sought treatment complaining that he felt like he was having a stroke on the right side directly from his ear drum. He had right ear pain for two weeks; and the provider noted the ear canal was red with white fluid. Close in time, in March 2019, the Veteran reported tinnitus and a continued problem with the right ear including pain. There are no hearing examinations or audiological findings in the post-service treatment records. In December 2019, the Veteran reported he did not have any difficulties with hearing.

At the August 2024 Board hearing, the Veteran testified that during basic training and AIT, he was exposed to machine fire; the ear plugs supplied were not effective on the shooting range; and he did not have a job post-service with noise levels near to what he was exposed to in the military. He noticed his hearing loss about eight months after separation from service; he can hear out of one ear more than the other; one ear often feels like he is in a swimming pool and it is distorted. The Veteran claimed the last time he had his hearing examined was one year earlier. Every time the Veteran complains about his ears to his doctors, they end up giving him "ear stuff"; and they used a device to
difficulties with hearing.

The Veteran is competent to identify his symptoms of hearing loss or distorted hearing which began within a few months after discharge and continued afterward. See Layno, 6 Vet. App. at 469. The Veteran is also competent to report pain associated with the right ear and how his medical providers have treated the condition. However, there is no indication from the record that the Veteran possesses the requisite qualifications to offer a diagnostic opinion or to render a medical nexus opinion. See Jandreau, supra.

The Veteran was not afforded a VA examination to assess whether he has hearing or other inner ear disability affecting his hearing. Consistent with the VA's duty to assist, under McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006), a VA medical examination must be provided when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i).

Here, there is medical evidence that the Veteran has some condition of the ear that causes pain, redness, and fluid in the ear, which may- or may not affect the Veteran's ability to hear clearly. He has maintained that he used the earplugs (provided by the military) to reduce the risk of hearing loss from noise exposure, but the ear plugs were ineffective. Therefore, there is evidence establishing that an injury may have occurred incurred in service. However, there is insufficient medical evidence to determine whether there is a nexus between the in-service noise exposure or use of ineffective ear plugs during service and the Veteran's current complaints of hearing loss, distorted hearing, and periods of pain.

The Board notes that where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and numbness in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018).

Given the evidence of a current disability reaching the level of functional impairment impacting earning capacity and the credible evidence of a hearing disability, the Board finds that VA has a duty to obtain a medical opinion to determine whether the Veteran's hearing disability is directly related to service.

Under the low threshold of McLendon, the Veteran's hearing disability may be directly related to service. Thus, the Veteran is entitled to an examination.

The failure to provide an adequate medical examination is a duty-to-assist error. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also 38 U.S.C. § 5103(A)(d).

Based on the failure to develop a claim for service connection, a remand is warranted. In doing so, the Board makes no determination, either positive or negative, concerning the credibility of lay statements of record.

2. Entitlement to service connection for hypertension is remanded.

The Veteran contends that his hypertension is due to active service.

2. Entitlement to service connection for hypertension is remanded.

The Veteran contends that his hypertension is due to active service.

In the December 2020 rating decision on appeal, the AOJ favorably found that the Veteran has a current hypertension diagnosis; is currently taking medication for hypertension; a qualifying event, injury, or disease had its onset during service; and the Veteran was treated for hypertension in April 1985. Since the Veteran meets the first two prongs of service connection (a current disability and an in-service event), the sole question before the Board is whether there is a causal connection between his hypertension and service or if his hypertension was either caused by or aggravated by a service-connected disability.

Turning to the evidence, the STRs show that, at entrance, on January 8, 1985, the Veteran's blood pressure was recorded as 120/78. The Veteran did not report any health issues involving the heart or vascular system. On January 20, 1985, the Veteran's blood pressure was recorded as 112/72. On February 5, 1985, the Veteran's blood pressure was recorded as 132/80. On March 22, 1985 the Veteran's blood pressure was recorded as 152/90, 148/92, and 100/110. On March 25, 1985, the Veteran presented to the clinic and complained of high blood pressure; his blood pressure was recorded as 144/90. He was diagnosed with hypertension and prescribed medications. On March 29, 1985, his blood pressure was recorded as 130/100. An April 4, 1985, treatment record noted a hypertension diagnosis and a referral for counseling on a restricted diet; his blood pressure was recorded as 132/96. On April 10, 1985, the Veteran attempted suicide by ingesting his prescription pills; his blood pressure was recorded as 130/90. A May 1985 inpatient treatment record showed a diagnosis of labile essential hypertension.

Military personnel records show that, in April 1985, following the attempted suicide, the Veteran's Request for Convalescent Leave was granted due to a diagnosis of depression and HCTZ, slow-k overdose. The Veteran was administratively discharged due to his psychiatric disability. The Board notes that the Veteran is service connected for PTSD.

Post-separation from service, an October 1985 private treatment record noted that the Veteran was suffering from increased blood pressure for the past six months. Private treatment records from 2012 through 2014 show the Veteran continued to have high blood pressure readings. In November 2011, blood pressure was 129/81; in March 2012, blood pressure was 136/81; in April 2012, blood pressure was 129/88; in May- and July 2013, blood pressure was 138/80; in November 2013, blood pressure was 148/100; and in September 2014, blood pressure was 130/80.

Additional private treatment records show that in December 2014, the Veteran was diagnosed with hypertension; when he presented for chronic hip pain, his blood pressure was recorded as 143/90, 151/99, 135/90, and 132/87.

In January 2016, the Veteran was afforded a VA examination to assess his hypertension disability. At the time the VA examination was afforded in the context of the Veteran's claim for a heart disability, not hypertension. The examiner indicated the Veteran does not have - and had not ever been diagnosed with hypertension or isolated systolic hypertension; and there is no note that any vital signs or other in-person testing was conducted. The examiner solely remarked that although there were instances of elevated blood pressure during service, there was no evidence of a diagnosis of hypertension based on VBA criteria of 2 elevated readings taken properly on three different dates. Thus, there was no evidence to support a claim for a current or chronic hypertension related to the Veteran's military service at this time.

The examiner opined the Veteran's hypertension was less likely than not incurred in or caused by service. The examiner reasoned that the Veteran confirmed that he was under stress while in the service. Physical and emotional stressors are known to transiently elevate blood pressure; and the Veteran's current civilian medical records do not demonstrate any evidence of current hypertension or sustained blood pressure elevation or required treatment for such at this time.

The Board finds that the January 2016 VA examination is inadequate for adjudication purposes. Primarily, the opinion is conclusory and ignores the significant evidence showing that (
readings taken properly on three different dates. Thus, there was no evidence to support a claim for a current or chronic hypertension related to the Veteran's military service at this time.

The Board finds that the January 2016 VA examination is inadequate for adjudication purposes. Primarily, the opinion is conclusory and ignores the significant evidence showing that (1) Veteran was diagnosed with hypertension as early as 1985 during service, (2) he was treated with blood pressure medication during service, (3) private treatment records show a hypertension diagnosis in 2014, and (4) numerous recordings of high blood pressure over the years. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (stating that a medical opinion must support its conclusion with an analysis that the Board can weigh, and a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (stating that "The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion."). Finally, there is no etiological opinion or discussion of any evidence related to the Veteran. See Bailey v. O'Rourke, 30 Vet. App. 54, 60-61 (2018) (holding that a medical opinion was inadequate as a matter of law because the rationale was based solely on general articles and did not discuss any facts pertaining to the Veteran's condition or individual circumstances.).

Although the January 2016 VA opinion is inadequate for adjudication purposes, it reasonably raises the issue that the Veteran's service-connected PTSD and hypertension may be related. Moreover, the Veteran's hypertension was concurrent with his psychiatric treatment during service. VA must consider all theories of entitlement either expressly raised by the claimant or that are reasonably raised by the record. See Robinson v. Shinseki, 557 F.3d 1355, 1362 (Fed. Cir. 2009). VA's duty to assist applies to the entire claim, which includes assistance in developing more than one theory in support of that claim. See Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Following the VA examination, the Veteran continued to receive treatment for his hypertension. VA treatment records show that, from February- through September 2016, the Veteran continued to have high blood pressure. In February 2016, blood pressure was 157/103; in March 2016, blood pressure was 133/87, 132/87, and 159/88; in July 2016, blood pressure was 150/91; and in August 2016, blood pressure was 164/100 and associated with level 5 pain. VA treatment records from October 2016 show his blood pressure recorded as 132/86 and 141/98. In February 2017, the Veteran reported he was previously on lisinopril for blood pressure but was told he could stop it; his blood pressure was 150/85. In March 2017, blood pressure was 139/86. In March 2019, the Veteran was again diagnosed with hypertension; he was to continue with amlodipine and HCTZ. A January 2019 private treatment record shows an essential hypertension diagnosis to be treated with lisinopril. VA treatment records from October 2020 show the Veteran takes amlodipine, clonidine, and metoprolol for high blood pressure.

At the August 2024 Board hearing, the Veteran testified that he takes medications for his hypertension and has done so since the late 1990s. Symptoms began during service; and, because he was too young to have high blood pressure, they started the Veteran on blood pressure medication at the time. As the years progressed, his high blood pressure has worsened so that he is now on three medications.

The Veteran is competent to identify his symptoms, the onset of those symptoms, and his history of medical treatment during and after service. See Layno, 6 Vet. App. at 469. However, there is no indication from the record that the Veteran possesses the requisite qualifications to offer a diagnostic opinion or to render a medical nexus opinion. See Jandreau, supra.

the Veteran testified that he takes medications for his hypertension and has done so since the late 1990s. Symptoms began during service; and, because he was too young to have high blood pressure, they started the Veteran on blood pressure medication at the time. As the years progressed, his high blood pressure has worsened so that he is now on three medications.

The Veteran was afforded a VA examination to assess his hypertension disability in 2016 in the context of his earlier claim for a heart disability; however, it is inadequate for the purposes of adjudicating the Veteran's hypertension claim. Consistent with the VA's duty to assist, under McLendon, a VA medical examination must be provided when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i).

In this case, there is significant competent evidence that the Veteran has current hypertension diagnosis, continuing symptoms, and takes medications for hypertension. In addition, the STRs confirm that the Veteran was diagnosed with hypertension during service. Medical treatment records and the 2016 VA examiner reasonably raise the issue that the Veteran's hypertension not only presented concurrently with his service-connected PTSD but may be due to the same.

Given the evidence of a current disability reaching the level of functional impairment impacting earning capacity and the credible evidence of a current hypertension disability, the Board finds that VA has a duty to obtain an adequate medical opinion to determine whether the Veteran's hypertension disability is directly related to service or is secondary to his service-connected PTSD disability, including any medications for his PTSD. The January 2016 VA opinion reasonably raised the issue that the Veteran's hypertension may be related to his service-connected psychiatric disability.

The failure to provide an adequate medical examination is a duty-to-assist error. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr, 21 Vet. App. at 311; see also 38 U.S.C. § 5103(A)(d).

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and likely etiology of his hearing loss (to include an ear disability). The Veteran's claims folder and a complete copy of this Remand must be made available to the clinician. All diagnostic testing deemed to be necessary by the clinician should be accomplished.

(a.) The clinician is requested to provide an opinion responsive to the following:

i. State whether it is at least as likely as not the Veteran's hearing loss was incurred in service or is otherwise related to an in-service injury, event, or disease including his reported exposure to noise trauma as relative to his training, the use of ineffective ear plugs issued by the military.

ii. Within the opinion, the clinician shall address the medical records showing periodic pain, redness, and fluid in the ear and whether it is at least as likely as not due to use of military issued ear plugs.

iii. If the clinician opines the Veteran's hearing loss or ear disability is unrelated to service including in-service noise trauma and the use of ineffective ear plugs, identify the etiology for the disability considered more likely and explain why that is so.

(b.) For all opinions provided the clinician should acknowledge that the Veteran was exposed to hazardous noise during service and was issued ear plugs which the Veteran contends were ineffective, the rationale for the opinion must specifically discuss all of the Veteran's varied lay statements as to his potential noise exposures.

(c.) It is not sufficient to base an opinion on a mere lack of documentation of complaints or treatment in the service- or post-service treatment records.

2. Schedule the Veteran for a VA medical examination with an
iii. If the clinician opines the Veteran's hearing loss or ear disability is unrelated to service including in-service noise trauma and the use of ineffective ear plugs, identify the etiology for the disability considered more likely and explain why that is so.

(c.) It is not sufficient to base an opinion on a mere lack of documentation of complaints or treatment in the service- or post-service treatment records.

2. Schedule the Veteran for a VA medical examination with an appropriate clinician to determine the nature and etiology of the Veteran's hypertension. The claims file and a complete copy of this Remand must be made available to the clinician. All diagnostic testing deemed to be necessary by the clinician should be accomplished.

(a.) Applying general medical principles, the clinician's experience, the clinical records, and any other medical literature, and the lay statements submitted by the Veteran, the clinician is instructed to provide an opinion responsive to the following:

i. State whether it is at least as likely as not that the Veteran's hypertension was incurred in service or is otherwise related to an in-service injury, event, or disease.

(b.) If the clinician opines that the Veteran's hypertension disability is not directly related to service, the clinician is instructed to provide a separate opinion addressing whether the service-connected PTSD caused or aggravated the hypertension disability as follows:

i. State whether but for the Veteran's service-connected PTSD, including any medications for the condition, he would not have a current hypertension disability.

ii. State whether the Veteran's hypertension disability would be less severe and result in less functional impairment but for his service-connected PTSD, including any medications for the condition.

iii. If the clinician opines that the hypertension would result in less functional impairment but for his service-connected PTSD, including any medications for the condition, the clinician must attempt to establish a baseline of severity of the hypertension disability prior to aggravation by the service-connected disability.

iv. The clinician is instructed to address (1) causation and (ii) aggravation separately. If separate opinions are not provided for causation and aggravation, the opinions will be found inadequate.

(c.) For all opinions provided the clinician should acknowledge the service treatment records showing a hypertension diagnosis and concurrence with the Veteran's mental health issue in service.

(d.) It is not sufficient to base an opinion on a mere lack of documentation of complaints or treatment in the service- or post-service treatment records.

3. Thorough rationales for all opinions must be provided.

John R. Doolittle, II

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. Treadwell

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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