TINNITUS

Summary

The Veteran served from June 1990 to February 1993. This case comes before the Board on appeal from a rating decision denying service connection for hypertension, aortic dissection, and tinnitus. The Veteran initially claimed tinnitus was related to in-service noise exposure. VA records and a March 2025 VA examination confirmed the Veteran has tinnitus and noted his MOS as a small arms repair technician had a high probability for noise exposure. However, service treatment records showed no complaints of tinnitus until April 2007, following a motor vehicle accident where the Veteran sustained a head and brain injury. Earlier VA records consistently documented the tinnitus onset post-accident. The March 2025 VA examiner found the Veteran's current claims of in-service onset contradictory to his documented medical history, deeming his assertions not credible. The examiner also noted the lack of contemporaneous service treatment record complaints and the post-service onset documented in VA records. The Board found the lay statements regarding in-service onset not credible due to these inconsistencies. The VA examination and addendum opinion regarding toxic exposure risk activities (TERA) were found adequate, concluding the tinnitus was less likely than not related to noise exposure or TERA, with the motor vehicle accident being a greater risk factor. Service connection for tinnitus was denied. The claim for hypertension was remanded due to an inadequate VA opinion; the examiner could not definitively link hypertension to the Veteran's service-connected respiratory conditions (obstructive sleep apnea, reactive airway disease) or TERA, noting obesity as a risk factor and the lack of specific literature. The opinion also failed to address aggravation. The claim for aortic dissection was also remanded, as it is intertwined with the hypertension claim and the VA opinion did not address its relationship to the respiratory conditions or TERA, and failed to address aggravation.

Rationale

Lay statements regarding in-service onset were not credible due to inconsistencies with documented medical history.; VA treatment records show tinnitus onset post-April 2007 motor vehicle accident, not during service.; VA examiner determined tinnitus was less likely than not related to noise exposure or TERA.; Motor vehicle accident with head injury identified as greater risk factor than TERA.; Lack of contemporaneous service treatment records for tinnitus.

Full Decision Text

Citation Nr: A26039364
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250723-569778
DATE: April 28, 2026

ORDER

Service connection for tinnitus is denied.

REMANDED

Service connection for aortic dissection is remanded.

Service connection for hypertension is remanded.

FINDING OF FACT

The Veteran's tinnitus did not manifest in service or within one year of service, and is not otherwise related to his service.

CONCLUSION OF LAW

Tinnitus was not incurred in or aggravated by service, and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1990 to February 1993.

These matters come to the Board of Veterans' Appeals on appeal from a rating decision issued on April 22, 2025 that denied service connection for hypertension, aortic dissection, and tinnitus. The Veteran?submitted?a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) on July 23, 2025 and elected the Direct Review docket. The Board may only consider the evidence of record when the rating decision on appeal was issued on April 22, 2025. 38 C.F.R. § 20.301.

The July 23, 2025 VA form 10182 included three issues from an earlier rating decision issued by the Agency of Original Jurisdiction (AOJ) on April 3, 2025. The AOJ had deferred decisions on the Veteran's claims for service connection for aortic dissection, hypertension, and tinnitus in the April 3, 2025 rating decision. Regarding these claims, the April 2, 2025 rating decision contained no actual decision. Rather, the AOJ deferred a decision until a later date. To the extent the Veteran wished to appeal the deferred decisions, the AOJ had not yet issued decisions on the issues for the Board to review. The deferred decisions did not constitute an adjudicative determination from which an appeal may be filed. 38 C.F.R. § 20.201; Shipley v. Shinseki, 24 Vet. App. 458 (2011) (concluding that a deferred rating decision does not constitute an appealable adjudicative action). As such, the Board cannot accept the VA Form 10182 as to the deferred decisions in the April 3, 2025 rating decision. However, the AOJ then issued the April 22, 2025 rating decision that denied service connection for aortic dissection, hypertension, and tinnitus. The AOJ did issue decisions on the Veteran's claim, and this appeal remains valid as to the decision the AOJ rendered in the April 22, 2025 rating decision.

Finally, the Veteran submitted a second VA Form 10182 on July 28, 2025 that lists the claims for service connection for aortic dissection, hypertension, and tinnitus from the April 22, 2025 rating decision as the issues the Veteran wished to appeal. The Veteran also selected the Direct Review docket in this second form. Veterans may typically elect a different appellate review option by submitting a new VA Form 10182 Notice of Disagreement within one year from the date that the Agency of Original Jurisdiction mails notice of the decision on appeal, or 60 days of the date the Board receives the Notice of Disagreement, whichever is later. 38 C.F.R. § 20.202 (c)(2). The Board finds the second VA Form 10182 was not a valid docket change request, as the Veteran again listed the Direct Review docket option. He also did not withdraw this appeal stream before submitting the second VA Form 10182. The primary difference between the first VA Form 10182 received on July 23, 2025 which initiated this appeal and the second VA Form 10182 received five days later is that the Veteran did not list the deferred decisions from April 3, 2025 on the second VA Form 10182. The Veteran also clarified his arguments in support of the claims in the second VA Form 10182. Considering the second VA Form 10182 could not constitute a valid docket change request.

Service Connection

Veterans are entitled to compensation from VA if they develop a disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S
 difference between the first VA Form 10182 received on July 23, 2025 which initiated this appeal and the second VA Form 10182 received five days later is that the Veteran did not list the deferred decisions from April 3, 2025 on the second VA Form 10182. The Veteran also clarified his arguments in support of the claims in the second VA Form 10182. Considering the second VA Form 10182 could not constitute a valid docket change request.

Service Connection

Veterans are entitled to compensation from VA if they develop a disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C. §§ 1110. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

If a Veteran submits a claim for compensation for a service-connected disability with evidence of a disability and evidence of participation in toxic exposure risk activities (TERA) during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, then VA shall provide the Veteran with a medical examination and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the claimed disability and the TERA. 38 U.S.C. § 1168 (a). Here, VA issued a memorandum in March 2025 finding he was exposed to industrial solvents, oils, and lead during his service, with possible exposures to asbestos. VA has found the Veteran participated in TERA, and he does have tinnitus. 

For certain chronic disease, including organic disease of the nervous system such as tinnitus, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. With chronic disease shown as such in service or within the presumptive period under § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected unless clearly attributable to intercurrent causes. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b).

If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Tinnitus.

The Veteran seeks service connection for tinnitus, which he initially argued was directly related to in-service noise exposure at gun ranges. 

VA treatment records and a March 2025 VA tinnitus examination show the Veteran does have tinnitus. The April 2025 rating decision on appeal also includes the favorable findings that the Veteran's in-service duties as a small arms repair technician had a high probability for noise exposure, and that the Veteran participated in toxic exposure risk activities during his service. 

Service treatment records do not include complaints, treatments, or diagnoses relating to tinnitus. VA treatment records show the Veteran's tinnitus began following a motor vehicle accident in April 2007. An October 2007 VA audiology and hearing aid evaluation consultation shows the Veteran had been involved in a motor vehicle accident in April 2007 with a brain injury, and that he had reported having constant tinnitus since the accident with "perfect hearing" before the accident occurred. A May 2008 VA audiology
 2025 rating decision on appeal also includes the favorable findings that the Veteran's in-service duties as a small arms repair technician had a high probability for noise exposure, and that the Veteran participated in toxic exposure risk activities during his service. 

Service treatment records do not include complaints, treatments, or diagnoses relating to tinnitus. VA treatment records show the Veteran's tinnitus began following a motor vehicle accident in April 2007. An October 2007 VA audiology and hearing aid evaluation consultation shows the Veteran had been involved in a motor vehicle accident in April 2007 with a brain injury, and that he had reported having constant tinnitus since the accident with "perfect hearing" before the accident occurred. A May 2008 VA audiology consultation also shows the Veteran reported constant bilateral tinnitus and that the tinnitus began after he sustained a head injury during the April 2007 motor vehicle accident. 

The Veteran was provided a VA examination for hearing loss and tinnitus in March 2025. Regarding tinnitus, the Veteran reported an onset during his service in 1992 being around weapons for a significant amount of time, and that the tinnitus was constant and increased in severity since its onset. 

The examiner diagnosed bilateral tinnitus, and determined the Veteran's tinnitus was not at least as likely as not caused by or a result of military noise exposure. The examiner acknowledged the Veteran served as a small arms repairer technician, which had a high probability for hazardous noise exposure. The examiner also noted the records had shown no reports of tinnitus until 2007, when the Veteran was seen at VA to obtain hearing aid amplification. The examiner explained that the October 2007 and May 2008 VA records documented that the Veteran's tinnitus began after the motor vehicle accident in April 2007 when the Veteran sustained a head injury and brain injury. The examiner noted the Veteran's reports documented in the October 2007 and May 2008 VA records showing his tinnitus had begun after the motor vehicle accident and that the Veteran had reported having "perfect hearing" prior to the accident. 

The examiner acknowledged the Veteran's reports made during the March 2025 VA examination that his tinnitus had begun in 1992 due to going out on the range in case a weapon malfunctioned. However, the examiner noted the Veteran's documented history of head injury during the motor vehicle accident with loss of consciousness and a stroke that also occurred in 2006. The examiner cited studies that symptoms of mild TBI or concussion frequently include tinnitus, which can occur not only as a direct consequence of the injury causing TBI but also as a side effect of medications commonly used to treat cognitive, emotional, and pain problems associated with TBI. The examiner explained that although the Veteran had now reported his tinnitus onset in 1992, documentation of this onset was not located in the Veteran's file. The examiner also explained that the Veteran had also reported during previous audiologic examinations that his tinnitus onset was following the motor vehicle accident, which was contradicting evidence. The examiner concluded that, given the amount of time that has elapsed since the Veteran's discharge from service in 1993, and the lack of evidence Veteran reported tinnitus in the years following discharge until 2007, a reasonable nexus could not be established between the Veteran's tinnitus and his military service.

VA obtained an addendum opinion in March 2025 pursuant to 38 U.S.C. § 1168 addressing whether the Veteran's tinnitus is related to his toxic exposure risk activities during service. After reviewing the record, the examiner concluded the Veteran's tinnitus was less likely than not caused by the indicated toxic exposure risk activities, even after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities. The examiner acknowledged the Veteran's toxic exposures documented in the March 2025 memorandum, including daily exposures to industrial solvents, oils, lead, and asbestos. However, the examiner explained the Veteran had risk factors outside military service that far outweighed the factors identified in the Veteran's toxic exposure risk activities, specifically the April 2007 motor vehicle accident with a brain injury. The examiner who provided the addendum opinion also determined that the examination also explained that the March 2025 examination supported finding a positive nexus to the motor vehicle accident that occurred in April 2007. 

First, the Board will consider the Veteran's lay statements regarding the causes and onset of his tinnitus. Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of a disability or symptoms subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Layno v
 a brain injury. The examiner who provided the addendum opinion also determined that the examination also explained that the March 2025 examination supported finding a positive nexus to the motor vehicle accident that occurred in April 2007. 

First, the Board will consider the Veteran's lay statements regarding the causes and onset of his tinnitus. Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of a disability or symptoms subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Tinnitus and its symptoms are easily lay observable and the presence and onset of tinnitus is not a determination that is medical in nature. Charles v. Principi, 16 Vet. App. 370 (2002). However, the Veteran's statements made in support of his claim for benefits conflict significantly with his previously documented medical history, including the cause and onset of his tinnitus. 

During the March 2025 VA examination, the Veteran reported that his tinnitus had begun during his service in 1992 and was related to his duties as a small arms repairer and technician, which required him to be at the rifle range for a significant amount of time in case of weapon malfunctions. The Veteran also argued that his tinnitus was related to this noise exposure when he filed his claim for service connection for tinnitus in October 2024, and reported that his duties required that he be at the rifle range every time someone from his unit had to qualify at the range. Earlier VA medical records establish that the Veteran's tinnitus began following a motor vehicle accident in April 2007. As noted above, during the October 2007 VA consultation for hearing aids, the Veteran reported constant tinnitus since the April 2007 motor vehicle accident, which involved a brain injury. The subsequent May 2008 VA audiology consultation again shows the Veteran's tinnitus began after the motor vehicle accident when he sustained a head injury.

In weighing the credibility of evidence, the Board may properly consider factors such as interest, bias, inconsistent statements, and consistency with other evidence of record. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); Macarubbo v. Gober, 10 Vet. App. 388 (1997). The Veteran's reports during the March 2025 examination that his tinnitus began during his service in 1992 are highly inconsistent with his earlier reports documented in VA treatment records, which show he had previously and consistently reported his tinnitus began following the April 2007 motor vehicle accident. These inconsistencies negatively affect the Veteran's credibly regarding the onset and continuation of his tinnitus. 

Moreover, the evidence does not reveal complaints or treatment regarding tinnitus until after the April 2007 motor vehicle accident, at which time VA records show the Veteran had consistently reported that his tinnitus had started as a result of the accident. VA then received the Veteran's initial claim for service connection was received in October 2024, over 30 years after he separated from active service and over 17 years after the motor vehicle accident. Although the Board cannot determine that lay statements lack credibility merely because the statements are unaccompanied by contemporaneous medical evidence, such as treatments and complaints for tinnitus during service or following his separation, the lack of contemporaneous medical evidence may be considered and weighed against the Veteran's lay statements regarding onset and continuity of his tinnitus. Buchanan, 451 F.3d at 1336-37. Furthermore, the record is not silent, as VA treatment records showed the Veteran had previously reported his tinnitus began after the April 2007 motor vehicle accident. A negative inference is also drawn from the absence of complaints or treatment for an extended period following separation, as well as the Veteran's initial reports that his tinnitus was caused by the April 2007 accident. The first documented report of tinnitus is during the October 2007 VA audiology consultation, and the Veteran originally reported that his tinnitus has started following the April 2007 motor vehicle accident, many years after he separated from service. Considering the foregoing, the Board finds the Veteran's subsequent assertions that tinnitus began during service are not credible.

Next, the Board will address the March 2025 VA examination and medical opinions. For medical evidence to be given weight, it must be: (1) based upon sufficient facts or data;
 negative inference is also drawn from the absence of complaints or treatment for an extended period following separation, as well as the Veteran's initial reports that his tinnitus was caused by the April 2007 accident. The first documented report of tinnitus is during the October 2007 VA audiology consultation, and the Veteran originally reported that his tinnitus has started following the April 2007 motor vehicle accident, many years after he separated from service. Considering the foregoing, the Board finds the Veteran's subsequent assertions that tinnitus began during service are not credible.

Next, the Board will address the March 2025 VA examination and medical opinions. For medical evidence to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). The probative value of a medical opinion primarily comes from its reasoning; threshold considerations are whether a person opining is suitably qualified and sufficiently informed. Id. at 304. 

An opinion is adequate when it is based upon consideration of the Veteran's prior medical history and examinations and describes the disability in sufficient detail so that the Board's evaluation will be a fully informed one. D'Aries v. Peake, 22 Vet. App. 97, 104 (2008). In addition, the opinion must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). An adequate medical report must rest on correct facts and reasoned medical judgment to inform the Board on a medical question and facilitate the Board's consideration and weighing of the report against any contrary reports. Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012).

The Board finds the March 2025 examination and medical opinion are adequate and constitute probative evidence regarding whether the Veteran's tinnitus is related to his service. The examiner's rationale was based on review of the claims file and analysis of the Veteran's history, and the examiner did concede the Veteran was exposed to noise exposure during service. The examiner relied heavily on the Veteran's documented medical history to provide the negative rationale, in particular the Veteran's prior reports shown in the VA medical records that his tinnitus had started after the April 2007 motor vehicle accident. The examiner specifically cited the October 2007 records documenting constant tinnitus since the accident with the Veteran's reports of "perfect hearing" prior to the accident, and the May 2008 records showing the Veteran had reported his tinnitus began after the motor vehicle accident and head injury. The rationale is based almost entirely on the Veteran's own prior lay statements that his tinnitus had a post-service onset, and the examiner did note the Veteran's inconsistent statements made during the examination. As explained above, the Board has found the Veteran's assertions that his tinnitus began during his service are not credible. Furthermore, service treatment records show no complaints or treatments for tinnitus, and the post-service record is absent any notation of tinnitus until the October 2007 VA audiology consultation, during which the tinnitus was attributed to the April 2007 motor vehicle accident.

The Board also finds the March 2025 addendum opinion addressing TERA under 38 U.S.C. § 1168 is adequate and probative evidence weighing against the claim. This opinion is also consistent with the Veteran's documented medical history. The examiner who provided the TERA addendum opinion determined the April 2007 motor vehicle accident with a brain injury was the greater risk factor that far outweighed any factors identified in the TERA memorandum, including the Veteran's exposures to solvents, oils, lead, and asbestos. The VA treatment records provide additional details regarding the motor vehicle accident. For example, the Veteran did sustain a head injury and traumatic brain injury during the accident. A June 2007 neuropsychology consultation the Veteran's head injury during the accident and that he was told he had a concussion, and a July 2007 neurosurgery consultation shows the Veteran did have a loss of consciousness during the accident. The Board reiterates that the Veteran had previously reported that his bilateral tinnitus began after the April 2007 motor vehicle accident. The Veteran's documented medical history, including the head injuries during the accident and his prior reports that his tinnitus was caused by the accident, is consistent with the March 2025 addendum opinion attributing the tinnitus to the accident rather than any in-service toxic exposures. As the examiner who provided the March 2025 addendum opinion observed, the March 2025 examination itself is consistent with finding a positive nexus to the April 2007 motor
 that he was told he had a concussion, and a July 2007 neurosurgery consultation shows the Veteran did have a loss of consciousness during the accident. The Board reiterates that the Veteran had previously reported that his bilateral tinnitus began after the April 2007 motor vehicle accident. The Veteran's documented medical history, including the head injuries during the accident and his prior reports that his tinnitus was caused by the accident, is consistent with the March 2025 addendum opinion attributing the tinnitus to the accident rather than any in-service toxic exposures. As the examiner who provided the March 2025 addendum opinion observed, the March 2025 examination itself is consistent with finding a positive nexus to the April 2007 motor vehicle accident. 

Finally, while tinnitus is a chronic disease, the probative evidence weighs substantially against finding that tinnitus or relevant symptoms manifested in service or within one year of separation. Although the Veteran reported an in-service onset during the March 2025 VA tinnitus examination, the Board has found these assertions are not credible. The Veteran had previously reported that his tinnitus began following the April 2007 motor vehicle accident, over 30 years after he separated from service in February 1993. Although the Veteran's exposure to noise during his service is conceded, the service treatment records do not reflect any complaints of tinnitus, and the Veteran's prior reports established a post-service cause and onset. The most credible, probative evidence shows the Veteran did not have characteristic manifestations sufficient to identify the chronic disease entity during service or within one year of separation from service. 38 C.F.R. § 3.303 (b).

In sum, the probative evidence weighs persuasively against finding that the Veteran's tinnitus began during service, within a year of separation from service, or is otherwise related to service. The benefit-of-the-doubt doctrine is not for application and service connection for tinnitus is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th 776; Gilbert, 1 Vet. App. at 49.

REASONS FOR REMAND

This appeal is subject to the Appeals Modernization Act. When a pre-decisional duty-to-assist error occurs, the Board may have those errors corrected before deciding the claims on appeal. The Board may also remand for correction of any other error by the Agency of Original Jurisdiction in satisfying a regulatory or statutory duty if correction of the error would have a reasonable possibility of aiding in substantiating a Veteran's claim.?38 C.F.R. § 20.802. 

2. Service connection for hypertension.

The Veteran seeks service connection for hypertension, which he initially claimed as secondary to his service-connected reactive airway disease with lung wall disease. The AOJ re-rated the Veteran's respiratory disability as obstructive sleep apnea with reactive airway disease with lung wall disease in the April 2025 rating decision on appeal.

Secondary service connection is warranted for disability which is proximately due to or the result of a service-connected disease or?injury. 38?C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease or injury will be service-connected.?38 C.F.R. § 3.310?(b). 

The Veteran was provided a VA hypertension examination in April 2025. The examiner diagnosed hypertension and concluded it was less likely than not that the Veteran's hypertension was proximately due to or the result of reactive airway disease with lung wall disease and sleep apnea. The examiner explained that the etiology of hypertension was multifactorial with several conditions, such as obesity, which increase the risk of developing hypertension. The examiner noted the Veteran did have a history of obesity, and explained that, without resorting to mere speculation, he did not have sufficient information to determine if the Veteran's reactive airway disease with lung wall disease and sleep apnea are the sole causes in the development of the Veteran's hypertension.

The Board finds the April 2025 opinion addressing whether hypertension is proximately due to or the result of the Veteran's respiratory disabilities inadequate. The examiner determined it would be speculative to attribute hypertension solely to the Veteran's respiratory disabilities, and noted the additional risk factor of obesity as potentially contributing to hypertension. However, the Veteran did submit excerpts from a medical article stating that obstructive sleep apnea was a recognized cause of secondary hypertension, and that reactive airway diseases such as asthma increased the risk of developing hypertension. The Veteran had submitted these excerpts before the examiner provided the April 2025 opinion indicating hypertension may be caused by sleep apnea and reactive airway diseases. As such,
nea are the sole causes in the development of the Veteran's hypertension.

The Board finds the April 2025 opinion addressing whether hypertension is proximately due to or the result of the Veteran's respiratory disabilities inadequate. The examiner determined it would be speculative to attribute hypertension solely to the Veteran's respiratory disabilities, and noted the additional risk factor of obesity as potentially contributing to hypertension. However, the Veteran did submit excerpts from a medical article stating that obstructive sleep apnea was a recognized cause of secondary hypertension, and that reactive airway diseases such as asthma increased the risk of developing hypertension. The Veteran had submitted these excerpts before the examiner provided the April 2025 opinion indicating hypertension may be caused by sleep apnea and reactive airway diseases. As such, the Board finds an additional opinion addressing these articles should have been provided before the rating decision on appeal was issued. 

In addition, no VA medical opinion was obtained that addresses aggravation under 38 C.F.R. § 3.310 (b). The Veteran did not limit his claim to only whether his hypertension was proximately due to his respiratory disabilities, and the claim for secondary service connection included a claim for aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013); Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (finding a medical opinion inadequate because it did not address aggravation and causation separately with rationale specific to those findings).

The April 2025 examiner also provided an opinion that it was less likely than not that the Veteran's hypertension was caused by his in-service toxic exposure risk activities, and explained that hypertension was multifactorial and there was no medical or scientific evidence available that provided an association between developing the diagnosed condition and the Veteran's TERA. While there is no reasons and bases requirement imposed on VA examiners, they?must support?their conclusions with an analysis that the Board can consider and weigh. Acevedo v. Shinseki,?25?Vet. App.?286, 293?(2012); Stefl v. Nicholson,?21?Vet. App.?120, 124 (2007). To be adequate, an opinion must contain clear conclusions with supporting data, as well as a reasoned medical explanation connecting the two. Stefl, 21?Vet. App. at 124. To adequately inform VA as to the nature of the relationship between the Veteran's claimed hypertension and his TERA, an opinion requires more than an inability to find medical literature supporting a relationship between the TERA and hypertension. The examiner must address the Veteran's particularized circumstances in providing an opinion addressing whether there is a relationship between the Veteran's TERA and his hypertension. See Bailey v. O'Rourke,?30?Vet. App.?54, 60-1 (2018). The April 2025 opinion addressing the Veteran's toxic exposure risk activities amounts to a conclusion supported by reference to non-existent medical and scientific literature, without any explanation addressing the Veteran's actual in-service toxic exposures.

Considering the foregoing, the claim must also remanded to correct pre-decisional duty to assist errors and obtain adequate opinions addressing the etiology of the Veteran's hypertension.

3. Service connection for aortic dissection.

The Veteran also seeks service connection for aortic dissection. In the initial application for service connection received in March 2025, the Veteran partially claimed his aortic dissection was related to his service connected obstructive sleep apnea with reactive airway disease with lung wall disease. He also argued that his respiratory disabilities had caused his hypertension, which in turn caused the aortic dissection. 

The Veteran's claim for service connection for aortic dissection is, in part, intertwined with his claim for service connection for hypertension. The AOJ requested a medical opinion addressing whether the Veteran's aortic dissection was proximately due to or the result of his service-connected respiratory disabilities. A VA examiner provided a negative opinion in April 2025. The examiner explained that hypertension and atherosclerosis were risk factors in development of aortic dissections, and found that the Veteran's history of hypertension was a likely contributing factor in the development of his aortic dissection. The Veteran has also submitted excerpts from an article stating that high blood pressure and hypertension is a major risk factor for aortic dissection. Two or more issues are inextricably intertwined if one claim could have significant impact on the other. Harris v. Derwinski, 1 Vet. App. 180 (1991). If service connection for hypertension is warranted, then service connection for the aortic dissection may be warranted as secondary to the hypertension. As the Board is remanding the Veteran's claim for service connection for hypertension, the claim for the Veteran's aortic dissection must also be remanded, as evidence suggests the
 the Veteran's history of hypertension was a likely contributing factor in the development of his aortic dissection. The Veteran has also submitted excerpts from an article stating that high blood pressure and hypertension is a major risk factor for aortic dissection. Two or more issues are inextricably intertwined if one claim could have significant impact on the other. Harris v. Derwinski, 1 Vet. App. 180 (1991). If service connection for hypertension is warranted, then service connection for the aortic dissection may be warranted as secondary to the hypertension. As the Board is remanding the Veteran's claim for service connection for hypertension, the claim for the Veteran's aortic dissection must also be remanded, as evidence suggests the hypertension may have caused the aortic dissection.

The Board also finds the claim for service connection for aortic dissection must be remanded to correct a pre-decisional duty to assist error and obtain adequate medical opinions. Although the April 2025 medical opinion primarily attributed the Veteran's aortic dissection to hypertension, the opinion does not address any relationship between the Veteran's obstructive sleep apnea with reactive airway disease with lung wall disease and his aortic dissection. The rationale only states that the Veteran's history of hypertension is "a likely contributing factor in the development" of the aortic dissection and does not contain any information or explanation regarding whether the aortic dissection is proximately due to or the result of the Veteran's respiratory disabilities. In addition, no VA medical opinion was obtained that addresses secondary aggravation under 38 C.F.R. § 3.310 (b). The Veteran did not limit his claim to only whether his aortic dissection was proximately due to his respiratory disabilities, and the claim for secondary service connection included a claim for aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013); Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (finding a medical opinion inadequate because it did not address aggravation and causation separately with rationale specific to those findings).

The April 2025 examiner also provided an opinion that it was less likely than not that the Veteran's hypertension was caused by his in-service toxic exposure risk activities, and explained that the Veteran's hypertension is a likely contributing factor in developing the diagnosed condition. The rationale provided also fails to address the Veteran's in-service toxic exposures, instead identifying hypertension as a likely contributing factor without providing any rationale specific to the Veteran's in-service TERA. 

Considering the foregoing, the claim must also be remanded to correct pre-decisional duty to assist errors and obtain adequate opinions addressing the etiology of the Veteran's aortic dissection.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination to determine the etiology of his hypertension. After reviewing the claims file and examining the Veteran, the examiner must provide the following opinions:

a.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that there is a relationship between the Veteran's hypertension and toxic exposure risk activities during his active service? 

The examiner must address the Veteran's potential toxic exposures outlined in the March 2025 memorandum, including exposures to industrial solvents, oils, and lead during his service, with possible exposures to asbestos.

b.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypertension is proximately due to or the result of his obstructive sleep apnea with reactive airway disease with lung wall disease?

c.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypertension is aggravated by his obstructive sleep apnea with reactive airway disease with lung wall disease?

A complete and separate rationale must be provided for each opinion. When providing the opinions for secondary service connection, the examiner must address the articles the Veteran submitted in support of his claim indicating obstructive sleep apnea and reactive airway diseases such as asthma may cause hypertension. The examiner is also reminded that secondary service connection is warranted where a nonservice-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

2. Schedule the Veteran for a VA examination to determine the etiology of his aortic dissection. After reviewing the claims file and examining the Veteran, the examiner must provide the following opinions:

a.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that there is a relationship
 and reactive airway diseases such as asthma may cause hypertension. The examiner is also reminded that secondary service connection is warranted where a nonservice-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

2. Schedule the Veteran for a VA examination to determine the etiology of his aortic dissection. After reviewing the claims file and examining the Veteran, the examiner must provide the following opinions:

a.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that there is a relationship between the Veteran's aortic dissection and toxic exposure risk activities during his active service? 

The examiner must address the Veteran's potential toxic exposures outlined in the March 2025 memorandum, including exposures to industrial solvents, oils, and lead during his service, with possible exposures to asbestos.

b.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's aortic dissection is proximately due to or the result of his obstructive sleep apnea with reactive airway disease with lung wall disease?

c.	Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's aortic dissection is aggravated by his obstructive sleep apnea with reactive airway disease with lung wall disease?

A complete and separate rationale must be provided for each opinion. When providing the opinions for secondary service connection, the examiner is reminded that secondary service connection is warranted where a nonservice-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

 

 

SHAUN S. SPERANZA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Morse, Stenson

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.