Case A26039460

KRISTY L. ZADORA · 2026 · Case ID: A26039460

MIXED

Summary

The veteran, who served from April 1969 to March 1971, appeals multiple rating decisions concerning various conditions. The primary issues on appeal involve the effective dates for granted benefits, including Total Disability based on Individual Unemployability (TDIU) for PTSD, Dependents' Educational Assistance, and special monthly compensation (SMC) based on housebound status, all granted with an effective date of April 7, 2022. The veteran also sought increased ratings for tension headaches, bilateral hearing loss, tinnitus, obstructive sleep apnea, hypertension, and PTSD, all of which were denied. Additionally, the veteran petitioned for readjudication of claims for cervical spine disorder, lumbar spine disorder, and gastroesophageal reflux disease, which were also denied. The Board found that the criteria for the granted benefits and their effective dates were met. For the denied increased ratings, the Board concluded that the evidence did not support the higher ratings sought, citing specific findings from rating decisions and the lack of evidence demonstrating the required severity or progression. The petitions for readjudication were denied due to a lack of new and relevant evidence. Consequently, the Board granted the effective dates for TDIU, Dependents' Educational Assistance, and SMC housebound status, while denying the claims for increased ratings and readjudication.

Rationale

TDIU granted with effective date of April 7, 2022; Veteran unable to secure substantially gainful employment due to PTSD since April 7, 2022; Met eligibility for Dependents' Educational Assistance and SMC housebound status

Special Benefit

SMC - HOUSEBOUND; TDIU

Docket No.

251208-616342

Full Decision Text

Citation Nr: A26039460
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 251208-616342
DATE: April 28, 2026

ORDER

Entitlement to an effective date of April 7, 2022, but no earlier, for the award of a total disability rating based on individual unemployability (TDIU) due to service connected PTSD is granted.

Entitlement to an effective date of April 7, 2022, but no earlier, for the award of basic eligibility to Dependents' Educational Assistance based on permanent and total disability status is granted.

Entitlement to an effective date of April 7, 2022, but no earlier, for the grant of special monthly compensation based on housebound criteria is granted.

Entitlement to an increased rating for tension headaches, rated as noncompensable prior to January 14, 2025 and 30 percent thereafter, is denied.

Entitlement to a rating in excess of 10 percent for bilateral hearing loss is denied.

Entitlement to a rating in excess of 10 percent for tinnitus is denied.

Entitlement to a rating in excess of 50 percent for obstructive sleep apnea is denied.

Entitlement to a compensable rating for hypertension is denied.

Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied.

New and relevant evidence having not been received, the petition to readjudicate the claim of entitlement to service connection for cervical spine to include painful range of motion is denied.

New and relevant having not been received, the petition to readjudicate the claim of entitlement to service connection for low back to include painful range of motion is denied.

New and relevant evidence having not been received, the petition to readjudicate the claim of entitlement to service connection for gastroesophageal reflux disease is denied.

FINDINGS OF FACT

1. An October 2024 rating decision assigned a 50 percent rating for obstructive sleep apnea as secondary to PTSD, effective April 7, 2022; there were no prior pending unadjudicated claims.

2. The Veteran's claims for a TDIU and Dependents' Educational Assistance were raised as part and parcel to his claims for an increased rating for obstructive sleep apnea.

3. Since April 7, 2022, the Veteran has been unable to secure or follow substantially gainful employment as a result of his service connected PTSD.

4. Based on the award of TDIU beginning on April 7, 2022, the Veteran met the basic eligibility requirements for Chapter 35 benefits as of April 7, 2022.

5. For the appeal period beginning on April 7, 2022, the Veteran has been in receipt of a TDIU based on his PTSD and has other disabilities independent of the PTSD combining to at least 60 percent.

6. For the appeal period prior to January 14, 2025, the Veteran's tension headaches did not manifest in characteristic prostrating attacks averaging one in two months over the last several months.

7. For the appeal period beginning on January 14, 2025, the evidence of record in this appeal does not demonstrate that the Veteran's tension headaches manifested with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability

8. Throughout the period on appeal, the Veteran's bilateral hearing loss has been manifested by hearing acuity of Level IV in the right ear and Level III in the left ear, at its worst.

9. The current 10 percent rating assigned for tinnitus is the maximum rating under the VA rating schedule.

10. Throughout the period on appeal, the Veteran's obstructive sleep apnea manifested as requiring the use of a continuous positive airway pressure machine without chronic respiratory failure with carbon dioxide retention, cor pulmonale or a tracheostomy.

11. Throughout the appeal period, the Veteran's hypertension has not required continuous medication for control and no evidence of diastolic pressure of predominantly 100 or more, a history of diastolic pressure of predominantly 100 or more nor by systolic pressure of predominantly 160 or more.

12. Throughout the appeal period, the Veteran's PTSD manifested as occupational and social impairment with deficiencies in most areas without total occupational and social impairment.

13. A June 2023 rating decision denied service connection for cervical spine to include painful range of motion, low back to include painful range of motion and gastroesophageal reflux disease.

14. October 2024 and February 2025 rating decisions denied the petition to readjudicate the claims for service connection for cervical spine to include painful range of motion, low back to include painful range of motion, and gastroesophageal reflux disease.

15. Since the issuance of the October 2024 and
of predominantly 100 or more nor by systolic pressure of predominantly 160 or more.

12. Throughout the appeal period, the Veteran's PTSD manifested as occupational and social impairment with deficiencies in most areas without total occupational and social impairment.

13. A June 2023 rating decision denied service connection for cervical spine to include painful range of motion, low back to include painful range of motion and gastroesophageal reflux disease.

15. Since the issuance of the October 2024 and February 2025 rating decisions, new and relevant evidence has not been received sufficient to warrant readjudication of the claims of service connection for cervical spine to include painful range of motion, low back to include painful range of motion, and gastroesophageal reflux disease.

CONCLUSIONS OF LAW

1. The criteria for an effective date of April 7, 2022, but no earlier, for the award of a TDIU have been met. 38 U.S.C. §§ 1155, 5110; 38 C.F.R. §§ 3.155, 3.340, 3.341, 3.400, 4.16.

2. The criteria for an effective date of April 7, 2022, but not earlier, for the award of Dependents' Educational Assistance have been met. 38 U.S.C. §§ 1155, 5110; 38 C.F.R. §§ 3.155, 3.340, 3.341, 3.400, 4.16.

3. The criteria for an effective date of April 7, 2022, but no earlier, for the award of special monthly compensation based upon housebound status have been met. 38 U.S.C. §§ 1114(s); 5107; 38 C.F.R. §§ 3.102, 3.350.

4. The criteria for an increased rating for tension headaches, rated as noncompensable prior to January 14, 2025 and 30 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.124a, Diagnostic Code 8100.

5. The criteria for a rating in excess of 10 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.85, 4.86, Diagnostic Code 6100.

6. The criteria for a rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.87, Diagnostic Code 6260.

7. The criteria for a rating in excess of 50 percent for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.97, Diagnostic Code 6847.

8. The criteria for a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.104, Diagnostic Code 7101.

9. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.125, 4.126, 4.130, Diagnostic Code 9411.

10. The criteria for the request to readjudicate the claim of entitlement to service connection for cervical spine to include painful range of motion have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 3.2501.

11. The criteria for the request to readjudicate the claim of entitlement to service connection for low back to include painful range of motion have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 3.250
4.1-4.14, 4.125, 4.126, 4.130, Diagnostic Code 9411.

12. The criteria for the request to readjudicate the claim of entitlement to service connection for gastroesophageal reflux disease have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 3.2501.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1969 to March 1971.

These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in February 2025 (as to cervical spine, gastroesophageal reflux disease, and low back), May 2025 (as to headaches, bilateral hearing loss, tinnitus, and hypertension), June 2025 (as to obstructive sleep apnea), August 2025 (as to PTSD) and September 2025 (as to special monthly compensation, TDIU and Dependents' Educational Assistance) as issued by the Department of Veterans Affairs (VA) Regional Office (RO). The rating decisions on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

Historically, a January 2020 rating decision granted service connection for PTSD rated 50 percent effective February 13, 2019. Another January 2020 rating decision granted service connection for bilateral hearing loss rated 10 percent and tinnitus rated 10 percent both effective from February 13, 2019. A June 2023 rating decision granted service connection for obstructive sleep apnea and assigned a zero percent rating effective April 7, 2022; the rating decision denied service connection for cervical spine disorder, lumbar spine disorder, and gastroesophageal reflux disorder. An October 2023 rating decision granted service connection for hypertension and assigned a zero percent rating, effective August 10, 2022; and granted service connection for tension headaches and assigned a zero percent rating, effective May 4, 2022.

In May 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for cervical spine disorder, lumbar spine disorder, and gastroesophageal reflux disease most recently addressed in a June 2023 rating decision; the Veteran also requested a review of the rating assigned for obstructive sleep apnea. In October 2024, the agency of original jurisdiction (AOJ) issued a supplemental claim which found that new and relevant evidence had not been received. Therefore, the Board must determine whether new and relevant evidence has been received based only on the evidence of record at the time of the decision on appeal. The October 2024 supplemental rating decision also granted a 50 percent rating for obstructive sleep apnea effective from April 7, 2022.

Although the Veteran initially requested Higher-Level Review when submitting the July 2024 VA Form 20-0996, Decision Review Request: Higher-Level Review, to review the October 2023 rating decision that addressed tension headaches, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development.

In January 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for cervical spine disorder, lumbar spine disorder, and gastroesophageal reflux disease most recently addressed in an October 2024 rating decision; the Veteran also requested a review of the rating assigned for obstructive sleep apnea; as well as requested entitlement to TDIU due to service-connected disabilities. In February 2025, the AOJ issued a supplemental claim which found that new and relevant evidence had not been received. Therefore, the Board must determine whether new and relevant evidence has been received based only on the evidence of record at the time of the decision on appeal. The October 2024 supplemental rating decision continued a zero percent rating for tension headaches.

In a May 2025 rating decision, the AOJ assigned a 70 percent rating for PTSD effective
, lumbar spine disorder, and gastroesophageal reflux disease most recently addressed in an October 2024 rating decision; the Veteran also requested a review of the rating assigned for obstructive sleep apnea; as well as requested entitlement to TDIU due to service-connected disabilities. In February 2025, the AOJ issued a supplemental claim which found that new and relevant evidence had not been received. Therefore, the Board must determine whether new and relevant evidence has been received based only on the evidence of record at the time of the decision on appeal. The October 2024 supplemental rating decision continued a zero percent rating for tension headaches.

In a May 2025 rating decision, the AOJ assigned a 70 percent rating for PTSD effective January 14, 2025; assigned a 30 percent rating for tension headaches effective January 14, 2025; continued 50 percent rating for obstructive sleep apnea; continued 10 percent ratings for bilateral hearing loss and tinnitus; continued a zero percent rating for hypertension; and granted TDIU and Dependents' Educational Assistance effective January 14, 2025.

In June 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a May 2025 decision. In June 2025 and August 2025, the AOJ issued decision. The June 2025 rating decision continued a 50 percent rating for sleep apnea; and the August 2025 rating decision continued a 70 percent rating for PTSD and continued TDIU and Dependents' Educational Assistance. A later September 2025 rating decision granted special monthly compensation based on housebound criteria.

In the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the February 18, 2025, May 12, 2025, June 12, 2025, August 12, 2025 and September 17, 2025 AOJ decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decisions on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes that the Veteran, through his representative, waived the right to any further notice/assistance or error therefrom, under 38 U.S.C. §§ 5103(a)(1) and 5103A in a December 2025 submission. The Veteran, through his representative, also waived the requirement for notice of the right to a pre-decisional hearing under 38 C.F.R. § 3.103(b), (d)(1) and further waived the right to a pre-decisional hearing before the AOJ in the December 2025 submission. Finally, the Veteran, through his representative, waived his right to further development under VA's duty to assist and requested that the Board promulgate a decision on the evidence of record in the December 2025. In light of these informed waivers by the Veteran's representative, the Board is proceeding with a merits decision.

The Board is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). Here, however, an exception applies where a veteran has already submitted evidence or testimony as described in 38 C.F.R. §§ 20.302 and 20.303, as this would
's representative, the Board is proceeding with a merits decision.

The Board is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). Here, however, an exception applies where a veteran has already submitted evidence or testimony as described in 38 C.F.R. §§ 20.302 and 20.303, as this would preclude a docket switch under 38 C.F.R. § 20.202(c)(2). Here, the Veteran's representative explicitly waived the remaining time to modify the Veteran's chosen Board appeal lane in a December 2025 submission. Therefore, the Board shall proceed with adjudication.

Earlier Effective Date Criteria

According to applicable law and regulation, except as otherwise provided, the effective date of an award of compensation based upon an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The date of entitlement to an award of service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i).

The effective date of an evaluation and an award of compensation based on a reopened claim is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2), (r). Thus, once a previous decision has become final, the earliest effective date of service connection generally is the date of the petition to reopen rather than the date of the initial claim. Exceptions to this rule include a later grant of service connection based in whole or in part on newly obtained service department records under certain circumstances, as provided in 38 C.F.R. § 3.156(c), and when the decision is revised or reversed on the basis of clear and unmistakable evidence, as provided in 38 U.S.C. § 5109A(a) and 38 C.F.R. § 3.105(a).

A "claim" is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication indicating an intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155(a). An informal claim must identify the benefits sought; and upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of the receipt of the informal claim. Id. VA regulation explicitly states that "[a]n intent to file a claim must identify the general benefit (e.g., compensation, pension) but need not identify the specific benefit claimed or any medical condition(s) on which the claim is based." See 38 C.F.R. § 3.155(b)(2).

The general rule for claims for increased ratings is that the award is effective the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(1). The effective date of an award of increased compensation is the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if the claim is received within one year from such date, otherwise, the date of receipt of the claim. 38 C.F.R. § 3.400(o)(2).

An exception to that rule provides that the effective date of an award of an increase shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2); see also Harper v. Brown, 10 Vet. App. 125 (1997).

However, if, at any time after the VA issues a decision on a claim, the VA receives or associates with the claims
year from such date, otherwise, the date of receipt of the claim. 38 C.F.R. § 3.400(o)(2).

However, if, at any time after the VA issues a decision on a claim, the VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when the VA first decided the claim, the VA will reconsider the claim, notwithstanding the subsection addressing reopening claims. 38 C.F.R. § 3.156(c)(3). Service department records that are relevant to the claimed in-service event, injury, or disease, are such § 3.156(c) records. However, to qualify as such records, the award of benefits must be based at least in part on the records. Additionally, this does not apply to records that the VA could not have obtained when it decided the claim because the records did not exist when the VA decided the claim, or because the claimant failed to provide sufficient information for the VA to identify and obtain the records.

Significantly, if the claim is granted based on such service department records, the award is to be effective on the date entitlement arose or the date the VA received the previously decided claim, whichever is later, or such other date as may be authorized by the provisions of this part applicable to the previously decided claim. 38 C.F.R. § 3.156(c)(3).

Although a claimant need not identify the benefit sought "with specificity," see Servello v. Derwinski, 3 Vet. App. 196, 199-200 (1992), some intent on the part of the Veteran to seek benefits must be demonstrated. See Brannon v. West, 12 Vet. App. 32, 34-35 (1998). See also Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995) (noting that while VA must interpret a claimant's submissions broadly, VA is not required to conjure up issues not raised by claimant). The United States Court of Appeals for the Federal Circuit has emphasized VA has a duty to fully and sympathetically develop a veteran's claim to its optimum. Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998). This duty requires VA to "determine all potential claims raised by the evidence, applying all relevant laws and regulations," Roberson v. West, 251 F.3d 1378, 1384 (Fed. Cir. 2001), and extends to giving a sympathetic reading to all pro se pleadings of record. Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004).

The mere presence of medical evidence does not establish intent on the part of the veteran to seek service connection for a disability. Brannon v. West, 12 Vet. App. 32, 35 (1998). The effective date of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but rather, on the date the application was filed with VA. Lalonde v. West, 12 Vet. App. 377, 382 (1999).

When all the evidence is assembled, the Secretary is then responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to an effective date of April 7, 2022, but no earlier, for the award of a TDIU due to service connected PTSD is granted.

2. Entitlement to an effective date of April 7, 2022, but no earlier, for the award of basic eligibility to Dependents' Educational Assistance based on permanent and total disability status is granted.

3. Entitlement to an effective date of April 7, 2022, but no earlier, for the grant of special monthly compensation based on housebound criteria is granted.

As noted
; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to an effective date of April 7, 2022, but no earlier, for the award of a TDIU due to service connected PTSD is granted.

3. Entitlement to an effective date of April 7, 2022, but no earlier, for the grant of special monthly compensation based on housebound criteria is granted.

As noted above, a May 2025 rating decision awarded TDIU and Dependents' Educational Assistance effective from January 14, 2025, the date of the claim. The Veteran contends that an April 7, 2022 date is the appropriate effective date for these awards as that is the date a claim for service connection for obstructive sleep apnea was made. See June 2025 correspondence attached to VA Form 20-0996. The Board agrees

Historically, an October 2024 rating decision assigned a 50 percent rating for the Veteran's obstructive sleep apnea and assigned an April 7, 2022 effective date, the date of the original claim for service connection for obstructive sleep apnea. In January 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested a review of the rating assigned for obstructive sleep apnea; as well as requested entitlement to TDIU due to service-connected disabilities. The Veteran has timely appealed the May 2025 rating decision. The Board finds that the Veteran has continuously pursued his claim for an increased rating for obstructive sleep apnea since the October 2024 rating decision and that the date of claim is April 22, 2022. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Rating boards should submit to the Director of Compensation Service for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). See 38 C.F.R. § 4.16(b).

Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to a TDIU is based on an individual's particular circumstances." Rice v. Shinseki, supra. Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran's education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); see Friscia v. Brown, 7 Vet. App. 294 (1994) (considering a veteran's experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering a veteran's 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering a veteran's master's degree in education and his part-time work as a tutor).

Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16.

The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

A claim for TDIU may be filed as a freestanding claim. In addition, TDIU may be an element of a claim for an increased disability rating when unemployability is raised by the record. See Rice v. Shinseki, supra.

VA will grant a total disability evaluation based on individual unemployability due to service-connected disorders when the evidence shows that a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16.

Service connection has been established for PTSD rated as 50 percent disabling prior to January 14, 2025 and as 70 percent thereafter; obstructive sleep apnea associated with PTSD rated as 50 percent effective from April 7, 2022; tension headaches associated with PTSD rated as 0 percent disabling prior to January 14, 2025 and as 30 percent thereafter; bilateral hearing loss rated as 10 percent disabling effective from February 13, 2019; tinnitus rated as 10 percent disabling effective from February 13, 2019; and hypertension rated as 0 percent disabling effective from August 10, 2022. The Veteran had a combined 60 percent rating from February 13, 2019, a combined 80 percent rating from April 7, 2022 and a combined 90 percent rating from January 14, 2025. Therefore, the Veteran meets the schedular criteria for consideration for a TDIU for the appeal period beginning on April 7, 2022. 38 C.F.R. § 4.16(a).

In the Veteran's January 2025 Application for Increased Compensation Based on Unemployability (VA Form 21-8940), he reported that he last worked full time and became too disabled to work in 2011 and that he was unable to work due to his PTSD; obstructive sleep apnea, headaches, bilateral hearing loss; tinnitus, and hypertension. He indicated that he had completed high school. He reported no earned income in the past 12 months.

A vocational assessment report from Z. F., a certified vocational rehabilitation counselor, was submitted in November 2025 in the post-VA Form 10182 evidence submission window. The provider opined, in part, that based on the Veteran's PTSD with obstructive sleep apnea it is at least as likely as not that the Veteran has been unable to meet the basic non-exertional requirements of all substantially gainful employment, even work at the unskilled sedentary level, on a consistent and reliable basis due to the symptoms and limitations from his service-connected PTSD and obstructive sleep apnea from at least April 2022 to the present. The provider noted that, as evidenced by the record, the Veteran's limitations from these service-connected conditions include but are not limited to limitations in his ability to meet employer expectations of adequate pace and productivity; and difficulty interacting with coworkers, peers, and the general public appropriately and effectively, which are basic requirements of substantially gainful employment at any skill or exertional level.

Based on the evidence of record, the Board finds that effective April 7, 2022, the effect of the Veteran's service connected PTSD precludes him from obtaining and maintaining substantially gainful employment that is consistent with his education and occupational experience. Regarding the economic component of a TDIU, the Veteran worked in maintenance, which required interacting with coworkers as well as the general public. Regarding the non-economic component of a TDIU, the Veteran's limitations with productivity, interacting appropriately with coworkers, peers, and the general public would impact his ability to work in this field, or in any similar profession.

The Board notes that while the Veteran asserts that he became too disabled to work in 2011, because the TDIU claim was
Based on the evidence of record, the Board finds that effective April 7, 2022, the effect of the Veteran's service connected PTSD precludes him from obtaining and maintaining substantially gainful employment that is consistent with his education and occupational experience. Regarding the economic component of a TDIU, the Veteran worked in maintenance, which required interacting with coworkers as well as the general public. Regarding the non-economic component of a TDIU, the Veteran's limitations with productivity, interacting appropriately with coworkers, peers, and the general public would impact his ability to work in this field, or in any similar profession.

The Board notes that while the Veteran asserts that he became too disabled to work in 2011, because the TDIU claim was received more than one year after it became factually ascertainable that the Veteran was unable to secure and follow substantially gainful employment, entitlement to a TDIU is effective the date of the claim, April 7, 2022. 38 C.F.R. § 3.400(o)(1), (2).

The Veteran seeks also entitlement to an earlier effective date for special monthly compensation based upon housebound status pursuant to 38 U.S.C. § 1114(s). See December 2025 VA Form 10182. Specifically, he contends that the appropriate effective date is April 7, 2022.

VA's duty to maximize benefits requires it to assess all of a claimant's service connected disabilities to determine whether any combination of the disabilities establishes eligibility for special monthly compensation under 38 U.S.C. § 1114(s). See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). In Bradley, the Court held that 38 U.S.C. § 1114(s) permits a TDIU rating based on a single disability to satisfy the statutory requirement of a "total" rating. When a veteran is awarded TDIU based on a single disability and receives schedular disability ratings for other conditions, special monthly compensation based on the statutory housebound criteria may be awarded so long as the same disability is not counted twice, i.e., as a basis for TDIU and as a separate disability rated 60 percent or more disabling. See 75 Fed. Reg. 11,229, 11,230; Summary of Precedent Opinions of the VA General Counsel (March 10, 2010) (withdrawing VAOPGCPREC 6-1999 in light of Bradley, 22 Vet. App. at 280).

A veteran with a 100 percent schedular rating for a single service-connected disability could also obtain a TDIU on a single separate disability (though not on multiple service-connected disabilities), in order to meet the special monthly compensation requirements (100 percent rating plus 60 percent rating). A TDIU could meet the special monthly compensation requirements by either: a) increasing a single disability rating of less than 60 percent to at least 60 percent (in a case where a separate 100 percent rating is already established), or b) increasing a single disability that is less than 100 percent to a "total" (100 percent) rating, in a case where there is already established a combination of other ratings that meet the separate 60 percent rating requirement for special monthly compensation. See Buie at 249-50. The Veteran has been awarded a TDIU based on the effects of his service connected PTSD herein and he has service connected disabilities that are separately rated as 60 percent disabling. Therefore, special monthly compensation under 38 U.S.C. § 1114(s) for statutory housebound benefits is warranted.

Eligibility for Dependents' Educational Assistance benefits requires an underlying service-connected disability that is both total and permanent in nature. 38 U.S.C. § 3501(a)(1)(A)(ii), (D)(i); see 38 C.F.R. §§ 3.807(a)(1)-(2), 21.3021(a)(1)(iii), (3)(i). As delineated above, the Veteran is now in receipt of a TDIU effective April 7, 2022. As a result of this finding, the Board now concludes that the same effective date should be used for the Veteran's basic eligibility for Dependents' Educational Assistance benefits.

Accordingly, based on the foregoing, the Board finds that an effective date of April 7, 2022, but no earlier, is warranted for a TDIU, the award of Dependents' Educational Assistance benefits and the award of special monthly compensation based upon housebound status pursuant to 38 U.S.C. § 1114(s) is warranted. To that extent, the appeals are granted. 38 U
(3)(i). As delineated above, the Veteran is now in receipt of a TDIU effective April 7, 2022. As a result of this finding, the Board now concludes that the same effective date should be used for the Veteran's basic eligibility for Dependents' Educational Assistance benefits.

Increased Rating Criteria

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

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

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

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; Lynch v. McDonough, supra.

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims.

4. Entitlement to an increased for tension headaches, rated as noncompensable prior to January 14, 2025 and 30 percent thereafter, is denied.

The Veteran contends that an increased rating for his service-connected tension headaches is warranted. Specifically, he contends that a 50 percent rating is warranted throughout the appeal period. See December 2025 VA Form 10182.

This appeal stems from an October 2023 rating decision granted service connection for the Veteran's tension headaches and assigned a noncompensable (zero) rating effective from May 4, 2022, the date of the claim for service connection. A May 2025 rating decision assigned a 30 percent rating effective from January 14, 2025. Therefore, the appeal period under consideration herein begins on May 4, 2022.

The Veteran's tension headaches are evaluated under Diagnostic Code 8100, which states that a noncompensable
his service-connected tension headaches is warranted. Specifically, he contends that a 50 percent rating is warranted throughout the appeal period. See December 2025 VA Form 10182.

The Veteran's tension headaches are evaluated under Diagnostic Code 8100, which states that a noncompensable rating is warranted for less frequent attacks than as follows. A 10 percent rating is assigned for migraines with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

Governing case law and regulations have not defined several words and phrases in the rating criteria for Diagnostic Code 8100. For reference, the Board notes that "prostration" is defined as "extreme exhaustion or powerlessness." See Dorland's Illustrated Medical Dictionary 1531 (32d. ed. 2012). "Very frequent" is a frequency of at least greater than once a month. Johnson v. Wilkie, 30 Vet. App. 245, 253 (2018). As for "productive of severe economic inadaptability," the Court has noted that "productive of" can mean either "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, headaches need not actually "produce" severe economic inadaptability to warrant the 50 percent rating. Id. at 445-46. Further, "economic inadaptability" does not mean unemployability, as such would undermine the purpose of regulations pertaining to TDIU. Id. at 446; see also 38 C.F.R. § 4.16. Finally, "severe" means "of a great degree." See Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/severe, Definition 8.

The use of the conjunctive "and" in a statutory provision means that all of the conditions listed in the provision must be met. Melson v. Derwinski, 1 Vet. App. 334 (1991); Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for a higher rating to be assigned).

Turning to the evidence, the Veteran was afforded a VA examination in June 2022. The Veteran reports that he takes Excedrin every day for the headaches. Symptoms of headache pain include pulsating or throbbing head pain, pain on both sides of the head, pain worsens with physical activity, worse with bending over. The Veteran does not experience non-headache symptoms associated with headaches. Duration of head pain lasts less than 1 day and he experiences on both sides of his head. The Veteran denies prostrating attacks of headache pain. The Veteran's headache impacts his ability to work in that he would have to rest briefly while working and take his medications to get rid of the headache.

The Veteran was afforded another VA examination in November 2024. He reports he uses Excedrin for headache pain. Symptoms of headache pain includes constant head pain, pulsating or throbbing head pain, pain on both sides of the head. Non-headache symptoms associated with headaches include nausea, sensitivity to light, sensitivity to sound, changes in vision (such as scotoma, flashes of light, tunnel vision); the symptoms usually lasts less than 1 day. The Veteran indicates no prostrating attacks of headache pain.

The Veteran was afforded another VA examination in May 2025. He reports over the counter Excedrin as needed. Reported symptoms include constant head pain, pulsating or throbbing head pain, pain on both sides of the head. Non headache symptoms include sensitivity to light that typically lasts less than 1 day on both sides of the head. The Veteran reports characteristic prostrating attacks of migraine pain that is greater than once per month. The Veteran reports he is a retired maintenance person at a campground. He also reports he cannot engage in his daily activities during episodes or headaches.

After review
otoma, flashes of light, tunnel vision); the symptoms usually lasts less than 1 day. The Veteran indicates no prostrating attacks of headache pain.

After review of the evidence, the Board finds that a compensable rating is not warranted at any point during the appeal period prior to January 14, 2025. In this regard, the evidence does not indicate that at any time prior to January 14, 2025 did the Veteran experience characteristic prostrating attacks of migraine or non-migraine headache pain averaging one in two months over the prior several months. Rather, the June 2022 and November 2024 VA examinations found that the Veteran did not experience prostrating attacks. There are no VA or private treatment records suggesting that the Veteran experienced prostrating attacks prior to January 14, 2025.

In light of the above, the Board finds that prior to January 14, 2025 the Veteran's headaches did not result in extreme exhaustion or powerlessness and thus did not rise to the level of a characteristic prostrating attack. Accordingly, a compensable rating for tension headaches is not warranted for the appeal period prior to January 14, 2025. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

For the appeal period beginning on January 14, 2025, the Board finds that a rating in excess of 30 percent is not warranted because the evidence of record in this appeal does not establish, and the Veteran has not alleged that his headaches were very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Therefore, a rating in excess of 30 percent for tension headaches for the appeal period beginning on January 14, 2025 is not warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

The Board notes that Diagnostic Code 8100 does not contemplate the use of medication. The Board is cognizant of the recent Court decision in Ingram v. Collins, in which the Court reaffirmed prior holdings that in rating disabilities, the Board must discount the beneficial effects of medication when the relevant rating criteria do not contemplate medication use. Ingram v. Collins, 38 Vet. App. 130 (2025); see also Jones v. Shinseki, 26 Vet. App. 56 (2012); McCarroll v. McDonald, 28 Vet. App. 267 (2016). Here, in reporting that he used Excedrin to address his symptoms at the VA examinations, the Veteran did not report that the use of any medication ameliorated his symptoms in any way, and the Board has thus discounted the ameliorative effects of medication in reaching its determination in this case.

In making its determination in this case, the Board acknowledges the Veteran's belief that his tension headaches are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran's reports regarding the severity of his condition.

The Board has considered whether a further staged rating under Fenderson v. West, supra, is appropriate; however, the Board finds that the Veteran's symptomatology has been stable throughout each period on appeal. Therefore, assigning a further staged rating is not warranted. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017).

Therefore, the Board finds that a compensable rating for the appeal period prior to January 14, 2025 and 30 percent thereafter for
be more persuasive than the Veteran's reports regarding the severity of his condition.

Therefore, the Board finds that a compensable rating for the appeal period prior to January 14, 2025 and 30 percent thereafter for tension headaches is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

5. Entitlement to a rating in excess of 10 percent for bilateral hearing loss is denied.

The Veteran generally contends that his bilateral hearing loss is worse than currently rated. See January 2025 VA Form 21-8940. Specific argument in support of this appeal has not been submitted. See December 2025 VA Form 10182.

This appeal stems from a May 2025 rating decision that denied the Veteran's claim for an increased rating for bilateral hearing loss. Therefore, the appeal period commenced January 14, 2025, with consideration of the one year lookback period pursuant to Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010).

Ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992).

The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, or Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86.

When the pure tone threshold at each of the four specified frequencies of 1000, 2000, 3000 and 4000 Hertz is 55 decibels or more, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIA, whichever results in the higher numeral. When the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. Table VIA can also be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc. 38 C.F.R. § 4.85(c).

In evaluating hearing impairment, disability ratings are derived by a mechanical application of the ratings schedule to the numeric designations assigned after audiometric evaluations are conducted. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The ratings schedule provides a
, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. Table VIA can also be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc. 38 C.F.R. § 4.85(c).

In evaluating hearing impairment, disability ratings are derived by a mechanical application of the ratings schedule to the numeric designations assigned after audiometric evaluations are conducted. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The ratings schedule provides a table for ratings purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in both ears. 38 C.F.R. § 4.85.

The Rating Schedule also considers exceptional patterns of hearing impairment. Consequently, when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000 and 4000 Hertz) is 55 decibels or more, the higher numeral designation for hearing impairment from Table VI or Table VIA will be applied. 38 C.F.R. § 4.86(a). Alternatively, when the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will determine from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher Roman numeral. 38 C.F.R. § 4.86(b).

Turning to the evidence, the Veteran underwent audiological evaluation February 2025. The Veteran's audiometric testing results, measured in decibels, and Maryland CNC Word List speech recognition score were as follows:

HERTZ

1000 2000 3000 4000 Average

RIGHT 35 80 85 90 72.50

LEFT 35 65 85 85 67.50

Speech audiometry revealed speech recognition ability of 78 percent in the right ear and of 84 percent in the left ear.

Applying the February 2025 VA audiological evaluation results to Table VI, the findings yield a numeric designation of Level IV in the right ear and Level III in the left ear. Entering the resulting bilateral numeric designation of Level IV for the right ear and Level III for the left ear in accordance with 38 C.F.R. § 4.85(f), Table VII, equates to a 10 percent rating under Diagnostic Code 6100. The pure tone thresholds of record does not reflect an exceptional pattern of hearing loss as contemplated by 38 C.F.R. § 4.86(a) because the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is not 55 decibels or more; therefore, this provision is not applicable and Table VIA cannot be applied.

During the appeal period, the evidence demonstrates that the Veteran's bilateral hearing loss did not warrant a rating in excess of 10 percent. At worst, the Veteran's bilateral hearing loss was evaluated for a Level IV in the right ear and a Level III in the left ear, which equates to a 10 percent rating under Diagnostic Code 6100, Table VI,. Thus, a higher rating is not warranted.

In addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in the final report. Martinak v. Nicholson, 21 Vet. App. 447 (2007). In the February 2025 VA audiological evaluation, the Veteran reported that he had difficulty hearing well in noisy situations and it has progressed over time. Therefore, the Board finds that the audiology evaluation report is are in compliance with the requirements of Martinak.

To the extent that the Veteran contends that his bilateral hearing loss is more severe than currently evaluated during any period on appeal, the Board observes that the Veteran, while competent to report symptoms, is not competent to report that his hearing acuity is of sufficient severity to warrant higher evaluations under VA's tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); See Jandreau v. Nicholson, supra; Buchanan v. Nicholson, 451 F.3d
report is are in compliance with the requirements of Martinak.

To the extent that the Veteran contends that his bilateral hearing loss is more severe than currently evaluated during any period on appeal, the Board observes that the Veteran, while competent to report symptoms, is not competent to report that his hearing acuity is of sufficient severity to warrant higher evaluations under VA's tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); See Jandreau v. Nicholson, supra; Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions).

The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Ross v. Shulkin, 29 Vet. App. 142, 145 (2017). In Doucette v. Shulkin, 28 Vet. App. 366 (2017), the Court held that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday environment as these are the effects that VA's audiometric tests are designed to measure. The Veteran has not otherwise described functional effects that are considered exceptional or, that are not otherwise contemplated by the assigned rating. Id. Thus, his complete disability picture is compensated under the rating schedule. Further, neither he nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. Id. (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

The Board has considered whether a staged rating under Hart v. Mansfield, supra is appropriate and notes at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra.

Thus, the Board finds that a rating in excess of 10 percent for bilateral hearing loss is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

6. Entitlement to a rating in excess of 10 percent for tinnitus is denied.

The Veteran generally contends that his tinnitus is worse than currently rated. See January 2025 VA Form 21-8940. Specific argument in support of this appeal has not been submitted.

At a February 2025 VA audiological evaluation, the Veteran reports tinnitus. The VA examiner indicates the Veteran's tinnitus does not impact his ability to work.

The Board concludes that there is no legal basis for the assignment a schedular rating in excess of 10 percent for tinnitus. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.87, Diagnostic Code 6260.

As noted above, Diagnostic Code 6260 provides a maximum schedular rating of 10 percent for tinnitus, recurrent. Note 1 states that a separate evaluation for tinnitus may be combined with an evaluation under diagnostic codes 6100, 6200, 6204, or other diagnostic code, except when tinnitus supports an evaluation under one of those diagnostic codes. Note 2 states to assign only a single evaluation for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head. Note 3 states do not evaluate objective tinnitus (in which the sound is audible to other people and has a definable cause that may or may not be pathologic) under this diagnostic code but evaluate it as part of any underlying condition causing it.

In this case, the Veteran's tinnitus has been assigned the maximum schedular rating available under Diagnostic Code 6260 for tinnitus. Neither the Veteran nor his representative has raised any other issues with respect to the above claim, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra.

As such, there is no legal basis upon which to award a higher schedular rating for tinnitus, his claim for a rating in excess of 10
3 states do not evaluate objective tinnitus (in which the sound is audible to other people and has a definable cause that may or may not be pathologic) under this diagnostic code but evaluate it as part of any underlying condition causing it.

As such, there is no legal basis upon which to award a higher schedular rating for tinnitus, his claim for a rating in excess of 10 percent on a schedular basis must be denied. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

7. Entitlement to a rating in excess of 50 percent for obstructive sleep apnea is denied.

The Veteran generally contends that his obstructive sleep apnea is worse than currently rated. Specific argument in support of this appeal has not been submitted. See December 2025 VA Form 10182.

This appeal stems from a June 2023 rating decision which granted service connection for obstructive sleep apnea and assigned an initial noncompensable rating, effective April 7, 2022. An October 2024 rating decision later assigned a 50 percent rating for obstructive sleep apnea, effective April 7, 2022. Therefore, the appeal period under consideration herein begins on April 7, 2022.

For the entire appeal period, the Veteran's obstructive sleep apnea has been rated as 50 percent disabling under Diagnostic Code 6847. 38 C.F.R. § 4.100. A 50 percent rating is warranted when use of a breathing assistance device such as a continuous positive airway pressure machine is required. A 100 percent rating is warranted for chronic respiratory failure with carbon dioxide retention or cor pulmonale or requires tracheostomy. 38 C.F.R. § 4.100, Diagnostic Code 6847.

Turning to the evidence, the Veteran was afforded a VA examination in May 2023 for sleep apnea. The Veteran was diagnosed with obstructive sleep apnea. It was noted that he used Trazadone medication for the sleep at night. He did not use a continuous positive airway pressure machine. The examiner noted symptoms of persistent daytime hypersomnolence, but there was no evidence of cor pulmonale, carbon dioxide retention, or chronic respiratory failure. Additionally, the condition had not required a tracheostomy. The examiner noted that the obstructive sleep apnea did impact the Veteran's ability to work in that he experiences memory issues, fatigue, dry eyes, increased headache, difficulty concentrating. The Veteran indicates that he sits frequently due to tiredness and feelings of weakness. He is unable to perform any job tasks optimally.

The Veteran was examined again in January 2025 for sleep apnea. He reports difficulty with sedentary work, long meetings, traveling, driving, or operating machinery when fatigued. He stated that no continuous medication needed. The Veteran reports that he uses a continuous positive airway pressure machine. The examiner noted symptoms of persistent daytime hypersomnolence, but there was no evidence of cor pulmonale, carbon dioxide retention, or chronic respiratory failure. Additionally, the condition had not required a tracheostomy. The examiner noted that the obstructive sleep apnea did impact the Veteran's ability to work in that he has difficulty with sedentary work, long meetings, traveling, driving, or operating machinery when fatigued. Must have access to electricity for a continuous positive airway pressure machine. Unable to work in an austere environment.

Further review of the record shows that the Veteran receives treatment for various disabilities, to include his obstructive sleep apnea. However, there is no indication from the treatment notes of record that the Veteran has reported symptoms of such disorder that are worse than those noted in the VA examination reports.

Based on the foregoing, the Board finds that to a rating in excess of 50 percent for obstructive sleep apnea is not warranted throughout the appeal period. Examinations and treatment records do not reflect chronic respiratory failure with carbon dioxide retention, cor pulmonale or a condition requiring tracheostomy consistent with a 100 percent rating under Diagnostic Code 6847. Thus, a higher 100 percent rating under Diagnostic Code 6847 for obstructive sleep apnea is not warranted.

In making its determination in this case, the Board acknowledges the Veteran's belief that his obstructive sleep apnea symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra.

The Board has considered whether a staged rating under Fenderson v. West, supra is appropriate; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the rating claim adjudicated herein. See Doucette v. Shulkin, supra.

Based on the foregoing, the Board finds that a rating in excess of 50 percent for obstructive sleep apnea is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

8. Entitlement to a compensable rating for hypertension is denied.

The Veteran generally seeks a higher compensable rating for his hypertension. See December 2025 VA Form 10182. He provides no specific argument in support of this appeal.

This appeal stems from a May 2025 rating decision that denied the Veteran's claim for an increased rating for hypertension. Therefore, the appeal period commenced January 14, 2025, with consideration of the one year lookback period pursuant to Gaston v. Shinseki, supra.

Under Diagnostic Code 7101, a 10 percent rating is assigned for hypertension with diastolic pressure (bottom number) predominantly 100 or more, or systolic pressure (top number) predominantly 160 or more. A 10 percent rating also is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is assigned for hypertension with diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent rating is assigned for hypertension with diastolic pressure predominantly 120 or more. The maximum 60 percent rating is assigned for hypertension with diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104.

There are three notes to 38 C.F.R. § 4.104, Diagnostic Code 7101. Note (1) provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure (i.e., bottom number) is predominantly 90 mm or greater, and isolated systolic hypertension means the systolic blood pressure (i.e., top number) is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Note (2) requires the evaluation of hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. Note (3) states that hypertension should be evaluated separately from hypertensive heart disease and other types of heart disease.

The Board notes that the use of medications is explicitly contemplated in Diagnostic Code 7101 and that the Court has held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of Diagnostic Code 7101 contemplates the effects of medications. McCarroll v. McDonald, supra.

The pertinent evidence is a January 2025 VA examination report. The Veteran reports he takes continuous medication for hypertension. Blood pressure readings taken that day revealed: 139/71; 124/65; 159/75.

Further review of the record shows that the Veteran receives treatment for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported hypertension symptoms, to include blood pressure readings, that are worse than those noted above.

Based on the foregoing, the Board finds that a compensable rating for the Veteran's hypertension is not warranted. In this regard
of blood pressure medication as the plain language of Diagnostic Code 7101 contemplates the effects of medications. McCarroll v. McDonald, supra.

Based on the foregoing, the Board finds that a compensable rating for the Veteran's hypertension is not warranted. In this regard, although the Veteran uses continuous medication for hypertension, the Board notes that diastolic pressure has never been shown to be 100 or more, or systolic pressure that was predominantly 160 or more. As noted, evidence shows diastolic pressures to be consistently less than 100 and systolic pressures to be consistently less than 160. Therefore, an initial compensable rating for hypertension is not warranted.

The Board acknowledges the Veteran's assertions that his hypertension is more severe than evaluated. The Veteran is competent to report his symptoms. See e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board finds, however, that the statements of the Veteran and clinical evidence demonstrates that the criteria for a compensable rating have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his hypertension. However, these records do not address the specific rating criteria necessary to substantiate a higher rating. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal.

The Board also observes that the Veteran, while competent to report his observable symptoms, he is not competent to report that his hypertension is of sufficient severity to warrant a higher rating under VA's tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (2007). Even after considering any contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007).

Consideration has been given to assigning a staged rating. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, supra. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra.

Accordingly, the Board finds that a compensable rating for hypertension is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

1. Entitlement to a rating in excess of 70 percent for PTSD is denied.

The Veteran seeks a higher rating for his PTSD because his symptoms are more severe than contemplated by the rating assigned. The Veteran indicates that PTSD prevents him from securing or following any substantially gainful employment. See January 2025 VA Form 21-8940.

This appeal stems from a May 2025 rating decision that denied the Veteran's claim for an increased rating for PTSD. Therefore, the appeal period commenced January 14, 2025, with consideration of the one year lookback period pursuant to Gaston v. Shinseki, supra.

Throughout the appeal period, the Veteran's PTSD has been assigned a 70 percent rating under 38 C.F.R. § 4.130, Diagnostic Code 9411.

Psychiatric disabilities are rated based on the
rating for his PTSD because his symptoms are more severe than contemplated by the rating assigned. The Veteran indicates that PTSD prevents him from securing or following any substantially gainful employment. See January 2025 VA Form 21-8940.

Throughout the appeal period, the Veteran's PTSD has been assigned a 70 percent rating under 38 C.F.R. § 4.130, Diagnostic Code 9411.

Psychiatric disabilities are rated based on the General Rating Formula codified in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. "A veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV) and (5th ed. 2013) (DSM-5). See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). VA is to engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran's service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017).

Under the General Rating Formula for Mental Disorders per 38 C.F.R. § 4.130, a 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id.

A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation on the basis of social impairment.

The Board notes that with regard to the use of the phrase "such as" in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment.

the manifestations of particular symptoms. However, the use of the phrase "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment.

The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, the Court of Appeals for Veterans Claims, or the U.S. Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale, and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal is after August 2014. As such, the DSM-5 applies, and the GAF scores will not be considered.

Turning to the evidence of record, in a February 2025 VA examination, the examiner notes the Veteran's PTSD manifests as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran reports he currently lives with his third wife and finds his wife supportive. Symptoms include; depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, flattened affect, difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, obsessional rituals which interfere with routine activities, impaired impulse control, such as unprovoked irritability with periods of violence, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. During VA examination, the Veteran was alert and generally cooperative; speech was expressive with normal rate, rhythm, and prosody, language was generally intact, sleep was poor, appetite was low, libido was chronically low, eye contact was within normal limits, insight and judgment was intact, knowledge was generally average, some mild memory lapses were noted due to anxiety of the exam, mood was anxious- depressed with stable congruent affect displayed; the behavior was organized with no evidence of disorganized thinking or behavioral or grossly inappropriate behavior; there is no evidence of psychotic thinking or behavior- although psychotic spectrum-sequalae or symptoms were observed; thought process and thought association was generally coherent and intact; no delusions or abnormal unusual thought content or abnormal mentation was present; the Veteran presented generally coherent, logical, linear in thought and was goal-future oriented. The Veteran did not endorse any current suicidal or homicidal ideation.

During June 2025 clarification VA opinion, the examiner indicates that upon review of the symptoms, an impairment that is predominantly consistent with occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, such as "difficulty adapting to stressful circumstances, including work or a work like setting", "obsessional rituals which interfere with routine activities", and "near-continuous panic or depression affecting the ability to function independently, appropriately and effectively". As such, it is concluded that the
or abnormal unusual thought content or abnormal mentation was present; the Veteran presented generally coherent, logical, linear in thought and was goal-future oriented. The Veteran did not endorse any current suicidal or homicidal ideation.

During June 2025 clarification VA opinion, the examiner indicates that upon review of the symptoms, an impairment that is predominantly consistent with occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, such as "difficulty adapting to stressful circumstances, including work or a work like setting", "obsessional rituals which interfere with routine activities", and "near-continuous panic or depression affecting the ability to function independently, appropriately and effectively". As such, it is concluded that the impairment level of "occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood" represents the most accurate category.

Further review of the record shows that the Veteran receives treatment for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported PTSD symptoms that are worse than those noted above.

Based on the foregoing, the Board finds that a rating in excess of 70 percent for PTSD is not warranted as total social and occupational impairment was not shown. The Veteran reported maintaining a multi-year marriage with his third wife and finds her to be supportive. Thus, total social impairment was not shown. The Veteran is currently shown to be unemployed for many years. Notably, he has been granted TDIU based solely on PTSD. Moreover, the Veteran did not generally demonstrate gross impairment in thought processes or communication, he did not experience any delusions or hallucinations, he was cooperative with all examiners and did not exhibit any grossly inappropriate behavior, he was appropriately dressed and had adequate hygiene during all examinations conducted during the period on appeal and there was otherwise no evidence of an inability to perform activities of daily living due to his psychiatric disability, and he remained fully oriented to time and place during the period on appeal. As such a 100 percent rating based upon total social and occupational impairment is not warranted.

In making its determination in this case, the Board acknowledges the Veteran's belief that his symptoms are more severe than the current rating reflects. Although the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Moreover, there is no evidence or suggestion that he underwent medical training. Rather, the Board finds the VA medical evidence in which the professional with medical expertise examined the Veteran, acknowledged his reported symptoms, and adequately described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran's reports regarding the severity of his condition.

In addition, the Board also acknowledges the assertions of the Veteran that his symptoms most closely approximated total occupational and social impairment. However, the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, again, he is not competent to provide an opinion regarding the severity of the symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra.

The Board notes the contentions of the Veteran that his psychiatric symptoms are more severe than currently shown on examination. The Board acknowledges the reports of the Veteran with problems anger, irritability, anxiety, isolation, and sleep disturbances. However, the Veteran's VA examination and clinical evidence of record does not demonstrate functional impairments that rise to total occupational and social impairment, and a higher rating are not met. The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, supra. This argument is therefore without merit.

The Board notes that Diagnostic Code 9411 contemplates the use of medication. As such, further discussion of the beneficial effects of medication is not warranted. See Ingram v. Collins, supra; see also Jones v. Shinseki, supra; McCarroll v. McDonald, supra.

The Board has also considered whether a staged rating under Hart v. Mansfield, supra, is appropriate for the Veteran's PTSD; however, the Board finds that his symptomatology referable to such disability has been stable throughout the period on appeal. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra.

Accordingly, the Board finds that a rating in excess of 70 percent for PTSD is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

New and Relevant Evidence Criteria

Under the AMA, a veteran who disagrees
. Mansfield, supra, is appropriate for the Veteran's PTSD; however, the Board finds that his symptomatology referable to such disability has been stable throughout the period on appeal. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra.

Accordingly, the Board finds that a rating in excess of 70 percent for PTSD is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

New and Relevant Evidence Criteria

Under the AMA, a veteran who disagrees with a prior VA decision may file a supplemental claim by submitting in writing or electronically a complete application on a form prescribed by VA any time after the AOJ issues notice of a decision, regardless of whether the claim is pending or has become finally adjudicated. 38 C.F.R. § 3.2501. If new and relevant evidence is presented or secured with respect to the supplemental claim, the AOJ will readjudicate the claim taking into consideration all of the evidence of record. Id.

New evidence is evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Id. The relevant evidence standard is a lower standard than the previously utilized material evidence standard because the statutory definition of relevant does not require that the new evidence relate to an unestablished fact or raise a reasonable possibility of substantiating the claim.

Without regard to whether a previous adjudication was made under the legacy or AMA standard, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim. Such records include but are not limited to: (i) Service records that are related to a claimed in service event, injury, or disease, regardless of whether those records mention the veteran by name; (ii) Additional service records forwarded by the Department of Defense or the service department to VA any time after VA's original request for service records; and (iii) Declassified records that could not have been obtained because the records were classified when VA decided the claim. 38 C.F.R. § 3.156(c). However, to qualify as such records, the award of benefits must be based at least in part on the records. Additionally, this does not apply to records that the VA could not have obtained when it decided the claim because the records did not exist when the VA decided the claim, or because the claimant failed to provide sufficient information for the VA to identify and obtain the records.

10. New and relevant evidence having not been received, the request to readjudicate the claim of entitlement to service connection for cervical spine to include painful range of motion is denied.

11. New and relevant having not been received, the request to readjudicate the claim of entitlement to service connection for low back to include painful range of motion is denied.

12. New and relevant evidence having not been received, the request to readjudicate the claim of entitlement to service connection for gastroesophageal reflux disease is denied.

The Veteran contends that cervical spine disorder and lumbar spine disorder are due to an in-service event, injury, or illness. Moreover, he contends that his gastroesophageal reflux disease is caused or aggravated by his service connected PTSD. See May 2022 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). The June 2023 rating decision made the following findings: that there was current diagnoses of cervical strain and lumbosacral strain; and that service connection for PTSD was established February 13, 2019. The Board is bound by these favorable findings.

By way of history, an original claim for entitlement to service connection for a cervical spine disorder, a lumbar spine disorder, and gastroesophageal reflux disease as secondary to PTSD was received by the VA in May 2022. See May 2022 VA Form 21-526EZ. A June 2023 rating decision denied entitlement to service connection denied for cervical spine to include painful range of motion, low back to include painful range of motion, and gastroesophageal reflux disorder as secondary to PTSD. Indeed, the June 2023 rating decision found that the Veteran's cervical spine and lumbar spine disorders were not due to an in-service injury, illness, or event and there was no medical evidence of a gastroesophageal reflux disease diagnosis. Evidence considered in the June 2023 rating decision included service treatment records;
a lumbar spine disorder, and gastroesophageal reflux disease as secondary to PTSD was received by the VA in May 2022. See May 2022 VA Form 21-526EZ. A June 2023 rating decision denied entitlement to service connection denied for cervical spine to include painful range of motion, low back to include painful range of motion, and gastroesophageal reflux disorder as secondary to PTSD. Indeed, the June 2023 rating decision found that the Veteran's cervical spine and lumbar spine disorders were not due to an in-service injury, illness, or event and there was no medical evidence of a gastroesophageal reflux disease diagnosis. Evidence considered in the June 2023 rating decision included service treatment records; service personnel records; VA Form 21-526EZ received February 10, 2022; VA treatment records; and VA contract examinations, dated June 28, 2022, to include medical opinions.

In June 2023, the Veteran was advised of the June 2023 rating decision and his appellate rights. The Veteran filed a May 2024 VA Form 20-0995 requesting readjudication of entitlement to service connection for cervical spine disorder, lumbar spine disorder, gastroesophageal reflux disease most recently addressed in a June 2023 rating decision.

An October 2024 rating decision denied the claims based on a finding that new and relevant evidence had not been received to readjudicate the claims for service connection. Evidence received since the June 2023 rating decision includes updated VA treatment records dated from March 29, 2023 to April 5, 2024. Although the treatment records are new as those records were not previously considered, they are not relevant because they do not tend to prove or disprove a matter at issue, namely that the Veteran's cervical strain and lumbar strain are due to an in-service event, injury, or illness; or that there is a current gastroesophageal reflux disease that is etiologically related to his service-connected PTSD.

In October 2024, the Veteran was advised of the October 2024 rating decision and his appellate rights. The Veteran filed a January 2025 VA Form 20-0995 requesting readjudication of entitlement to service connection for cervical spine disorder, lumbar spine disorder, gastroesophageal reflux disease most recently addressed in an October 2024 rating decision.

A February 2025 rating decision denied the claims based on a finding that new and relevant evidence had not been received to readjudicate the claims for service connection. Evidence received since the October 2024 rating decision includes updated VA treatment records dated from October 6, 2024 to November 20,

2024. Although the treatment records are new as those records were not previously considered, they are not relevant because they do not tend to prove or disprove a matter at issue, namely that the Veteran's cervical strain and lumbar strain are due to an in-service event, injury, or illness; or that there is a current gastroesophageal reflux disease that is etiologically related to his service-connected PTSD. Significantly, these treatment records reflect no complaints or treatments for the claimed cervical spine disorder, lumbar spine disorder and/or gastroesophageal reflux disease. Therefore, the Board finds that readjudication of the Veteran's claims for service connection for cervical spine to include painful range of motion, low back to include painful range of motion, gastroesophageal reflux disease is not warranted.

The Board has also considered the applicability of 38 C.F.R. § 3.156(c). In this regard, such provides that, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of the same section (which defines new and material evidence). The regulation further identifies service records related to a claimed in-service event, injury, or disease as relevant service department records. 38 C.F.R. § 3.156(c)(1)(i). As such, new and material evidence is not needed to reopen a previously denied claim when relevant service treatment records and/or any other relevant service department records are received after a prior final denial. Rather, the claim is simply reviewed on a de novo basis. In this case, additional service department records were not associated with the claims file after the initial June 2023 rating decision. Therefore, 38 C.F.R. § 3.156(c) does not apply.

Accordingly, the Board finds that readjudication of the claims for service connection for cervical spine to include painful range of motion, low back to include painful range of motion, gastroesophageal reflux disease as is not warranted. The appeals are denied. 38 U
i). As such, new and material evidence is not needed to reopen a previously denied claim when relevant service treatment records and/or any other relevant service department records are received after a prior final denial. Rather, the claim is simply reviewed on a de novo basis. In this case, additional service department records were not associated with the claims file after the initial June 2023 rating decision. Therefore, 38 C.F.R. § 3.156(c) does not apply.

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. McPhaull, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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