HYPERTENSION

J.P. NORMAN · 2026 · Case ID: A26039704

MIXED

Summary

The Veteran, who served in the U.S. Navy from June 1966 to April 1970, appeals the denial of service connection for hypertension, nonalcoholic liver problems (mild hepatic steatosis), and an acquired mental health condition (anxiety and depression). The Board denied service connection for hypertension, finding the evidence persuasively against a nexus to service, despite the Veteran's contention of secondary connection to anxiety and toxic exposure. The VA examiner opined hypertension was less likely than not caused by asbestos and lead paint exposure, citing lifestyle factors as primary causes. The Board afforded great weight to this opinion. For the liver condition, the Veteran claimed secondary connection to lead and asbestos exposure. The VA examiner again opined the condition was less likely than not caused by these exposures, citing medical literature that does not support the link. The Board found this opinion persuasive and denied service connection. For the mental health claim, the Veteran alleged connection to sleep disturbance and hearing loss but had not sought mental health treatment. The Board found no probative evidence of a current diagnosis or nexus to service, deeming a VA exam unnecessary. The Board denied all three claims. The claim for obstructive sleep apnea (OSA) was remanded due to an inadequate VA examination, as the examiner provided a negative TERA opinion but failed to address direct service connection or the Veteran's lay statements about sleep issues during service.

Rationale

No competent positive nexus opinion; VA examiner opined less likely than not caused by toxic exposure; Hypertension attributed to lifestyle factors

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250922-589201

Full Decision Text

Citation Nr: A26039704
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250922-589201
DATE: April 28, 2026

ORDER

Entitlement to service connection for hypertension (HTN) is denied.

Entitlement to service connection for nonalcoholic liver problems - mild hepatics steatosis is denied.

Entitlement to service connection for an acquired mental health condition (claimed as anxiety and depression) is denied.

REMANDED

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

FINDINGS OF FACT

1. The competent and probative evidence of record does not reflect that the Veteran's hypertension is related to his military service or a service-connected disability.

2. The competent and probative evidence of record does not reflect that the Veteran's nonalcoholic liver problems - mild hepatics steatosis condition is related to his military service.

3. The probative evidence of record weighs persuasively against finding that the Veteran has had a diagnosed acquired mental health condition (claimed as anxiety and depression) disability at any time during or approximate to the pendency of the claim that is causally related to an injury, event, or disease in service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for hypertension (HTN) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.310.

2. The criteria for entitlement to service connection for nonalcoholic liver problems - mild hepatics steatosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for an acquired mental health condition (claimed as anxiety and depression) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from June 1966 to April 1970.

In June 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a February 2025 rating decision. In September 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior February 2025 decision.

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 20, 2026.

Therefore, the Board may only consider the evidence of record at the time of the February 2025 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim of entitlement to service connection for OSA, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. §
If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in, or if preexisting service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

To establish service connection for a disability there must be competent evidence of the following: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). However, a current diagnosis is not the only evidence necessary to show a current disability. In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that "pain in the absence of a presently diagnosed condition can cause functional impairment," which may qualify as a disability for VA compensation purposes. The Federal Circuit in Saunders, however, cautioned against the notion that "a veteran could demonstrate service connection simply by asserting subjective pain" because, to establish that a disability is present, the veteran "will need to show that... pain reaches the level of a functional impairment of earning capacity." Id. at 1367-68. The Federal Circuit noted that functional impairment is defined as the inability of the body or a constituent part of it to function under the ordinary conditions of daily life including employment. Id. at 1363 (quoting 38 C.F.R. § 4.10).

Ultimately, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for the evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either
1363 (quoting 38 C.F.R. § 4.10).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

1. Entitlement to service connection for hypertension (HTN) is denied.

The Veteran contends that his hypertension is secondary to anxiety and long workdays in excess of 15-16 hours. He does not contend that this condition is directly related to his service nor that service connection is warranted on another basis. See Doucette, 28 Vet. App. at 371.

Initially, the Board notes that in the February 2025 rating decision, the AOJ found that the Veteran has sufficient service to meet the minimum requirements for presumptive service connection, and his DD-214 shows he served more than 90 days active duty service; that the Veteran has been diagnosed with a disability, as he has been diagnosed with hypertension by his doctors in his treatment records and at his VA exam; and that participation in a toxic exposure risk activity is conceded, as the evidence shows that he served as a culinary specialist and was exposed to asbestos and lead paint. The Board is bound by these favorable findings.

With respect to the contention that service connection is warranted on a secondary basis, the Board notes that service connection for anxiety is denied elsewhere in this decision. Therefore, there is no basis to grant service connection for hypertension on a secondary basis.

In connection with his claim, the Veteran was afforded a VA Hypertension examination in January 2025. Based on an in-person examination and review of the Veteran's VA e-folder, the VA examiner reported a diagnosis of hypertension. The examiner noted the Veteran's report of onset in the 1990s. As a result of the examination, the VA examiner opined that the Veteran's hypertension was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. By way of rationale, the VA examiner explained that the TERA Memo dated 12/17/2024 indicates that the Veteran had exposure to asbestos and red lead primary; that medical literature does not support hypertension has been caused by asbestos or red primer/paint exposure; and that hypertension is caused by Lifestyle: Unhealthy habits like smoking, drinking too much alcohol, eating a diet high in salt and low in potassium, and not getting enough physical activity; Health conditions: certain health conditions, like diabetes, obesity, and chronic kidney disease; Age: blood pressure tends to increase because arteries stiffen and collect plaque; Genetics: genes can play a role in the risk of development hypertension; and Race: African Americans are more likely to have high blood pressure than white Americans. In support of the opinion, the VA examiner cited to medical literature. See January 2025 VA examination report.

The Board affords great weight to the January 2025 VA medical examiner's opinion as it demonstrates a thorough review of contentions of the Veteran and relevant medical literature. The VA medical opinion also considers multiple sources of information and offers a thorough rationale.

The Board acknowledges that the Veteran submitted medical literature discussing an association of blood lead level with elevated blood pressure in hypertensive patients. However, the Board finds that there is not a competent positive nexus opinion to support the Veteran's claim. Hearing testimony and medical literature submitted after issuance of the rating decision on appeal is not a basis for remand, as this evidence was not available to the AOJ at the time of the rating decision on appeal.

The Board acknowledges that, while the Veteran may genuinely believe that his hypertension is related to service, the Veteran does not have the requisite medical knowledge
it demonstrates a thorough review of contentions of the Veteran and relevant medical literature. The VA medical opinion also considers multiple sources of information and offers a thorough rationale.

The Board acknowledges that, while the Veteran may genuinely believe that his hypertension is related to service, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render an opinion as to etiology. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011).

Based on the foregoing, the Board finds that the evidence is persuasively against finding a nexus between the Veteran's in-service exposures and his hypertension. Accordingly, service connection for hypertension is not warranted.

In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence persuasively favors one side or the other, the doctrine is not for application. See Lynch, supra; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is DENIED.

2. Entitlement to service connection for nonalcoholic liver problems - mild hepatics steatosis is denied.

The Veteran contends that his nonalcoholic liver problems - mild hepatics steatosis condition is related to service. Specifically, he contends that the condition is secondary to exposure to lead based primer and paint in service. See September 2024 VA Form 21-526EZ; see also November 2024 lay statement.

Initially, the Board notes that in the February 2025 rating decision, the AOJ found that the Veteran has sufficient service to meet the minimum requirements for presumptive service connection, as his DD-214 shows that he served more than 90 days active service; that he has been diagnosed with a disability, as he has been diagnosed with non-alcoholic steatohepatitis (NASH) at his VA exam; and that participation in a toxic exposure risk activity is conceded, as the evidence shows he served as a culinary specialist and was exposed to lead pain and asbestos. The Board is bound by these favorable findings.

The Veteran was afforded a VA Hepatitis, Cirrhosis, and Other Liver Conditions examination in January 2025. Based on an in-person examination and review of the Veteran's VA e-folder, the VA examiner reported a diagnosis of non-alcoholic steatohepatitis (NASH). As a result of the examination, the VA examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. By way of rationale, the examiner explained that TERA Memo dated 12/17/2024 indicates the Veteran had exposure to asbestos and red lead primer; that the medical literature does not support mild hepatic steatosis has been caused by asbestos or red primer/paint exposure; and that hepatic steatosis, also known as fatty liver disease, occurs when excessive fat accumulates in the liver. The examiner explained that the main causes include obesity, insulin resistance, Type 2 diabetes, high cholesterol and triglycerides, certain medications, and genetic factors. In support of the opinion, the examiner cited to various medical literature. See February 2025 VA examination report.

The Board acknowledges that the Veteran submitted medical literature discussing an association of lead exposure and hepatic steatosis. However, the Board finds that there is not a competent positive nexus opinion to support the Veteran's claim. Hearing testimony and medical literature submitted after issuance of the rating decision on appeal is not a basis for remand, as this evidence was not available to the AOJ at the time of the rating decision on appeal.

The Board acknowledges that, while the Veteran may genuinely believe that his nonalcoholic liver problems - mild hepatics steatosis is related to service, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render an opinion as to etiology.
offers a thorough rationale.

Based on the foregoing, the Board finds that the evidence is persuasively against finding a nexus between the Veteran's in-service exposures and his nonalcoholic liver problems - mild hepatics steatosis. Accordingly, service connection for nonalcoholic liver problems - mild hepatics steatosis is not warranted.

3. Entitlement to service connection for an acquired mental health condition (claimed as anxiety and depression) is denied.

The Veteran contends that he has an acquired mental health condition that is related to service. Specifically, he contends that the condition is caused by trouble sleeping and hearing loss. See September 2024 VA Form 21-526EZ.

During his hearing, the Veteran testified that he has not seen a mental health profession with respect to his claimed anxiety. See January 2026 hearing transcript.

The Board observes that the Veteran's service treatment records contain no complaints of, or treatment for, any psychiatric condition during his time in service.

The Veteran has not submitted or identified any medical records which he has contended include a diagnosis of an acquired mental health condition. Upon a thorough review of the record, the Board has not located a diagnosis of any such condition.

While a VA medical opinion has not been obtained, the Board finds that one is not required before adjudication of this appeal. VA must provide a medical examination or obtain medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). Although McLendon sets a low bar, that bar has not been met here. Given that there is no probative evidence of a current diagnosis, the first prong of McLendon is not met.

The Board acknowledges that, while the Veteran may genuinely believe that he has an acquired mental health condition (claimed as anxiety and depression) related to service, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a diagnosis or an opinion as to etiology. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011).

For the reasons discussed above, the Board finds that the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for an acquired mental health condition (claimed as anxiety and depression). As such, the benefit-of-the-doubt rule does not apply in this regard, and the claim is hereby DENIED. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303; Lynch v. McDonough, 21 F. 4th
to render a diagnosis or an opinion as to etiology. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011).

REASONS FOR REMAND

Under the AMA, remands are limited to correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal and (2) AOJ errors in satisfying a regulatory or statutory duty if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a).

Although the Board sincerely regrets further delay, for the reasons discussed below, the Board finds that remand is required to correct a duty to assist error that occurred prior to the issuance of the rating decision on appeal. Specifically, remand is required in order to obtain an adequate VA examination with respect to the nature and etiology of the Veteran's OSA.

1. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

The Veteran contends that his OSA is related to service. Specifically, he contends that the condition is due to changes in time zones and duty roster. He further contends that he began to have problems sleeping while he was still on board the USS Cadmus and that his shipmates would tell him that he stopped breathing while sleeping. See September 2024 VA Form 21-526EZ; see also November 2024 lay statement; see also January 2026 hearing transcript.

In connection with the Veteran's claim, he was afforded a VA Sleep Conditions examination in January 2025. Based on an in-person examination and review of the Veteran's VA e-folder, the VA examiner reported a diagnosis of OSA. The examiner noted the Veteran's report of onset in the 1990s and that he started having symptoms decades ago and formally diagnosed in 2018.

While the VA examiner offered a negative TERA opinion, despite the Veteran's contentions that he began having symptoms during service, an opinion was not provided regarding direct service connection. This is inadequate.

Whenever VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

Based on the foregoing, the Board finds that the failure to obtain an adequate VA examination is a pre-decisional duty to assist error. Accordingly, remand is required to obtain an adequate VA examination.

The matter is REMANDED for the following action(s):

1. Forward the complete record to an appropriate clinician for an opinion addressing the nature and etiology of the Veteran's OSA. The record, to include a copy of this Remand, must be made available to the clinician. The need for examination of the Veteran is left to the discretion of the clinician selected to write the opinion. After reviewing the record, the clinician should provide an opinion as to the following:

a) Is it at least as likely as not that the Veteran's OSA had its onset in, or is otherwise related to, his military service?

In offering such opinion, the clinician should address the Veteran's lay statements pertaining to his symptoms during service.

A thorough rationale for any opinion offered should be provided.

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. Fulmer

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.

Analyze in VA Law Explorer