DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

THOMAS H. O'SHAY · 2026 · Case ID: A26040009

MIXED

Summary

The veteran, who served from August 2016 to August 2022, appeals the denial of service connection for lumbar spine degenerative disc disease, anxiety disorder, tension headaches, bilateral knee disabilities, bilateral hand disabilities, GERD, neck disability, and bilateral hearing loss. The Board denied higher ratings for the lumbar spine and anxiety disorder, finding the evidence did not approximate the criteria for higher evaluations. For tension headaches, the Board denied a compensable rating, noting the absence of prostrating attacks or severe economic inadaptability. Service connection for the knees, hands, GERD, and neck was denied due to lack of current diagnosis, in-service incurrence, or secondary connection, with the Board finding the lay evidence not probative for these conditions. Bilateral hearing loss was denied due to lack of current diagnosis per VA criteria and the Board's reliance on competent VA audiological examinations. The Board granted an earlier effective date of December 14, 2022, for service connection for obstructive sleep apnea, recognizing the Veteran's intent to file and credible report of symptoms beginning in 2022, resolving reasonable doubt in the Veteran's favor.

Rationale

Evidence did not approximate criteria for higher rating; VA exams showed normal range of motion and no neurological abnormalities; No intervertebral disc syndrome diagnosis

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250429-539012

Full Decision Text

Citation Nr: A26040009
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250429-539012
DATE: April 29, 2026

ORDER

Entitlement to an initial rating higher than 10 percent for lumbar spine degenerative disc disease is denied.

Entitlement to an initial 50 percent rating for unspecified anxiety disorder with alcohol use disorder and cannabis use disorder (hereinafter anxiety disorder) is denied.

Entitlement to an initial compensable rating for tension headaches is denied.

Entitlement to service connection for a right knee disability, to include as secondary to a service-connected disability, is denied.

Entitlement to service connection for a left knee disability, to include as secondary to a service-connected disability, is denied.

Entitlement to service connection for a right hand disability (claimed as right hand arthritis) is denied.

Entitlement to service connection for a left hand disability (claimed as left hand arthritis) is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to a service-connected disability, is denied.

Entitlement to service connection for a neck disability, to include as secondary to a service-connected disability, is denied.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to an effective date of December 14, 2022, for service connection for obstructive sleep apnea is granted.

FINDINGS OF FACT

1. The service-connected lumbar spine degenerative disc disease at most was manifested by 80 degrees of flexion with flare-ups without guarding or muscle spasm.

2. Throughout the appeal period, the Veteran's anxiety disorder is not shown to have been manifested by a disability picture that more nearly approximates that of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

3. The Veteran's tension headaches are not manifested by characteristic prostrating attacks averaging one in two months over the last several months.

4. A disability manifested by pain in the right knee did not manifest during service, is not etiologically related to service, and is not secondary to a service-connected disability.

5. A disability manifested by pain in the left knee did not manifest during service, is not etiologically related to service, and is not secondary to a service-connected disability.

6. A disability manifested by pain in the right hand did not manifest during service and is not etiologically related to service.

7. A disability manifested by pain in the left hand did not manifest during service and is not etiologically related to service.

8. The Veteran does not have GERD or any symptoms associated with GERD.

9. A disability manifested by neck pain did not manifest during service and is not etiologically related to service.

10. The evidence is persuasively against a finding that the Veteran has, or has had at any time during the appeal, bilateral hearing loss for VA purposes.

11. On December 14, 2022, the Veteran's intent to file a claim was received for entitlement to service connective for obstructive sleep apnea, and in July 2023 the Veteran's claim for obstructive sleep apnea was received.

CONCLUSIONS OF LAW

1. The criteria for an initial rating higher than 10 percent for the lumbar spine degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5017(b); 38 C.F.R. §§ 3.159, 4.7, 4.71a, Diagnostic Code 5242.

2. The criteria for an initial rating higher than 50 percent for anxiety disorder have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 4.130, Diagnostic Code 9413.

3. The criteria for an initial compensable rating for tension headaches have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. 4.3, 4.124a Diagnostic Code 8100.

4. The criteria for service connection for a right knee disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for service connection for a left knee disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.
5, 5107(b); 38 C.F.R. 4.3, 4.124a Diagnostic Code 8100.

6. The criteria for service connection for a right hand disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a left hand disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

8. The criteria for service connection for GERD, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

9. The criteria for service connection for a neck disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

10. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a).

11. The criteria for entitlement to an effective date of December 14, 2022, for the award of service connection for obstructive sleep apnea have been met. 38U.S.C. §5110; 38C.F.R. §§3.156, 3.400.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from August 2016 to August 2022.

A Higher-Level Review rating decision was issued in December 2024 addressing all issues on appeal with the exception of the effective date for the grant of service connection for obstructive sleep apnea, which arose from a March 2025 rating decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. The Veteran timely appealed the decisions to the Board in April 2025 and requested the Board's direct review lane under the AMA review system. In August 2024, the Veteran filed a Higher-Level Review claim regarding the underlying rating decision dated in October 2023 with a notice letter dated in November 2023. The evidentiary record in a Higher-Level Review rating decision is limited to the evidence considered in the prior Agency of Original Jurisdiction (AOJ) decision under review; the Higher-Level adjudicator may not consider additional evidence. 38 C.F.R. § 3.2601(f). Thus, in reviewing a Higher-Level Review decision, the Board may consider the evidence of record at the time of the underlying rating decision for which the Veteran requested Higher-Level review (as that is the evidence that the AOJ was permitted to consider in the Higher-Level Review decision on appeal), as well as any evidence submitted by the Veteran during an evidentiary window. In this case, as the December 2024 rating decision on appeal constitutes a Higher-Level Review rating decision, the Board's current review is limited to the evidence of record at the time of the AOJ's October 2023 rating decision regarding the issues on appeal with the exception of an earlier effective date for the grant of service connection for obstructive sleep apnea. As for the effective date of sleep apnea, the Veteran requested direct review of the evidence considered by the AOJ in the March 2025 rating decision. If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.

To the extent that the Veteran in the
constitutes a Higher-Level Review rating decision, the Board's current review is limited to the evidence of record at the time of the AOJ's October 2023 rating decision regarding the issues on appeal with the exception of an earlier effective date for the grant of service connection for obstructive sleep apnea. As for the effective date of sleep apnea, the Veteran requested direct review of the evidence considered by the AOJ in the March 2025 rating decision. If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.

To the extent that the Veteran in the notice of disagreement indicated that he was appealing the evaluations and effective dates for his tension headaches, anxiety disorder, and low back disorder, the effective dates are part and parcel of his claims for the higher ratings currently on appeal.

In the December 2024 rating decision the AOJ made the following favorable findings: the Veteran had toxic exposure risk activities (TERA) during service based on his duties as a refuel/bomber aircraft maintenance journeyman, his service-connected disabilities in part include a bilateral shoulder disability, he complained of neck stiffness in April 2022 during service, he had acoustic trauma during service, and he was treated for bilateral hand pain in March 2022 during service. The AOJ also determined that new and relevant evidence was received and the service connection claims for bilateral hearing loss, right hand disability, and left hand disability, were being reconsidered. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

Higher Ratings

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In addition, separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," regardless whether it is an initial rating case or not. Hart v. Mansfield, 21 Vet. App. 505 (2007).

Rating factors for a disability of the musculoskeletal system include functional loss due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion, weakness, excess fatigability, incoordination, pain on movement, swelling, or atrophy. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995).

In evaluating musculoskeletal disabilities, the VA must determine whether pain could significantly limit functional ability during flare-ups, or when the joints are used repeatedly over a period of time. See DeLuca 8 Vet. App. at 206.

Issue 1: Entitlement to an initial rating higher than 10 percent for lumbar spine degenerative disease.

The Veteran's service-connected lumbar spine disability during the appeal period has been rated under Diagnostic Code 5242, for degenerative arthritis and degenerative disc disease other than intervertebral disc syndrome, which is part of the General Rating Formula for Diseases or Injuries of the Spine, Diagnostic Codes 5235 to 5243. The code for intervertebral disc syndrome, Diagnostic Code 5243, applies when there is disc herniation with compression and/or irritation adjacent to the nerve root, otherwise a rating is to be assigned under Diagnostic Code 5242 for all other disc diagnoses. Diagnostic Code 5243 permits rating under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher rating when all disabilities are combined. 38 C.F.R. § 4.71a.

Under the General Rating Formula for Diseases or
for Diseases or Injuries of the Spine, Diagnostic Codes 5235 to 5243. The code for intervertebral disc syndrome, Diagnostic Code 5243, applies when there is disc herniation with compression and/or irritation adjacent to the nerve root, otherwise a rating is to be assigned under Diagnostic Code 5242 for all other disc diagnoses. Diagnostic Code 5243 permits rating under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher rating when all disabilities are combined. 38 C.F.R. § 4.71a.

Under the General Rating Formula for Diseases or Injuries of the Spine (General Formula), a 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating, and unfavorable ankylosis of the entire spine warrants a 100 percent rating. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243.

When rated based on incapacitating episodes, a 20 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent rating is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months.

An "incapacitating episode" is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243. 38 C.F.R. § 4.71a , Diagnostic Code 5235-5243.

The normal findings for range of motion of the lumbar spine are from 0 to 90 degrees for forward flexion; 0 to 30 degrees for extension, lateral flexion, and rotation. 38 C.F.R. § 4.71a, Plate V.

Note (5) of the General Formula defines unfavorable ankylosis as a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in the neutral position (zero degrees) always represents favorable ankylosis.

Pursuant to Note (1) of the General Formula, associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are separately evaluated under an appropriate diagnostic code.

By way of history, the AOJ in a December 2022 rating decision granted service connection for the low back disability and assigned a zero present rating. In July 2023 the Veteran filed a supplemental claim, and in the October 2023 rating decision the AOJ granted a 10 percent rating for the low back disability effective July 10, 2023. In August 2024 the Veteran filed a Higher-Level Review Request and, in the December 2024, Higher-Level Review rating decision the AOJ granted an effective date of August 2, 2022, which is the day after the Veteran was separated from service, for the 10 percent rating for the low back disability. Thus, the Veteran has continuously pursed his claim for a higher rating for the low back disability since August 2, 2022.

The evidence does not more nearly approximate the criteria for a higher initial rating greater than 10 percent
, and in the October 2023 rating decision the AOJ granted a 10 percent rating for the low back disability effective July 10, 2023. In August 2024 the Veteran filed a Higher-Level Review Request and, in the December 2024, Higher-Level Review rating decision the AOJ granted an effective date of August 2, 2022, which is the day after the Veteran was separated from service, for the 10 percent rating for the low back disability. Thus, the Veteran has continuously pursed his claim for a higher rating for the low back disability since August 2, 2022.

The evidence does not more nearly approximate the criteria for a higher initial rating greater than 10 percent as the findings do not more nearly approximate or equate to forward flexion to be greater than 30 degrees but not greater than 60 degrees, to include consideration of any additional functional loss due to pain, pain on movement, swelling, atrophy, fatigue, weakness, incoordination, to include during flare-ups and with repeated use as set forth in 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca v. Brown, 8 Vet. App. 202 (1995). The findings do not approximate the combined range of motion of the thoracolumbar spine to be not greater than 120 degrees, nor do the findings approximate muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The findings also do not approximate or equate to ankylosis of the entire thoracolumbar spine, nor do the findings show objective neurologic abnormalities to include bowel or bladder impairment.

On VA back examination in November 2022, the examiner determined that the Veteran had 90 degrees of flexion; extension, right lateral flexion, left lateral flexion, right lateral rotation and left lateral rotation were all 30 degrees. Passive range of motion testing was medically contraindicated. There was no evidence of pain upon range of motion testing. There was no additional loss of function after three repetitions, estimated range of motion after repeated use and with flare-ups remained the same. There was no guarding or muscle spasm. Reflex exam and sensory exams were normal. There was no ankylosis. The Veteran did not have any other neurologic abnormalities to include bowel or bladder impairment. The examiner opined that the Veteran did not have intervertebral disc syndrome.

On VA back examination in September 2023, forward flexion was 90 degrees, extension was 30 degrees, right and left lateral flexion were each 15 degrees, and right and left lateral rotation were each 30 degrees. Passive range of motion testing was medically contraindicated. There was no evidence of pain upon range of motion testing. There was no additional loss of function after three repetitions. Estimated range of motion with flare-ups was 80 degrees flexion, 25 degrees of extension, 15 degrees each of right and left lateral flexion, and 30 degrees each of right and left lateral rotation. There were no muscle spasms and no guarding. Reflex exam and sensory exams were normal. There was no ankylosis. The Veteran did not have any other neurologic abnormalities to include bowel or bladder impairment. The examiner opined that the Veteran did not have intervertebral disc syndrome.

As the findings show that the Veteran did not have intervertebral disc syndrome the evidence does not approximate a higher rating under Diagnostic Code 5243 for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

The above findings are uncontroverted by the other competent evidence of record. To the extent that the Veteran may believe that he is entitled to a higher rating, the Board finds the objective medical findings by skilled professionals are more persuasive which, as indicated above, do not support a rating higher than 10 percent for the low back disability.

Accordingly, the Board finds that an initial rating higher than 10 percent for lumbar spine degenerative disc disease is not warranted. Thus, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b).

Issue 2. Entitlement to an initial rating higher than 50 percent for anxiety disorder.

The Veteran's service-connected anxiety disorder is evaluated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130, Diagnostic Code 9413. Under these criteria, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to particular symptoms such as: flattened affect; circumstantial, circumlocutory
the Board finds that an initial rating higher than 10 percent for lumbar spine degenerative disc disease is not warranted. Thus, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b).

Issue 2. Entitlement to an initial rating higher than 50 percent for anxiety disorder.

The Veteran's service-connected anxiety disorder is evaluated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130, Diagnostic Code 9413. Under these criteria, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to particular symptoms such as: flattened affect; circumstantial, circumlocutory or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id.

A 70 percent rating is warranted where there is 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.

A 100 percent rating is warranted where there is 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 personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.

In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length 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 the 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. 38 C.F.R. § 4.126(b).

The Board notes, with regard to the use of the phrase "such as" in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), that 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). The United States Court of Appeals for the Federal Circuit emphasized that the list of symptoms under a given rating is a nonexhaustive list, as indicated by the words "such as" that precede each list of symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). It held that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration. Other language in the decision indicates that the phrase "others of similar severity, frequency, and duration," can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating.

The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. VA must consider all symptoms of a claimant's condition affecting the level of occupational and social impairment, including, if applicable, those identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shin
of similar severity, frequency, and duration," can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating.

The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. VA must consider all symptoms of a claimant's condition affecting the level of occupational and social impairment, including, if applicable, those identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). It is the impact of the symptoms on occupational and social functioning that determines the rating.

By way of history, in the December 2022 rating decision the AOJ granted service connection for the Veteran's anxiety disorder and assigned a 30 percent rating. In July 2023 the Veteran filed a supplemental claim. In a rating decision in October 2023 the AOJ granted a 50 percent rating for anxiety disorder effective July 10, 2023. In August 2024 the Veteran's Higher-Level Review Request was received. In the December 2024 rating decision, the AOJ granted an effective date of August 2, 2022, for the 50 percent rating for anxiety disorder. Thus, the Veteran has continuously pursed his claim for a higher rating for anxiety disorder since August 2, 2022.

On VA examination for mental disorders in October 2022, the examiner opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran reported having good relationships with family members and had close friends and casual acquaintances. He worked full time as a millwright. His symptoms included anxiety, chronic sleep impairment, and disturbances of motivation and mood. The Veteran was appropriately groomed and dressed, his thought process was logical and goal directed. His speech was normal. The Veteran reported waking up at night and denied suicidal or homicidal ideation. He was oriented to person, place, and time.

On VA examination for mental disorders in September 2023, the examiner opined that the Veteran had occupational and social impairment with reduced reliability and productivity. The examiner noted that the Veteran occasionally socialized with friends. In December 2022 he left his millwright position and in January 2023 he began working as a mechanic ranch hand. On examination his symptoms included depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood. The examiner noted that the Veteran was appropriately groomed and his thought process was logical and goal directed. His speech pattern was normal. The examiner noted that the Veteran continued to experience daily anxiety, was easily overwhelmed, and continued to endorse decreased motivation, and concentration problems. He denied a history of suicidal and homicidal ideation.

The medical and lay evidence of record presented above shows that the Veteran's anxiety disorder does not more nearly approximately most of the symptoms listed in the 70 percent criteria that would overall cause occupational and social impairment with deficiencies in most areas due to symptoms such 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; spatial disorientation; neglect of personal appearance and hygiene; or inability to establish and maintain effective relationships.

Crucially, the presence of certain symptoms is not necessarily determinative. These symptoms must also cause the occupational and social impairment in the referenced areas. See Vazquez-Claudio, supra. While the Board recognizes that the symptoms that the Veteran does have caused some deficiencies in work and social relationships, during the appeal period he has been working as a millwright and afterwards as a mechanic ranch hand. He has had good relationships with family members and friends.

A higher schedular rating of 100 percent also is not warranted as that rating requires evidence of total occupational and social impairment. Neither the lay nor medical evidence of record discussed above shows that the Veteran has 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 personal hygiene; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The Veteran's
has been working as a millwright and afterwards as a mechanic ranch hand. He has had good relationships with family members and friends.

A higher schedular rating of 100 percent also is not warranted as that rating requires evidence of total occupational and social impairment. Neither the lay nor medical evidence of record discussed above shows that the Veteran has 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 personal hygiene; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The Veteran's ability to work negates the finding of total occupational and social impairment.

Accordingly, the Board finds that an initial rating higher than 50 percent for anxiety disorder is not warranted. Thus, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b)

Issue 3: Entitlement to an initial compensable rating for tension headaches.

The Veteran's service-connected tension headaches have been evaluated under the criteria of 38 C.F.R. § 4.124a, Diagnostic Code 8100 for migraine headaches. Under Diagnostic Code 8100, a noncompensable rating is warranted for less frequent migraine attacks. A 10 percent rating is warranted for characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for characteristic prostrating attacks occurring on an average once a month over the last several months. Finally, a maximum 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.

In determining whether the Veteran experiences the type and frequency of prostrating attacks of migraine headaches necessary for a higher rating under Diagnostic Code 8100, the Board observes that the rating criteria do not define "prostrating." However, the Court, in Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018), proffered the definition found in Webster's Third New International Dictionary of The English Language Unabridged (1966) that "[p]rostrating" means "lacking in vitality or will: powerless to rise: laid low." The Court concluded that because Diagnostic Code 8100 specifically governs migraine headaches, the phrase "characteristic prostrating attacks" plainly describes migraine attacks that typically produce powerlessness or a lack of vitality. Id.

The terms "productive of severe economic adaptability" have not been clearly defined by regulations or case law. The Court has noted that "productive of" can either have the meaning of "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Migraines need not actually "produce" severe economic inadaptability to warrant the 50 percent rating. Id. at 445-46. Economic inadaptability does not mean unemployability, as such would undermine the purpose of regulations pertaining to a total disability rating based on individual unemployability. Id. at 446; 38 C.F.R. § 4.16. At a minimum, however, migraines must be capable of producing "severe" economic inadaptability.

The rating criteria under Diagnostic Code 8100 are successive, meaning that to satisfy the criteria for a higher level, a claimant must satisfy all the requirements of the lower levels, and 38 C.F.R. §§ 4.7 and 4.21 do not apply to circumvent these requirements. Johnson, supra.

By way of history, in the December 2023 rating decision the AOJ granted service connection for tension headaches effective August 2, 2022, and assigned a zero percent rating. In July 2023 the Veteran filed a supplemental claim. In a rating decision in October 2023 the AOJ continued to deny an initial compensable rating for headaches. In August 2024 the Veteran's Higher-Level Review Request was received. In the December 2024 rating decision, the AOJ continued to deny a compensable rating for the tension headaches. Thus, the Veteran has continuously pursed his claim
4.7 and 4.21 do not apply to circumvent these requirements. Johnson, supra.

By way of history, in the December 2023 rating decision the AOJ granted service connection for tension headaches effective August 2, 2022, and assigned a zero percent rating. In July 2023 the Veteran filed a supplemental claim. In a rating decision in October 2023 the AOJ continued to deny an initial compensable rating for headaches. In August 2024 the Veteran's Higher-Level Review Request was received. In the December 2024 rating decision, the AOJ continued to deny a compensable rating for the tension headaches. Thus, the Veteran has continuously pursed his claim for an initial compensable rating for tension headaches since August 2, 2022.

Upon review of the totality of the record, the Board finds that an initial compensable rating is not warranted for the Veteran's tension headaches during the appeal period.

On VA headaches examination in November 2022, the examiner noted that the Veteran was not taking medication for his headaches, he was not experiencing headache pain and instead had symptoms of nausea. He did not have characteristic prostrating attacks of migraine/non-migraine headache pain. He did not have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability.

On VA headaches examination in September 2023, the examiner indicated that the Veteran was not taking medication for his headaches. He had pain on both sides of the head, with typical duration of less than one day. The examiner determined that the Veteran did not experience non-headache symptoms associated with the headaches. The Veteran did not have characteristic prostrating attacks of migraine/non-migraine headache pain. He did not have completely prostrating and prolonged attacks of migraine/non-migraine pain.

The above findings are not controverted by the other competent evidence of record. The Board acknowledges that the Veteran has had headaches, and in the August 2024 Higher-Level Review Request contended that private medical records in June 2023 show frequent headaches. However, the rating criteria for Diagnostic Code 8100 link the ratings for headaches to two elements: severity and frequency. It is not sufficient to demonstrate the existence of a particular frequency of headaches; the headaches must be of a specific prostrating character. As discussed above, the competent evidence of record does not show that the Veteran had headaches of prostrating character.

As the rating criteria under Diagnostic Code 8100 are successive, given that the Veteran does not meet the criteria for a 10 percent rating it follows that he does not meet the criteria for higher ratings of 30 percent and 50 percent under Diagnostic Code 8100. See Johnson 30 Vet. App. 245.

Accordingly, the Board finds that an initial compensable rating for tension headaches is not warranted. Thus, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b)

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d).

For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for diseases such as arthritis, sensorineural hearing loss, and other organic diseases of the nervous system, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

Service connection may also be granted on a secondary basis for a disability which was caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310.

To grant service connection under any theory of entitlement, there must be a current disability. Degmetich v. Brown, 104 F.3d 1328, 1332 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Absent a diagnosis, a symptom significant enough to result in functional impairment in earning capacity qualifies as a disability. Saunders v. Wilkie, 886 F.3d 1356, 1367-1368 (Fed. Cir. 2018) (concerning the symptom of pain). A disability is current if present near or at the time a claim is filed or at any time during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Issues 4-9: Entitlement to service connection for: a right knee disability, left knee disability, right hand disability, left hand disability, GERD, and neck disability.

In the claim received in August 2022, the Veteran contended that he had arthritis in his hands due to being a mechanic in service. In August 2024 the Veteran's Higher-Level Review Request was received whereby through his attorney he contended that his neck disability was secondary to his service-connected bilateral shoulder disability, GERD was secondary to his service-connected psychiatric and orthopedic disorders, and his bilateral knee disability was secondary to his service-connected back disability.

Service treatment records show that in March 2022 the Veteran was treated for bilateral hand pain. He reported having pain, numbness, and tingling for over a year. Physical evaluation shows the hands were normal. In April 2022 the Veteran was treated for neck stiffness. The assessment was segmental and somatic dysfunction of the cervical region. Service treatment records in February 2022 also show neck stiffness. Other service treatment records including in May 2022 show segmental and somatic dysfunction of the cervical region. Service treatment records do not show complaints, findings or treatment for the knees and GERD.

The Veteran's DD 214 Form shows his military occupational specialty was refuel/bomber aircraft maintenance journeyman.

In an October 2023 Memorandum it was determined that the Veteran had toxic exposure risk activities (TERA) during service based on his military occupational specialty as a refuel/bomber aircraft maintenance journeyman. It was noted that the Veteran had Persian Gulf War service, however his TERA activities were attributed to his military occupational specialty.

A VA general medical examination in November 2022, shows normal physical evaluations for the knees, hands, neck, and GERD.

On VA knee examination in August 2023, the examiner opined that the Veteran did not have a diagnosis of a right knee disability and a left knee disability. The examiner acknowledged the Veteran's complaints of knee pain. For the claimed right knee disability and left knee disability the examiner opined that there were no diagnoses and the examiner explained that the history suggested a mild soft tissue disorder but did not strongly suggest a chronic disability. Thus, the overall context of the opinion shows that the Veteran did not have a chronic bilateral knee disability. See Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record).

On VA hand and fingers examination in November 2022, the examiner noted that hand x-rays in service in March 2022 were benign. The Veteran reported having pain, numbness, and tingling. The examiner opined that the Veteran did not have a current diagnosis associated with his claimed bilateral hand disability. The Veteran reported that stiffness in his hand started around 2021 when it was cold. The examiner opined that no diagnosis could be rendered as there was no chronic disorder. He stated that the decreased flexibility during cold exposure was physiologic. There was no indication of arthritis or Raynaud's.

On VA esophageal examination in August 2023, the examiner opined that the Veteran does not now and has never been diagnosed with an esophageal disorder to include GERD. The examiner noted that the Veteran reported that symptoms started in 2018, but he did not know the symptoms, and they can occur randomly without eating. The examiner
a current diagnosis associated with his claimed bilateral hand disability. The Veteran reported that stiffness in his hand started around 2021 when it was cold. The examiner opined that no diagnosis could be rendered as there was no chronic disorder. He stated that the decreased flexibility during cold exposure was physiologic. There was no indication of arthritis or Raynaud's.

On VA esophageal examination in August 2023, the examiner opined that the Veteran does not now and has never been diagnosed with an esophageal disorder to include GERD. The examiner noted that the Veteran reported that symptoms started in 2018, but he did not know the symptoms, and they can occur randomly without eating. The examiner opined that the Veteran did not have any symptoms associated with an esophageal disorder to include GERD. The examiner concluded that the evidence did not support a chronic disorder consistent with GERD. Previous medical evaluations deny a history of symptoms. The examiner opined that the history was inconsistent with a diagnosis of GERD and suggested symptom amplification. Thus, the history was not reliable for a diagnosis.

On VA neck examination in August 2023, it was noted that service treatment records in February 2022 show segmental and somatic dysfunction of the cervical region. There also were some notes from a chiropractic clinic including in April 2023 for segmental and somatic dysfunction of the cervical region but that also included the thoracic and lumbar spine. The examiner noted that in May 2022 the service treatment records show dorsalgia, chiropractic segmental and somatic dysfunction of the cervical region. Review of symptoms was negative for musculoskeletal symptoms. The examiner opined that the Veteran did not have a current diagnosis associated with the neck or cervical spine disability. The examiner concluded that there was no diagnosis for the claimed neck disability, because the history suggested a mild muscle strain, which was not a chronic disability. The examiner reiterated that the records do not support a chronic disability and there seemed to be some symptom amplification and self-limitation noted on exam. Thus, no diagnosis was rendered.

The Board finds the above VA examinations and opinions to be probative as they were based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). They are uncontroverted by the other competent evidence of record.

As a lay person, the Veteran is competent to report symptoms pertaining to a disorder, which is within the realm of one's personal knowledge and personal knowledge which comes through the use of senses. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the diagnosis and etiology of the claimed bilateral knee disability, bilateral hand disability, neck disability, and GERD, fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Moreover, these are not the type of disorders that are readily amenable to mere lay diagnoses or probative comment regarding their etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorders. Thus, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent it need not be further addressed.

The Board acknowledges that VA etiological opinions have not been obtained to determine the nature and etiology of the claimed bilateral knee disability, bilateral hand disability, GERD, and neck disability. However, VA examinations were obtained as discussed above, and it was determined that diagnoses could not be rendered for the bilateral knee disability, bilateral hand disability, GERD, and neck disability and there were no chronic disabilities. The probative evidence does not establish an in-service incurrence of the claimed disorders and continuous symptoms since service. Therefore, it is insufficient to trigger VA's duty to assist by providing a medical opinion regarding service connection. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d
to determine the nature and etiology of the claimed bilateral knee disability, bilateral hand disability, GERD, and neck disability. However, VA examinations were obtained as discussed above, and it was determined that diagnoses could not be rendered for the bilateral knee disability, bilateral hand disability, GERD, and neck disability and there were no chronic disabilities. The probative evidence does not establish an in-service incurrence of the claimed disorders and continuous symptoms since service. Therefore, it is insufficient to trigger VA's duty to assist by providing a medical opinion regarding service connection. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010).

On August 10, 2022, the President signed into law The Sergeant First Class Health Robinson Honoring our Promise to Address Comprehensive Toxics Act (PACT Act). Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in toxic exposure risk activities (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38U.S.C. §1168. Here, as indicated above, the Veteran participated in TERA during service. As discussed above, the Veteran contends that his bilateral knee disability, bilateral hand disability, and neck disability on either a direct or secondary basis were due to physical trauma, thus subsection (a) of 38 U.S.C. § 1168 does not apply. See VBA Letter 20-24-06, Exception to TERA Examination and Medical Opinion Requirement at pages 12-14 (June 12, 2024). As the probative evidence shows that the Veteran does not have a diagnosis of GERD, a TERA opinion addressing GERD also is not warranted. Furthermore, the presumptions referable to Persian Gulf veterans pursuant to 38 C.F.R. § 3.317 are inapplicable as the record does not show a qualifying chronic disability, nor does the Veteran contend he has such disability or disabilities.

Thus, for the above reasons the evidence is persuasively against the claims of service connection for a bilateral hand disability on a direct basis; and service connection for a bilateral knee disability, neck disability, and GERD, on a direct and secondary basis, the benefit-of-the-doubt doctrine is not for application, and service connection for a right knee disability, left knee disability, right hand disability, left hand disability, neck disability, and GERD must be denied 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Issue 10: Entitlement to service connection for bilateral hearing loss.

Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; where the auditory thresholds for at least three of these frequencies are 26 decibels or greater or when the Maryland CNC speech recognition scores are less than 94 percent. 38 C.F.R. § 3.385. The threshold for normal hearing is from 0 to 20 decibels, with higher threshold levels indicating some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993).

In the claim received in August 2022, the Veteran contended that his bilateral hearing loss was due to acoustic trauma during service.

On VA audiological examination in November 2022, puretone thresholds for the right ear, in decibels, at 500, 1000, 2000, 3000, and 4000 Hertz were as follows: 5, 10, 5, 5, and 10; and puretone thresholds for the left ear, in decibels, at 500, 1000, 2000, 3000, and 4000 Hertz were as follows: 15, 10, 10, 10, and 10. The speech recognition score, using the Maryland CNC Test, was 100 percent in the right ear and 100 percent in the left ear.

On VA audiological examination for tinnitus in August 2023, an associated audiogram continues to show that the Veteran did not meet the criteria for hearing loss pursuant to 38 C.F.R. § 3.385 as when considering 500 to 4000 Hertz he at most had 15 decibels in the
tone thresholds for the left ear, in decibels, at 500, 1000, 2000, 3000, and 4000 Hertz were as follows: 15, 10, 10, 10, and 10. The speech recognition score, using the Maryland CNC Test, was 100 percent in the right ear and 100 percent in the left ear.

The above findings are uncontroverted by the other competent evidence of record.

The Board concludes that the Veteran does not have a current diagnosis of bilateral hearing loss per VA regulatory criteria and has not had one at any time during the pendency of the claim. 38 C.F.R. § 3.303 (a),(d). In the absence of proof of a present disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223 (1992).

While the Veteran believes that he has a diagnosis of bilateral hearing loss, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it is based on audiometric findings and requires specialized medical education/knowledge to interpret diagnostic testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent evidence.

Thus, for the above reasons the evidence is persuasively against the claim of entitlement to service connection for bilateral hearing loss, the benefit-of-the-doubt doctrine is not for application, and the claim of service connection for hearing loss must be denied. 38 U.S.C. § 5107(b).

Issue 11: Entitlement to an effective date earlier than December 4, 2023, for the grant of service connection for obstructive sleep apnea.

Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA's adjudication regulations be filed on a standard form. The amendments also, inter alia, eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155. The amended regulations apply only to claims filed on or after March 24, 2015.

Under 38 U.S.C. § 5110 (b)(1) and 38 C.F.R. § 3.400 (b)(2)(i), the effective date for a grant of direct service connection will be the day following separation from active service, if a claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of claim or date entitlement arose, whichever is later.

The regulation also allows a claimant to submit an intent to file a claim, and VA may recognize the receipt date of the intent to file a claim as the date of claim so long as VA receives the successfully completed claim form within a year. 38 C.F.R. § 3.155(b). There are three ways in which a claimant may submit an intent to file a claim: (i) saved electronic application when an application otherwise meeting the requirements of paragraph (b) is electronically initiated and saved in a claims submission tool with a VA web-based electronic claims application system, (ii) written intent, signed and dated on the intent to file a claim form prescribed by the Secretary, and (iii) oral intent communicated to designated VA personnel, recorded in writing, and documented in the claimant's records. Id.

In the March 2025 rating decision, the AOJ granted service connection for obstructive sleep apnea and assigned a 50 percent rating effective December 4, 2023, which is the date of the sleep study which diagnosed obstructive sleep apnea.

In a May 2025 statement, the Veteran's attorney contended that the Veteran was entitled to an effective date no later than December 14, 2022, which is the date VA received the Veteran's intent to file a claim. A review of the claims file shows that on December 14, 2022, the Veteran's intent to file a claim was received, which was followed by his formal claim on VA Form 21-526EZ for sleep apnea in July 2023. While the sleep study showing a diagnosis of sleep apnea is dated December 4, 2023, on VA examination for sleep apnea in December 2024, the Veteran reported that symptoms pertaining to sleep apnea began approximately in 2022 when he started having issues with waking up frequently through the night and waking startled and gasping for air. He would occasionally snore and felt excessively tired during the day. As a lay person, the Veteran is competent to report symptoms pertaining to a disorder, which are within the realm of one's personal knowledge and personal knowledge which comes through the use of senses. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board has no reason to doubt the credibility of the Veteran's report to the December 2024 VA examiner.

In an accompanying opinion to the December 2024 VA examination, the examiner explained that obstructive sleep apnea is due to airway obstruction during relaxation of muscles in the airway in the REM cycle of sleep. It responds to positive airway pressure from CPAP which opens the airway. The private sleep study dated December 4, 2023, noted the snoring count was 63 and snoring index was 15.3. Thus, symptoms pertaining to obstructive sleep apnea, which the Veteran reported beginning in 2022 on the December 2024 VA examination are consistent with symptoms associated with a diagnosis of obstructive sleep apnea discussed above.

Thus, resolving reasonable doubt in the Veteran's favor the Board finds that in 2022 entitlement arose for service connection for obstructive sleep apnea and the Veteran is entitled to an effective date of December 14, 2022, for the grant of service connection for obstructive sleep apnea as that is the date his intent to file a claim was received.

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mac, M.

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

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