HYPERTENSION

B. D. WATSON · 2026 · Case ID: A26040557

MIXED

Summary

The veteran, who served from December 1969 to September 1973 as an Inhalation Therapist/Respiratory Care Technician, appeals the denial of service connection for hypertension, toenail fungus, and bronchitis with pneumonia. The Board found no competent evidence of a current disability for any of these claims. For hypertension, service treatment records did not indicate any issues with elevated blood pressure, and while a private PA-C noted hypertension in the veteran's diagnoses, she did not specify if it was a current diagnosis or provide a nexus to service. For toenail fungus, service records were negative, and the private PA-C's letter noted the veteran's self-report but did not provide a diagnosis or nexus. For bronchitis with pneumonia, service records showed symptoms of upper respiratory infection but no diagnosis, and the private PA-C's letter was deemed conclusory regarding exposure and diagnosis. The Board determined that the duty to provide a VA examination was not triggered for these claims due to the lack of competent evidence of a current disability. The case is remanded for service connection for bilateral hearing loss, as the VA examiner's opinion regarding noise exposure and the progression of hearing loss was found inadequate. The examiner did not adequately reconcile the audiometer readings from enlistment to separation or address the veteran's contentions regarding in-service noise exposure.

Rationale

No competent evidence of current disability; PA-C's opinion lacked nexus and specificity regarding diagnosis timing; No VA examination triggered due to lack of competent evidence

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250918-588734

Full Decision Text

Citation Nr: A26040557
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250918-588734
DATE: April 30, 2026

ORDER

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for toenail fungus is denied.

Entitlement to service connection for bronchitis with pneumonia is denied.

REMANDED

Entitlement to service connection for bilateral hearing loss is remanded.

FINDING OF FACT

The weight of the evidence is against finding that the Veteran has had a diagnosis of hypertension, toenail fungus, or bronchitis with pneumonia at any time during the pendency of the appeal.

CONCLUSIONS OF LAW

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

2. The criteria for entitlement to service connection for toenail fungus 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 bronchitis with pneumonia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran served on active duty from December 1969 to September 1973.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2025 rating decision by a regional office of the Department of Veterans Affairs (VA). In September 2025, the Veteran filed a timely notice of disagreement to that decision, and elected the Hearing Review docket in the modernized review system, also known as the Appeals Modernization Act (AMA). The Veteran and his brother testified at a Board hearing in January 2026; a transcript of that hearing is of record.

Based on the Veteran's election, the Board may only consider the evidence of record at the time of the July 2025 decision on appeal, as well as any evidence submitted by the Veteran at the hearing, or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Thus, any evidence submitted either (1) during the period after the agency of original jurisdiction (AOJ) issued the July 2025 decision, and prior to the January 2026 hearing, or (2) more than 90 days after 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 the VA to consider any evidence that was added to the claims file 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, the 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 Veteran's claim for service connection for bilateral hearing loss, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. Brammer v. Derwinski, 3 Vet. App. 223, 225 (
evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time he files a claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

With chronic disease shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). To show a chronic disease in service, a combination of manifestations sufficient to identify the disease entity is required, as is sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). However, 38 C.F.R. § 3.303(b), applies to only those chronic diseases listed in 38 C.F.R. § 3.309(a) (e.g., cardiovascular-renal diseases including hypertension). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 U.S.C. § 1101.

Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities (e.g., hypertension) are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time.

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and it must provide reasons for rejecting any evidence favorable to the Veteran. See Masors v. Derwinski, 2 Vet. App. 181 (1992). The Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994).

Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Layno, 6 Vet. App. at 469; see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived or experienced, were directly through the senses. 38 C.F.R. § 3.159 (competent lay evidence
a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Layno, 6 Vet. App. at 469; see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived or experienced, were directly through the senses. 38 C.F.R. § 3.159 (competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience; lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.); Layno, 6 Vet. App. at 469-71 (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge; personal knowledge is that which comes to the witness through the use of the senses; lay testimony is competent only so long as it is within the knowledge and personal observations of the witness, but lay testimony is not competent to prove a particular injury or illness); see Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation).

The Board is responsible for ascertaining whether the evidence supports the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt rule does not apply. Id.; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990).

1. Entitlement to service connection for hypertension

The Veteran seeks service connection for hypertension. He specifically contends that the stress of his military occupational specialty (MOS) resulted in his claimed disability of "hypertension/high blood pressure." See e.g., VAF 21-526EZ Fully Developed Claim, VA Form 21-4138 Statement in Support of Claim, associated 3/11/2025; Board Hearing Transcript, associated 1/16/2026.

The Board notes that hypertension refers to persistently high arterial blood pressure. For VA rating purposes, the term "hypertension" means that the diastolic blood pressure is predominantly 90 mm Hg or greater. The term "isolated systolic hypertension" means that the systolic blood pressure is predominantly 160 mm Hg or greater with a diastolic blood pressure of less than 90 mm Hg. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). For VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. [Effective November 9, 2021, DCs 7000-7007, 7009-7011, and 7015-7020 are evaluated using the General Rating Formula for Diseases of the Heart.]

The Veteran testified and service records confirm that he attended recruit training at the Great Lakes training center in Illinois, and the remainder of his active duty was served as "Inhalation Therapist/Respiratory Care Technician" at the Naval Hospital, Great Lakes, Illinois. See e.g., DD Form 2014, associated 10/14/1971; Military Personnel Record, associated 6/5/2025; Board Hearing Transcript, associated 1/16/2026.

Service treatment records (STRs) do not contain complaints, diagnoses, or treatment for elevated blood pressure or hypertension. An August 1973 Report of Medical Examination noted the Veteran's blood pressure on the day of exam as 110 systolic/60 diastolic. See STR-Medical, associated 6/6/2025.

VA conceded that the Veteran was exposed to hazardous materials (asbestos) during his military service. See Rating Decision, associated 7/25/2025.

The record contains no VA treatment records. At the hearing, the Veteran testified that he receives all
Military Personnel Record, associated 6/5/2025; Board Hearing Transcript, associated 1/16/2026.

VA conceded that the Veteran was exposed to hazardous materials (asbestos) during his military service. See Rating Decision, associated 7/25/2025.

The record contains no VA treatment records. At the hearing, the Veteran testified that he receives all his treatment from private, not VA, facilities. See Board Hearing Transcript, associated 1/16/2026.

The record contains no private treatment records. On his original claim, the Veteran indicated that he receives treatment for "all conditions" from J.D., PA-C, from 2000 to present. He authorized release of records from PA-C J.D. However, the Veteran did not provide any of PA-C J.D.'s contact information. See VA Form 21-526EZ, VA Form 21-4142 Authorization for Release of Information, associated 3/11/2025. In March and June 2025 correspondence, VA requested the Veteran provide VA with PA-C J.D.'s contact information to request medical information. See Correspondence, associated 3/14/2025; Subsequent Development Letter, associated 6/2/2025. The Veteran did not respond.

At the Board hearing, the Veteran answered in the affirmative as to whether he had been diagnosed with hypertension by a medical professional. The Veteran did not submit any medical treatment records thereafter. However, in support of the claim, he submitted a letter by J.D., PA-C, dated 1/26/2026, who stated that the Veteran has been a patient since 2016, and she personally reviewed the Veteran's medical history and chart and examined him "often while he has been under my care." PA-C J.D. noted that the Veteran's "diagnoses include" hypertension, and he "gets regular blood work, MRI's, CT scans and follows with multiple specialists." See Medical Treatment Record-Non-Government Facility (MTR-NGF), associated 2/6/2026. However, PA-C J.D. did not indicate when the Veteran was diagnosed with hypertension, or whether his hypertensive diagnosis is a current one or a past one (i.e., resolved).

In light of the foregoing, there is no competent evidence of record establishing that a current disability existed at the time the Veteran filed his claim in March 2025, or during the pendency of this appeal. In reaching this conclusion, the Board has considered the Veteran's lay statements. See e.g., VA Form 21-526EZ, VA Form 21-4138, associated 3/11/2025; Board Hearing Transcript, associated 1/16/2026. However, while the Veteran is competent to report symptoms of his hypertensive condition, stating he currently has "hypertension/high blood pressure," the Board finds the question of whether such amounts to a true disability is medical in nature and here, the record does not indicate that the Veteran has the training to make such a medical determination. See Jandreau, supra. Further, while PA-C J.D. does appear to be a person who is qualified through education, training, or experience to offer a medical diagnosis, she fails to indicate whether the Veteran's hypertension is a current diagnosis, merely noting his "diagnoses include" hypertension, without more. Moreover, the record contains no medical records reflecting elevated blood pressure readings or a diagnosis of hypertension confirmed by readings taken two or more times on at least three different days. The presence of a current disability is the cornerstone of any service connection claim. See Brammer, supra. Accordingly, as there is no competent evidence of a "current" disability with respect to the claim, the Board does not reach the issue of whether the claimed disability is related to service.

The Board acknowledges that the Veteran has not been afforded a VA examination in connection with his claim for service connection. In accordance with the duty-to-assist provisions codified at 38 U.S.C. § 5103A(d) and by regulation found at 38 C.F.R. § 3.159(c)(4), a medical opinion or examination is required if the information and evidence of record does not contain sufficiently competent medical evidence to decide the claim, but there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting 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. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). As all of the enumerated elements have not been met, VA's duty to provide the Veteran with a medical examination/opinion in this case was not triggered.

In sum, in the absence of a current disability, service connection for hypertension cannot be established. See Holton, 557 F.3d at 1366 (holding that entitlement to service connection requires, among other things, evidence of a current disability); see also Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (upholding VA's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes). As the evidence of record weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

2. Entitlement to service connection for toenail fungus

The Veteran seeks service connection for "toenail fungus." He specifically contends that toenail fungus began or worsened as a result of community showers, to include toxic exposures (i.e., cleaning chemicals, asbestos) therein, and required footwear worn during military service. See e.g., VAF 21-526EZ Fully Developed Claim, VA Form 21-4138 Statement in Support of Claim, associated 3/11/2025; Board Hearing Transcript, associated 1/16/2026.

As noted above, the Veteran attended recruit training at the Great Lakes, Illinois, and the remainder of his active duty was served as "Inhalation Therapist/Respiratory Care Technician" at the Naval Hospital, Great Lakes, Illinois. See e.g., DD Form 2014, associated 10/14/1971; Military Personnel Record, associated 6/5/2025; Board Hearing Transcript, associated 1/16/2026.

STRs do not contain complaints, diagnoses, or treatment for any toenail-related problems. An August 1973 Report of Medical Examination noted the Veteran's feet as "normal" on clinical evaluation. See STR-Medical, associated 6/6/2025.

VA conceded that the Veteran was exposed to hazardous materials (asbestos) during his military service. See Rating Decision, associated 7/25/2025.

The record contains no VA treatment records. At the hearing, the Veteran testified that he receives all his treatment from
, associated 10/14/1971; Military Personnel Record, associated 6/5/2025; Board Hearing Transcript, associated 1/16/2026.

VA conceded that the Veteran was exposed to hazardous materials (asbestos) during his military service. See Rating Decision, associated 7/25/2025.

The record contains no private treatment records. As noted on his original claim, the Veteran receives treatment for "all conditions" from J.D., PA-C, from 2000 to present. He authorized release of records from PA-C J.D. However, the Veteran did not provide any of PA-C J.D.'s contact information. See VA Form 21-526EZ, VA Form 21-4142, associated 3/11/2025. In March and June 2025 correspondence, VA requested that the Veteran provide VA with PA-C J.D.'s contact information to request medical information. See Correspondence, associated 3/14/2025; Subsequent Development Letter, associated 6/2/2025. The Veteran did not respond.

At the Board hearing, the Veteran testified that his feet "didn't breathe well with the footwear that I had to wear" and he "sought some help there from the doctors while I was in service." The Veteran contended he developed the condition while in the service, and that he has had the condition since service, and still has it today. The Veteran did not submit any medical treatment records thereafter. However, in support of the claim, he submitted a letter by PA-C J.D. who stated the Veteran has been a patient since 2016, she personally reviewed his medical history and chart and examined him often, and he "gets regular blood work, MRI's, CT scans and follows with multiple specialists." PA-C J.D. noted the Veteran's self-report of having toenail fungus since his time in the military. See MTR-NGF, associated 2/6/2026. However, PA-C J.D. did not indicate whether she had examined the Veteran's feet, or whether the Veteran has/had a diagnosis of "toenail fungus."

In light of the foregoing, there is no competent evidence of record establishing that a "current" disability existed at the time the Veteran filed his claim in March 2025, or during the pendency of this appeal. In reaching this conclusion, the Board has considered the Veteran's lay statements. See e.g., VA Form 21-526EZ, VA Form 21-4138, associated 3/11/2025; Board Hearing Transcript, associated 1/16/2026. However, while the Veteran is competent to report his symptomatology, such as having toenail fungus, the Board finds the question of whether such amounts to a true disability are medical in nature and here, the record does not indicate that the Veteran has the request training to make such a medical determination. See Jandreau, supra. Further, while PA-C J.D. does appear to be a person who is qualified through education, training, or experience to offer a medical diagnosis, she does not provide a diagnosis of "toenail fungus" but merely notes the Veteran's self-report of same. Moreover, the record contains no medical treatment records reflecting complaints or diagnosis of "toenail fungus." As indicated, the presence of a current disability is the cornerstone of any service connection claim. See Brammer, supra. Accordingly, as there is no current disability with respect to the claim, the Board does not reach the issue of whether the claimed disability is related to service.

The Board acknowledges that the Veteran has not been afforded a VA examination in connection with his claim for service connection. As noted above, a VA medical opinion or examination is required if the information and evidence of record does not contain sufficiently competent medical evidence to decide the claim, but there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting 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. See McLendon, supra. As all of the enumerated elements have not been met, VA's duty to provide the Veteran with a medical examination/opinion in this case was not triggered.

In sum, in the absence of a current disability, service connection for "toenail fungus" cannot be established. See Holton, supra; see also Degmetich, supra. As the evidence of record is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra.

3. Entitlement to service connection for bronchitis with pneumonia

The Veteran asserts that his on/off bouts of bronchitis with pneumonia onset in service, specifically during his recruit training at the Great Lakes training center, to include as due to various toxic exposures (i.e., cleaning chemicals, asbestos). See e.g., VA Form 21-526EZ, VA Form 21-4138, associated 3/11/2025; Board Hearing Transcript, 1/16/2026.

As noted, the Veteran attended recruit training at the Great Lakes, Illinois, and the remainder of his active duty was served as "Inhalation Therapist/Respiratory Care Technician" at the Naval Hospital, Great Lakes, Illinois. See e.g., DD Form 2014, associated 10/14/1971; Military Personnel Record, associated 6/5/2025; Board Hearing Transcript, associated 1/16/2026.

STRs contain entries for complaints/treatment for upper respiratory infection-like symptoms (i.e., sore throat, headache, chills, cough, nausea, high temperature) during the Veteran's recruit training, and after. No diagnosis for bronchitis with pneumonia was indicated. An August 1973 Report of Medical Examination did not note any defects/diagnoses with regard to the Veteran's respiratory system and instead marked such as "normal" on clinical evaluation. See STR-Medical, associated 6/6/2025.

VA conceded that the Veteran was exposed to hazardous materials (asbestos) during his military service. See Rating Decision, associated 7/25/2025.

The record contains no VA treatment records. At the hearing, the Veteran testified that he receives all his treatment from private not VA facilities. See Board Hearing Transcript, associated 1/16/2026.

At the Board hearing, the Veteran testified that his condition is "off and on" and "sometimes it flares up and gets worse" and he treats himself with over-the-counter medication but it had "been a while since I've had any prescriptions." The Veteran testified he was "historically" diagnosed "off and on, seeing different doctors" but "I'm not being treated for bronchitis right at this time." He further testified that he "constantly have a lot of mucus coming up. It's pretty much a continual thing." The Veteran did not submit any medical treatment records thereafter. However, in support of the claim, he submitted a letter by PA-C J.D., who stated the Veteran has been a patient since 2016, she personally reviewed his medical history and chart and examined him often, his "diagnoses include" bronchitis and pneumonia, and he "gets regular blood work, MRI's, CT scans and follows with multiple specialists." See MTR-NGF, associated 2/6/2026. However, PA-C J.D. did not indicate when the Veteran was diagnosed with "bouts of bronchitis and pneumonia," or whether the diagnosis is a current one or a past one (i.e., resolved).

In light of the foregoing, there is no competent evidence of record establishing that a current disability existed at the time the Veteran filed his claim in March 2025, or during the pendency of this appeal. In reaching this conclusion, the Board has considered the Veteran's lay statements. See e.g., VA Form 21-526EZ, VA Form 21-4138, associated 3/11/2025; Board Hearing Transcript, associated 1/16/2026. However, while the Veteran is competent to report symptoms of his condition(s) and that the condition comes/goes or is continual (i.e., mucus coming up) in nature, the Board finds the question of whether such amounts to a true disability is medical in nature and here, the record does not indicate that the Veteran has the training to make such a medical determination. See Jandreau, supra. Further, while PA-C J.D. does appear to be a person who is qualified through education, training, or experience to offer a medical diagnosis, she fails to indicate whether the Veteran's condition is a current diagnosis, merely noting that his "diagnoses include ...bouts of bronchitis and pneumonia," without more. Moreover, there are no medical treatment records reflecting complaints/diagnoses of bronchitis and/or pneumonia. The presence of a current disability is the cornerstone of any service connection claim. See Brammer, supra. Accordingly, as there is no competent evidence of a "current" disability with respect to the claim, the Board does not reach the issue of whether the claimed disability is related to service.

Moreover, while noting the "circumstances and events" of the Veteran's military service to include his MOS, and his report of exposure to "asbestos and different chemicals" during service, PA-C J.D. concluded it "at least as likely as not that [the Veteran's] conditions are a direct result of his exposures during military service." However, the letter does not indicate PA-C J.D. reviewed the Veteran's service records or his medical records prior to 2016, nor does she provide rationale for her conclusion, such as referencing/citing to peer-reviewed literature, medical research/studies, etc. to support finding the Veteran's claimed condition a direct result of "his exposures." Most of the probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez, supra. Here, the Board finds PA-C J.D.'s opinion merely conclusory, lacking adequate
during service, PA-C J.D. concluded it "at least as likely as not that [the Veteran's] conditions are a direct result of his exposures during military service." However, the letter does not indicate PA-C J.D. reviewed the Veteran's service records or his medical records prior to 2016, nor does she provide rationale for her conclusion, such as referencing/citing to peer-reviewed literature, medical research/studies, etc. to support finding the Veteran's claimed condition a direct result of "his exposures." Most of the probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez, supra. Here, the Board finds PA-C J.D.'s opinion merely conclusory, lacking adequate supporting data or a reasoned medical explanation that connects the claimed condition to the Veteran's military service.

In sum, in the absence of a current disability, service connection for bronchitis with pneumonia cannot be established. See Holton, supra; see also Degmetich, supra. As the evidence of record is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra.

REASONS FOR REMAND

Although the Board regrets the delay, upon review of the claims file, the Board finds that remand is necessary to correct the below-indicated pre-decisional duty to assist errors in the adjudication of the Veteran's remaining claims.

The law provides that VA shall make reasonable efforts to notify a claimant of the evidence necessary to substantiate a claim and requires the VA to assist a claimant in obtaining that evidence. 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.159. Such assistance includes providing the claimant a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. Id.

Moreover, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007).

4. Entitlement to service connection for bilateral hearing loss

The Veteran seeks service connection for bilateral hearing loss. He specifically contends that he was exposed to hazardous noises while in the service, to include from small arms fire, heavy equipment (e.g., floor buffer, construction equipment, etc.), medical equipment, and hospital alarms, etc. See e.g., VA Form 21-526EZ, VA Form 21-4138, associated 3/11/2025; Board Hearing Transcript, 1/16/2026.

Regarding the first element of a service-connection claim under Holton, a current disability, the AOJ favorably found in the July 2025 decision on appeal that the July 2025 VA examiner diagnosed the Veteran with sensorineural hearing loss. Regarding the second element of a service-connection claim under Holton, in-service incurrence or aggravation of a disease or injury, the AOJ favorably found that the Veteran's MOS was consistent with exposure to hazardous noise, albeit of a low probability. The AOJ also conceded that the Veteran was exposed to hazardous materials (asbestos) during his military service. Such favorable findings by the AOJ are binding on the Board. See 38 C.F.R. § 3.104(c).

Thus, the only question that remains is whether the Veteran's current hearing loss is related to his in-service hazardous noise exposures, or toxic exposures.

In that regard, the Veteran was afforded VA examination in July 2025 to determine the nature and etiology of his hearing loss. Upon audio examination, notation of the Veteran's medical history and report of onset, and review of the claims folder, the examiner opined the Veteran's hearing loss was not "at least as likely as not" caused by or a result of an event, injury, or disease incurred during his military service. As to rationale, the examiner determined, although noise exposure is conceded and the relationship of noise, auditory damage, and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise along as there must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology and here, the Veteran's MOS was of low probability for hazardous noise exposure, he reported change in hearing post-service, and, while mild loss was found at 6000 at his exit from service, it is outside of VA pertinent frequencies.

However, while the examiner discussed the "mild loss found at 6k," the examiner did not discuss the decreases reflected in most of the pertinent frequencies from enlistment in 1969 to separation in 1973 or reconcile whether such decreases were indicative of reduced hearing such that the Veteran's current hearing loss was/was not at least as likely as not caused by or a result of an event, such as the decrease in audio frequency results incurred during military service. For instance, in the April 1969 Report of Medical Examination, the Veteran's audiometer results showed:

500 1000 2000 3000 4000

RIGHT 0 0 0 0 0

LEFT 0 0 0 0 0

Yet his August 1973 Report of Medical Examination showed:

500 1000 2000 3000 4000

RIGHT 5 0 0 5 5

LEFT 10 5 0 10 10

In addition, while the examiner noted that the Veteran reported at the time of the July 2025 examination the date of onset of his hearing loss "is after service," the examiner did not reconcile that with his earlier statements contending hearing loss as due to exposure to "hospital noise" and "constantly hearing grinder sounds and buffer sounds, and medical equipment" during his military service. See VA Form 21-4138, associated 3/11/2025; C&P Exam, associated 7/25/2025. VA examination is adequate when the examiner considers all of the evidence of record, as well as the Veteran's contentions in providing an opinion. The Board finds this opinion with regard to direct service connection inadequate for adjudication purposes. See Barr, supra.

The examiner also provided a separate medical opinion, opining that the Veteran's hearing loss was less likely than not caused by the indicated toxic exposure risk activities (TERAs), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. As to rationale, the examiner cited to VA research and medical literature [cited] to support there being no causal connection between toxic exposures, such as the Veteran's exposure to asbestos, and hearing loss.

As the July 2025 VA examiner's opinion with regard to direct service connection pertaining to hazardous noise exposures therein was inadequate, the AOJ's reliance on such constituted a pre-decisional duty to assist error. Accordingly, remand is warranted to afford the Veteran an additional examination with medical opinion based on full consideration of his documented medical history and contentions, and supported by clearly stated rationale

The matters are REMANDED for the following action:

Forward the record, to include a copy of this Remand, to an appropriate VA clinician in order to obtain an examination and opinion addressing the etiology of the Veteran's bilateral hearing loss.

Following a full review of the record, and after eliciting from the Veteran a full medical history, the examiner should offer opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed hearing loss had its onset in or within one year of, or is otherwise related to, his military service, to include his conceded in-service noise exposure.

In providing the requested opinion
by clearly stated rationale

The matters are REMANDED for the following action:

Forward the record, to include a copy of this Remand, to an appropriate VA clinician in order to obtain an examination and opinion addressing the etiology of the Veteran's bilateral hearing loss.

In providing the requested opinion, the examiner should specifically consider and address the indicated decreases in audiometer readings from the Veteran's enlistment in 1969 to his separation in 1973.

The examiner is directed to assume for the purposes of this examination that the Veteran is competent to report symptoms and treatment and that his reports, including his reports as to the onset and nature of his symptoms, must be taken into account, along with other evidence of record, in formulating the requested opinions. If the Veteran's reports are dismissed by the examiner for any reason, an accompanying rationale is required.

If medical literature is relied upon, the examiner should identify and specifically cite each reference material used.

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The examiner should set forth all examination findings, along with the complete rationale for any conclusions reached.

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Picard

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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