TINNITUS

M. HYLAND · 2026 · Case ID: A26038912

MIXED

Summary

The Veteran served on active duty from October 1965 to October 1967. The Veteran appeals the denial of service connection for bilateral lower extremity peripheral neuropathy and seeks an increased rating for hypertension. The Board granted service connection for tinnitus, finding the Veteran's lay statements credible and establishing continuity of symptomatology, resolving reasonable doubt in his favor. The claim for bilateral lower extremity peripheral neuropathy was denied, as the Board found the evidence persuasively against its existence, noting the absence of diagnosis or symptoms in the record and the VA examiner's negative opinion. The Board also granted an initial 10 percent rating for hypertension, finding the Veteran credible regarding his history of high diastolic pressure requiring medication, resolving reasonable doubt in his favor. However, the evidence was persuasively against a higher rating. The Board remanded claims for porphyria cutanea tarda, a back disability, and an increased rating for heart condition CAD, finding the VA examinations inadequate due to inconsistencies and lack of explanation. The remand instructions require new VA examinations to address these issues, including assessing the nexus for porphyria cutanea tarda and the Veteran's back disability, and to provide a fully reasoned opinion for the cardiac condition.

Rationale

Chronic disease; Continuity of symptomatology; Benefit of the doubt applied

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250721-638389

Full Decision Text

Citation Nr: A26038912
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250721-638389
DATE: April 27, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for bilateral lower extremity peripheral neuropathy is denied.

Entitlement to an initial rating of 10 percent, but no higher, for hypertension is granted.

REMANDED

Entitlement to service connection for porphyria cutanea tarda is remanded.

Entitlement to service connection for a back disability is remanded.

Entitlement to an initial rating in excess of 10 percent for heart condition CAD is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in favor of the Veteran, the evidence establishes that it is at least as likely as not that his tinnitus started during active service and has continued since service.

2. The evidence is persuasively against finding that the Veteran had bilateral lower extremity peripheral neuropathy, or any signs or symptoms of bilateral lower extremity peripheral neuropathy, at any time during or approximate to the pendency of the claim.

3. Resolving reasonable doubt in favor of the Veteran, the evidence establishes that it is at least as likely as not that his service-connected hypertension more nearly approximates manifestation with a history of diastolic pressure predominantly 100 mm/Hg or more and requires continuous medication for control, but is persuasively against a finding that it has manifested with diastolic pressure predominantly 110 mm/Hg or more, or systolic pressure predominantly 200 mm/Hg or more at any time during the appeal period.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

2. The criteria for service connection for bilateral lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for an initial 10 percent rating, but no higher, for hypertension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.10, 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1965 to October 1967.

Under the Appeals Modernization Act (AMA) framework, an appeal consists of a properly completed VA Form 10182 submitted to the Board within one year from the date that the AOJ mails the notice of decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.201, 20.202, 20.203. Where a VA Form 10182 is not timely filed, the Board may grant an extension of time to file and accept the VA Form 10182 as timely filed where good cause has been shown. 38 C.F.R. § 20.203. Whether good cause for an extension has been established will be determined by the Board, however, the "request for such an extension must be in writing and must be filed with the Board." Id.

Here, the Veteran filed a request for extension of time with the Board. The Board finds that good cause has been shown and accepts the July 2025 VA form 10182 as timely filed as to the July 2024 AOJ decision on appeal.

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2024 rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the Agency of Original Jurisdiction (AOJ) issued the July 2024 rating decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

As to the claims of entitlement to service connection for tinnitus and bilateral lower extremity peripheral neuropathy, as well as the claim of entitlement to an increased rating for hypertension, 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 (
record at the time of the July 2024 rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the Agency of Original Jurisdiction (AOJ) issued the July 2024 rating decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

As to the claims of entitlement to service connection for tinnitus and bilateral lower extremity peripheral neuropathy, as well as the claim of entitlement to an increased rating for hypertension, 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.

As to the claims of entitlement to service connection for porphyria cutanea tarda and a back disability, as well as the claim of entitlement to an increased rating for heart condition CAD, because the Board is remanding these claims, 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).

Finally, the Board notes that the Veteran's representative implicitly requested the qualifications of the June 2024 VA examiner in the March 2026 Written Brief Presentation, after the July 2024 AOJ decision on appeal was issued. The Veteran has the right to receive the examiner's qualifications for purposes of assessing whether he wants to proffer a competency challenge. See Francway v. Wilkie, 940 F.3d 1304, 1308 (2019). However, as this request was received after the July 2024 AOJ decision was issued, it is not the basis for a pre-decisional duty to assist error and is therefore not the subject of a remand directive. This request has been referred to the Board's privacy office for any appropriate action.

Service Connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303.

Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

1. Entitlement to service connection for tinnitus is granted.

For chronic diseases shown in service, the second and third elements of service connection may be established through demonstrating chronicity or continuity of symptomatology in accordance with 38 C.F.R. § 3.303(b). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Tinnitus is a chronic disease. See Fountain v. McDonald, 27 Vet. App. 258, 271 (2015) (section 3.309(a) "includes tinnitus, at a minimum where there is evidence of acoustic trauma, as an 'organic disease[s] of the nervous system'").

The Veteran has stated that, while he was in service, he was exposed to loud military noises, such as riding in a helicopter. Reading the Veteran's statement in the light most favorable to the Veteran, it is reasonable to infer that the Veteran was stating that his tinnitus started when he was exposed to loud noises in service and has continued ever since. The Veteran's lay reports and arguments are sufficient to establish that his tinnitus first manifested in service, as well as continuity of symptomatology since service, and current tinnitus. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). Thus, resolving reasonable doubt in favor of the Veteran, the Board finds that the record establishes that it is at least as likely as not that the Veteran's tinnitus started in service and has continued since. Accordingly, service connection for tinnitus is warranted. See Wise v. Shinseki
it is reasonable to infer that the Veteran was stating that his tinnitus started when he was exposed to loud noises in service and has continued ever since. The Veteran's lay reports and arguments are sufficient to establish that his tinnitus first manifested in service, as well as continuity of symptomatology since service, and current tinnitus. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). Thus, resolving reasonable doubt in favor of the Veteran, the Board finds that the record establishes that it is at least as likely as not that the Veteran's tinnitus started in service and has continued since. Accordingly, service connection for tinnitus is warranted. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) ("By requiring only an 'approximate balance of positive and negative evidence' the Nation, 'in recognition of our debt to our veterans,' has 'taken upon itself the risk of error' in awarding... benefits.")

2. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is denied.

The Board finds that entitlement to service connection for bilateral lower extremity peripheral neuropathy is not warranted as the evidence is persuasively against finding that the Veteran had bilateral lower extremity peripheral neuropathy, or any signs or symptoms of bilateral lower extremity peripheral neuropathy, at any time during or approximate to the pendency of the claim.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F.3d 1328 (1997). The Veteran claims that he has bilateral lower extremity peripheral neuropathy that is due to his service-connected diabetes mellitus.

A June 2024 VA diabetes mellitus examination reflects that the Veteran does not have diabetic peripheral neuropathy. The VA examiner's finding is consistent with the Veteran's medical treatment records which do not reflect a diagnosis of peripheral neuropathy. Finally, the record is silent as to any signs or symptoms of peripheral neuropathy, such as numbness or tingling. In fact, the Veteran's medical records reflect that he was consistently found to not have any sensory abnormalities.

The Board acknowledges the holding in Saunders v. Wilkie, which states that, where pain causes functional impairment, a disability for VA compensation purposes exists even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). In other words, pain alone resulting in functional impairment is a disability and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. Here, the evidence persuasively establishes that there has not been functional impairment associated with peripheral neuropathy, as the evidence persuasively establishes that the Veteran consistently had no sensory abnormalities. Accordingly, the Board finds that the evidence persuasively establishes that the Veteran does not have functional impairment due to symptoms of peripheral neuropathy.

Accordingly, there is no competent medical evidence showing a diagnosis of bilateral lower extremity peripheral neuropathy, or any signs or symptoms of bilateral lower extremity peripheral neuropathy, at any time during, or proximate to, the appeal period. The Veteran is not competent to provide a diagnosis of bilateral lower extremity peripheral neuropathy. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Accordingly, the Board finds the medical evidence of record to be the most probative evidence of record regarding a diagnosis of bilateral lower extremity peripheral neuropathy, or regarding any signs or symptoms of bilateral lower extremity peripheral neuropathy resulting in functional impairment in earning capacity.

Finally, the Board notes that the Veteran has not been afforded a separate VA examination regarding his claim for bilateral lower extremity peripheral neuropathy. However, the Board finds that VA did not have a duty to provide the Veteran with a VA examination as to this claim as one was not warranted under either McLendon v. Nicholson, 20 Vet. App. 79 (2006), or the PACT Act. In this regard, the Board notes that VA is obliged to provide an examination where there is insufficient information to decide the claim and there is an indication the current disability may be associated with service. McLendon, 20 Vet. App. 79. In addition, the Board notes that the provisions of the PACT Act provide that, if a veteran submits a claim for service connection with evidence of disability and evidence of participation in a TERA, then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168
Vet. App. 79 (2006), or the PACT Act. In this regard, the Board notes that VA is obliged to provide an examination where there is insufficient information to decide the claim and there is an indication the current disability may be associated with service. McLendon, 20 Vet. App. 79. In addition, the Board notes that the provisions of the PACT Act provide that, if a veteran submits a claim for service connection with evidence of disability and evidence of participation in a TERA, then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168. As, for the reasons stated above, there is no indication of peripheral neuropathy, or signs or symptoms of peripheral neuropathy, at any time during the appeal period, VA was not obligated to obtain a medical opinion pursuant to McLendon or the PACT Act as to the Veteran's claim for bilateral lower extremity peripheral neuropathy.

In sum, as the Board finds that the evidence persuasively establishes the Veteran does not have a current diagnosis of bilateral lower extremity peripheral neuropathy, or any signs or symptoms of bilateral lower extremity peripheral neuropathy, resulting in functional impairment in earning capacity, the benefit-of-the-doubt doctrine does not apply, and his service connection claim for bilateral lower extremity peripheral neuropathy is denied. In denying this claim, the Board finds that the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Board notes that, in the July 2025 VA Form 10182, the Veteran asserts that VA acknowledged that his bilateral lower extremity peripheral neuropathy was a direct result of his service-connected diabetes mellitus because, in the July 2024 AOJ decision on appeal, VA stated that "'[t]he claimed primary disability is service-connected' citing to [his] diabetes mellitus." The Veteran is correct that the AOJ decision on appeal reflects that the Veteran is service-connected for diabetes mellitus, however, the Board finds that this statement does not concede that the Veteran either has bilateral lower extremity peripheral neuropathy or that any bilateral lower extremity peripheral neuropathy is related to his service-connected diabetes mellitus.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be viewed in relation to their entire history. 38 C.F.R. § 4.1. VA is required to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. VA is also required to evaluate functional impairment on the basis of lack of usefulness and the effects of the disabilities upon the claimant's ordinary activity. 38 C.F.R. § 4.10.

If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

Entitlement to an initial rating of 10 percent, but no higher, for hypertension is granted.

The Veteran's service-connected hypertension is currently rated as noncompensable under Diagnostic Code 7101. Under this rating criteria, a 10 percent rating is warranted when a veteran's diastolic pressure is predominantly 100 mm/Hg or more, or systolic pressure is predominantly 160 mm/Hg or more, or, if the veteran has a history of diastolic pressure predominantly 100 mm/Hg or more and requires continuous medication for control. A 20 percent rating is warranted when a veteran's diastolic pressure is predominantly 110 mm/Hg or more, or systolic pressure is predominantly 200 mm/Hg or more. A 40 percent rating is warranted when a veteran's diastolic pressure is predominantly 120 mm/Hg or more. A 60 percent rating is warranted when
1. Under this rating criteria, a 10 percent rating is warranted when a veteran's diastolic pressure is predominantly 100 mm/Hg or more, or systolic pressure is predominantly 160 mm/Hg or more, or, if the veteran has a history of diastolic pressure predominantly 100 mm/Hg or more and requires continuous medication for control. A 20 percent rating is warranted when a veteran's diastolic pressure is predominantly 110 mm/Hg or more, or systolic pressure is predominantly 200 mm/Hg or more. A 40 percent rating is warranted when a veteran's diastolic pressure is predominantly 120 mm/Hg or more. A 60 percent rating is warranted when a veteran's diastolic pressure is predominantly 130 mm/Hg or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. Although undefined in the rating criteria, Meriam-Webster's Collegiate Dictionary defines the word predominantly as "for the most part." https://www.merriam-webster.com/dictionary/predominantly.

The medical evidence of record contains the following blood pressure readings: 162/80 in December 2005; 140/82, 159/85, and 144/88 in June 2006; 145/85 and 147/86 in January 2007; 124/80 in August 2007; 156/87 in February 2008; 135/79 in February 2009; 146/77, 155/73, 139/89, and 135/70 in August 2009; 110/60 in January 2010; 136/71 in April 2010; 148/92 in October 2010, 136/72 and 164/88 in December 2010; 150/91 in May 2011; 129/62 in July 2011; 151/75, 130/70, 137/70, and 160/85 in August 2011; 124/68 in September 2011; 109/64 in October 2011; 124/68 in November 2011; 167/66 in March 2012; 128/75 and 138/70 in June 2012; 146/77 in August 2012; 131/75 in October 2012; 129/68 in February 2013; 152/82 140/70, 144/78, 118/54, 139/92, 143/79, 139/81, 149/74, 139/78, 157/83, 134/76, 165/80, 144/78, 163/78, 153/79, and 153/74 in March 2013; 139/89, 152/78, 140/69, and 138/76 in May 2013; 141/73 in July 2013; 118/97 in September 2014; 160/74 in October 2014; 130/76 in January 2015; 142/76 in June 2015; 132/76 in August 2015; 138/82 and 140/76 in November 2015; 158/80 in January 2016; 132/74 in March 2016; 112/62 in April 2016; 112/64 in July 2016; 134/76 in September 2016; 134/82 and 138/64 in January 2017; 134/82 in April 2017; 120/80 and 148/76 in August 2017; 144/72 in November 2017; 134/60 and 152/94 in February 2018; 146/78 and 134/72 in March 2018; 200/88 in May 2018; 126/84 in June 2018; 128/58 in September 2018; 136/68 and 132/78 in November 2018; 120/62 in December 2018; 132/76 and 134/50 in January 2019; 136/88, 125/62, and 124/76 in March 2019; 140/60 in April 2019; 150/70 in May 2019; 144/68 in June 2019; 110/55 and 132/58 in July 2019; 139/89 in September 2019; 129/62 in November 2019; 115/59 in February
84 in June 2018; 128/58 in September 2018; 136/68 and 132/78 in November 2018; 120/62 in December 2018; 132/76 and 134/50 in January 2019; 136/88, 125/62, and 124/76 in March 2019; 140/60 in April 2019; 150/70 in May 2019; 144/68 in June 2019; 110/55 and 132/58 in July 2019; 139/89 in September 2019; 129/62 in November 2019; 115/59 in February 2020; 124/61 and 128/78 in March 2020; 121/71 in May 2020, 130/79 in September 2020; 162/72 in April 2021; 172/77, 144/80, and 146/74 in October 2021; 150/80 in August 2022; 138/62 in October 2022; 131/77 in January 2023; 132/75 in March 2023; 127/75 in July 2023; 138/82 in November 2023; and 153/79 in January 2024.

In an August 2014 VA treatment record the Veteran stated that his weekly average blood pressure readings were about 145 to 150/75 to 80. A May 2019 private treatment record reflects that the Veteran's home blood pressure log showed readings in the 130s to 150s. A July 2019 private treatment record reflects that the Veteran's home blood pressure log showed readings in the 140s.

A June 2024 VA hypertension examination reflects that the Veteran reported that he had blood pressure issues for a long time, but did not know when they started. The examiner found that the Veteran's treatment plan included taking continuous medication. The examiner also found that the Veteran did not have a history of a diastolic blood pressure elevation to predominantly 100 or more. On the date of the examination, the Veteran's blood pressure readings were 150/80, 160/80, and 156/80. There were no other pertinent physical findings, complications, conditions, signs or symptoms related to the Veteran's hypertension, and the examiner opined that the Veteran's hypertension did not impact his ability to work.

In a statement attached to his VA Form 10182, the Veteran stated that, before medication management, he had a history of diastolic pressure predominantly 100 or more, which led his medical provider to place him on continuous medication for blood pressure control.

The United States Court of Appeals for Veterans Claims (Court) held in Wilson v. McDonough, 35 Vet. App. 75 (2021) that, when a veteran is receiving a noncompensable rating for hypertension under Diagnostic Code 7101, the language of Diagnostic Code 7101 relating to "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, and therefore may require analyzing blood pressure readings prior to the period on appeal. Here, none of the medical records reflect any blood pressure readings with a diastolic pressure of 100 or more. However, it appears as though the medical records do not contain any blood pressure readings taken before the Veteran began medication to control his hypertension. The Veteran has stated that, prior to taking medication to control his blood pressure, he had a history of diastolic pressure predominantly 100 or more. The Board finds that the Veteran is credible and competent to report his history of diastolic pressure prior to taking medication to control his hypertension. Thus, resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence establishes that it is at least as likely as not that the Veteran has a history of diastolic pressure predominantly 100 mm/Hg or more and requires continuous medication for control of his hypertension. Accordingly, an initial rating of 10 percent is warranted for the Veteran's hypertension.

However, the Board also finds that the evidence is persuasively against a finding that the Veteran's hypertension has manifested with diastolic pressure predominantly 110 mm/Hg or more, or systolic pressure predominantly 200 mm/Hg or more. Specifically, the evidence contains no blood pressure readings with a diastolic pressure of 110 mm/Hg or more, and there is only one blood pressure reading with a systolic pressure of 200 mm/Hg or more in May 2018. Thus, the Board finds that the evidence is persuasively against a finding
/Hg or more and requires continuous medication for control of his hypertension. Accordingly, an initial rating of 10 percent is warranted for the Veteran's hypertension.

However, the Board also finds that the evidence is persuasively against a finding that the Veteran's hypertension has manifested with diastolic pressure predominantly 110 mm/Hg or more, or systolic pressure predominantly 200 mm/Hg or more. Specifically, the evidence contains no blood pressure readings with a diastolic pressure of 110 mm/Hg or more, and there is only one blood pressure reading with a systolic pressure of 200 mm/Hg or more in May 2018. Thus, the Board finds that the evidence is persuasively against a finding that the Veteran's hypertension resulted in diastolic pressure predominantly 110 mm/Hg or more, or systolic pressure predominantly 200 mm/Hg or more.

In sum, the Board finds that, resolving reasonable doubt in favor of the Veteran, an initial 10 percent rating is warranted for his service-connected hypertension. However, the Board also finds that the evidence is persuasively against a finding that a rating in excess of 10 percent is warranted for the service-connected hypertension. In this regard, the Board finds that the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Board notes that the Veteran and his representative "question the qualifications of the [June 2024 VA examiner] to accurately assess the severity" of the Veteran's cardiac conditions as "[a] review of the online resumes and professional profiles of this provider reveals no special training, education or experience that would qualify him to make accurate assessments on the severity of complex and long-standing Cardiac ... disabilities that this veteran has." The Board finds that the Veteran has not presented a prima facie reason for the Board to question the competency of the June 2024 VA examiner, as the only reason the examiner's qualifications are questioned is because they are a nurse practitioner, which is insufficient to rebut the presumption of competency. Cox v. Nicholson, 20 Vet. App. 563, 569 (2007) (specifically finding that a nurse practitioner is competent to conduct a VA Compensation & Pension examination and a competency challenge merely premised on the examiner being a nurse practitioner is insufficient to rebut the presumption of competency).

REASONS FOR REMAND

The duty to assist requires VA to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with military service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006).

In addition, once VA undertakes the effort to provide an examination or opinion, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Failure to obtain an adequate examination constitutes a pre-decisional duty to assist error requiring a remand.

1. Entitlement to service connection for porphyria cutanea tarda is remanded.

The Veteran filed a claim of entitlement to service connection for porphyria cutanea tarda. Although the Veteran's medical records do not reflect a diagnosis of porphyria cutanea tarda, they do reflect liver dysfunction, which may be a sign or symptom of porphyria cutanea tarda. In addition, porphyria cutanea tarda is one of the enumerated diseases that is presumptively service connected for veterans exposed to certain herbicide agents, and it is conceded that the Veteran has been exposed to herbicide agents in service. See 38 C.F.R. § 3.309(e). Accordingly, the Board finds that the low threshold for obtaining a VA examination has been met as to the Veteran's claim for porphyria cutanea tarda, however, no VA examination has been obtained. Accordingly, remand is warranted to obtain a VA examination to comply with VA's duty to assist.

2. Entitlement to service connection for a back disability is remanded.

A VA back conditions examination was obtained in June 2024 which the Board finds is inadequate because it is inconsistent with the medical evidence of record, without explanation. Specifically, the VA examiner noted that the Veteran's only diagnosed back condition was a lumbosacral strain. However, the Veteran's private treatment records reflect that the Veteran has other lumbosacral conditions. For example, x-ray images in the Veteran's private treatment records reflect findings of degenerative disc changes throughout the Veteran's thoracolumbar spine. In addition, the Veteran's private treatment records reflect diagnoses such as osteoarthritis of the spine. Without further explanation, it is unclear to the Board how the VA examiner found that the Veteran's only back condition was a lumbosacral strain. Accordingly, remand is warranted to obtain a new VA examination to comply with VA's duty to assist.

3. Entitlement to an initial rating in excess of 10 percent for heart condition CAD is remanded.

A VA heart conditions examination was obtained in June 2024 which the Board finds is inadequate for the following reasons. First, the Board finds that the examiner's findings are inconsistent with the medical evidence of record, without explanation. Specifically, the VA examiner noted that there was no evidence of cardiac hypertrophy, however, the Veteran's private treatment records show left ventricular hypertrophy on several echocardiograms. Second, the Board finds that the VA examiner's findings were internally inconsistent without explanation. Specifically, the VA examiner determined that exercise stress testing was not required as part of the Veteran's current treatment plan and the test was not without significant risk. However, the VA examiner also noted that the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. In this regard, the VA examiner did not perform an exercise based stress test or complete the interview based METs test. Without further explanation, the Board finds the examiner's findings to be inconsistent. Accordingly, the Board finds the June 2024 VA heart conditions examination to be inadequate and that remand is warranted to obtain a new VA examination to comply with VA's duty to assist.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination with an appropriate clinician regarding his claim of entitlement to service connection for porphyria cutanea tarda. After review of the claims file and examination of the Veteran, the clinician is asked whether the Veteran has or had a diagnosis of porphyria cutanea tarda.

2. Schedule the Veteran for an examination with a qualified clinician regarding his claim for service connection for a back disability.

After review of the claims file and examination of the Veteran the clinician should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that any back disability found at any point during the appeal period began in or is otherwise caused by the Veteran's active service.

For the purposes of the opinion, the examiner should assume the Veteran's statements about his symptoms are credible, unless they are inconsistent with the medical evidence or with medical principles concerning his condition. The Board emphasizes that this does not constitute a positive credibility determination, as the Board will weigh the evidence if the appeal returns.

If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. In doing so, the examiner may identify any discrepancies, inconsistencies, or contradictions contained in the evidence of record, and may state whether or not the Veteran's lay statements are supported by medical or other evidence. The examiner may not dismiss the Veteran's statements about his symptoms solely because they are not documented in contemporaneous treatment records.

All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided.

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3. Schedule the Veteran for an appropriate VA examination to assess the nature and severity of his service-connected heart condition CAD. The entire claims file must be provided to, and reviewed by, the clinician, and any indicated tests, studies, or evaluations should be performed.

After review of the claims file, and examination of the Veteran, the clinician is
dismiss the Veteran's statements about his symptoms solely because they are not documented in contemporaneous treatment records.

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After review of the claims file, and examination of the Veteran, the clinician is asked to provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the applicable rating criteria. The clinician must attempt to elicit information regarding the severity, frequency, and duration of symptoms during the appeal period. To the extent possible, the clinician should identify any symptoms and impairments due to the service-connected disability being assessed, including the impact on occupational functioning and activities of daily living.

M. HYLAND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Elias, M

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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