SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

B. D. WATSON · 2026 · Case ID: A26040874

MIXED

Summary

The veteran served in the United States Army from May 2012 to July 2012 and from February 2016 to December 2017. The veteran appealed the denial of service connection for obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), and left lower extremity radiculopathy (sciatica), as well as the dismissal of appeals for deferred claims of OSA and migraines. The Board dismissed the appeals for deferred OSA and migraines due to lack of appellate jurisdiction, as deferred claims are not appealable. For OSA, the Board denied service connection, finding that while the veteran had a current diagnosis and reported sleep issues in service, the most probative evidence, a negative VA medical opinion, indicated the condition was less likely than not related to service. The examiner cited the Veteran's BMI and lack of in-service complaints specific to OSA as rationale. For GERD, service connection was denied due to a lack of in-service complaints or treatment, a significant temporal gap in post-service treatment, and no medical opinion linking the condition to service. The Board found no pre-decisional duty to assist error for not obtaining a VA examination for GERD, as the evidence did not suggest a link to service. For left lower extremity radiculopathy, service connection was denied due to a lack of in-service complaints, treatment, or diagnosis, and a significant temporal gap between service and the post-service diagnosis. The Board also noted the Veteran's denial of back problems in service and the examiner's negative nexus opinion. The Board found no basis for secondary service connection for radiculopathy as the Veteran is not service-connected for a back condition. The Board remanded the claim for migraines, to include as secondary to service-connected tinnitus and right knee disability, due to an inadequate VA medical opinion that failed to address aggravation and did not fully develop the secondary claim based on the knee condition.

Rationale

Negative VA nexus opinion; Lack of specific in-service complaints; BMI as primary etiology

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250328-529334

Full Decision Text

Citation Nr: A26040874
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250328-529334
DATE: April 30, 2026

ORDER

The appeal regarding the deferred claim for entitlement to service connection for obstructive sleep apnea (OSA) is dismissed.

The appeal regarding the deferred claim for entitlement to service connection for migraines is dismissed.

Entitlement to service connection for OSA is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.

Entitlement to service connection for left lower extremity radiculopathy (claimed as sciatica) is denied.

REMANDED

Entitlement to service connection for migraines, to include as secondary to service-connected disabilities, is remanded.

FINDINGS OF FACT

1. A March 3, 2025 rating decision deferred adjudication of the issue of entitlement to service connection for OSA; the deferred rating decision does not constitute the necessary adjudicative determination from which a disagreement may be filed.

2. A March 3, 2025 rating decision deferred adjudication of the issue of entitlement to service connection for migraines; the deferred rating decision does not constitute the necessary adjudicative determination from which a disagreement may be filed.

3. The most probative and persuasive evidence weighs against finding that the Veteran's OSA began during active service or is otherwise related to an in-service injury or disease.

4. The most probative and persuasive evidence weighs against finding that the Veteran's GERD began during active service or is otherwise related to an in-service event, injury, or disease.

5. The most probative and persuasive evidence weighs against finding that the Veteran's left lower extremity radiculopathy began during active service or within one year of service, or is otherwise related to an in-service injury or disease

CONCLUSIONS OF LAW

1. The Board lacks jurisdiction to review the appeal of the deferred issue of entitlement to service connection for OSA, and the claim is dismissed. 38 U.S.C. § 7104(c); 38 C.F.R. §§ 20.104(a), 20.105, 20.201.

2. The Board lacks jurisdiction to review the appeal of the deferred issue of entitlement to service connection for migraines, and the claim is dismissed. 38 U.S.C. § 7104(c); 38 C.F.R. §§ 20.104(a), 20.105, 20.201.

3. The criteria for service connection for OSA have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

4. The criteria service connection for GERD have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 29, 2012 to July 27, 2012 and from February 2016 to December 2017.

These matters come before the Board of Veterans' Appeals (Board) on appeal from March 3, 2025 and March 26, 2025 rating decisions issued by a Department of Veterans Affairs (VA) regional office, the agency of original jurisdiction (AOJ).

In the March 28, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the applicable March 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplement
March 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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

Service Connection Criteria

Service connection will be granted for a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

Service connection requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Consistent with this framework, service connection is warranted 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).

Certain chronic diseases, including migraines and lower extremity radiculopathy (organic diseases of the nervous system) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time following separation from service (usually one year). 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. For the chronic diseases listed in 38 C.F.R. § 3.309(a), nexus to service may be established by showing continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Establishing service connection on a secondary basis requires competent and credible evidence demonstrating (1) the existence of a current disability; (2) a service-connected disability; and (3) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

The Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claim of the veteran, the benefit-of-the-doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v.
2009).

1. The appeal regarding the deferred claim for entitlement to service connection for obstructive sleep apnea is dismissed.

2. The appeal regarding the deferred claim for entitlement to service connection for migraines is dismissed.

A March 3, 2025 rating decision deferred adjudication of entitlement to service connection for OSA and migraines. Then, a March 26, 2025 rating decision denied entitlement to service connection for sleep apnea and migraines. See Rating Decision - Narrative, March 3, 2025 and March 26, 2025.

The Veteran filed a VA Form 10182 (Notice of Disagreement) on March 28, 2025, appealing both the March 3, 2025 deferred rating decision as well as the March 26, 2025 rating decision. See VA Form 10182, March 28, 2025.

A deferred rating decision does not constitute an adjudicative determination from which a notice of disagreement may be filed; thus, the Board does not have jurisdiction to review this claim, and the appeal must be dismissed for lack of appellate jurisdiction. 38 U.S.C. § 7104(c); 38 C.F.R. §§ 20.104(a), 20.105, 20.201; Shipley v. Shinseki, 24 Vet. App. 458 (2011) (concluding that a deferred rating decision does not constitute an appealable adjudicative action). Accordingly, the appeals regarding the deferred claims of entitlement to a service connection for OSA and migraines are dismissed.

The Board will address the Veteran's appeal of the March 26, 2025 rating decision in the sections below.

3. Entitlement to service connection for OSA is denied.

The Veteran claims entitlement to service connection for OSA. No specific contentions have been advanced in support of the claim to include an approximate date when the Veteran's OSA began or how the condition is related to his service. See VA 21-526EZ, Fully Developed Claim (Compensation), November 2024.

The Board finds that service connection is not warranted for the reasons outlined below.

The first two elements of service connection are not in dispute. The AOJ made the following favorable findings in the March 26, 2025 rating decision: (1) the Veteran has a current diagnosis of OSA; and (2) the evidence shows that a qualifying event, injury, or disease had its onset during the Veteran's service; specifically, the Veteran complained of sleep issues in August 2016 and March 2017. The Board is bound by these two favorable findings absent clear and unmistakable error, which is not present here. See 38 C.F.R. § 3.104(c). Thus, the first and second elements of service connection, a current disability and an in-service incurrence, have been satisfied.

The remaining determination for the Board is whether a nexus (i.e., link) exists between the Veteran's OSA and the in-service incurrences.

Turning to the evidence, the Veteran's service treatment records (STRs) show that in August 2016, the Veteran reported feeling down and depressed since arriving at his duty station and he had trouble falling and staying asleep. A STR dated March 2017 reflects that the Veteran had trouble sleeping due to chest congestion and a cough. A May 2017 STR shows that the Veteran reported panic attacks, trouble sleeping, and that he received an Article 15 the week prior for refusing to train. A behavioral health treatment note dated June 2017 reflects that the Veteran was diagnosed with adjustment disorder with mixed emotional features. A July 2017 treatment record indicates that the Veteran's mood and sleep problems had resolved. Treatment notes from August 2017 to October 2017 reflect that the Veteran denied trouble falling or staying asleep, and that he usually slept 6-8 hours per night. A November 2017 treatment record reflects that the Veteran requested to be evaluated for depression medication, and that he was
reflects that the Veteran had trouble sleeping due to chest congestion and a cough. A May 2017 STR shows that the Veteran reported panic attacks, trouble sleeping, and that he received an Article 15 the week prior for refusing to train. A behavioral health treatment note dated June 2017 reflects that the Veteran was diagnosed with adjustment disorder with mixed emotional features. A July 2017 treatment record indicates that the Veteran's mood and sleep problems had resolved. Treatment notes from August 2017 to October 2017 reflect that the Veteran denied trouble falling or staying asleep, and that he usually slept 6-8 hours per night. A November 2017 treatment record reflects that the Veteran requested to be evaluated for depression medication, and that he was experiencing depression, anxiety, and irritability. See STR, received November 21, 2022.

The Veteran explicitly denied having frequent trouble sleeping and that he had "no health issues" in a July 2017 report of medical history. The contemporaneous report of medical examination is devoid of any abnormalities related to a sleep or respiratory issue. See STR, July 2017.

The Veteran underwent a VA mental disorders examination in March 2024. The examiner noted a diagnosis of depressive disorder and that his psychiatric disorder manifested in various symptoms, including chronic sleep impairment. See C&P Exam, Mental Disorders DBQ, March 2024.

A June 2024 rating decision granted service connection for major depressive disorder and assigned a 70 percent rating based on various symptoms including chronic sleep impairment. See Rating Decision - Narrative, June 2024.

A VA examiner, Dr. R.S., M.D., reviewed records in March 2025 and noted a diagnosis of OSA based on the results of a home sleep study conducted in February 2025. See C&P Exam, Sleep Apnea DBQ, March 2025.

The examiner provided a negative nexus opinion, determining that the Veteran's OSA was less likely than not incurred in or caused by an in-service injury, event, or illness. As rationale, the examiner documented the Veteran's service treatment records reflecting the Veteran's reports of trouble falling and staying asleep, the Veteran's in-service mental health issues/evaluation, and the February 2025 home sleep study showing moderate OSA. The examiner explained that the most common cause of OSA is excess weight and obesity, which is associated with soft tissue of the mouth and throat; during sleep, when the throat and tongue muscles are more relaxed, this soft tissue can cause the airway to become blocked; OSA occurs when the airway collapses and there is no airflow, despite efforts to breathe; OSA is a disease with a clear and specific etiology; the Veteran reported sleeping issues/somnolence during a mental health evaluation during service, but it was due to insomnia, as he reported no issues such as snoring or choking, and his body mass index (BMI) at that point was 26; the February 2025 sleep study notes that the Veteran's BMI was greater than 35; thus, the Veteran's OSA was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner cited to various medical literature in support of his opinion. See C&P Exam, Medical Opinion DBQ, March 2025.

After review of the evidence, the Board finds that service connection is not warranted as there is no nexus between the Veteran's OSA and an in-service injury, or disease, to include the Veteran's reported sleep issues in August 2016 and March 2017.

The Board affords significant probative weight to the negative nexus opinion rendered by the VA examiner. The opinion was provided by a qualified medical professional, a physician, after review of the claims file and application of the facts to current medical knowledge. The examiner's opinion included sufficient rationale and was supported with a reasoned medical explanation and applicable medical literature. Thus, the opinion is probative and persuasive See Nieves-Rodriguez, 22 Vet. App. at 302- 22 Vet. App. 295, 301 (2008).

Significantly, there are no medical opinions of record linking the Veteran's OSA to service, nor is there any competent evidence establishing a causal relationship between the Veteran's OSA and his active-duty service.

To the extent that the Veteran asserts that his OSA is related to his service, such an opinion requires medical expertise, and that determination cannot simply be made by lay observation alone. The Veteran is competent to the extent that he can provide information regarding what he experienced through his senses, but he is not competent (meaning medically qualified through training or expertise) to provide a medical opinion, such as the etiology of OSA. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently,
no medical opinions of record linking the Veteran's OSA to service, nor is there any competent evidence establishing a causal relationship between the Veteran's OSA and his active-duty service.

To the extent that the Veteran asserts that his OSA is related to his service, such an opinion requires medical expertise, and that determination cannot simply be made by lay observation alone. The Veteran is competent to the extent that he can provide information regarding what he experienced through his senses, but he is not competent (meaning medically qualified through training or expertise) to provide a medical opinion, such as the etiology of OSA. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence of record.

The Board finds that the third element of service connection has not been met given that there is probative negative nexus opinion of record and no competing positive nexus opinion. Consequently, service connection for OSA is not warranted.

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for OSA. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection for OSA must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

4. Entitlement to service connection for GERD is denied.

The Veteran claims entitlement to service connection for OSA. No specific contentions have been advanced in support of the claim to include an approximate date when the Veteran's GERD began or how the condition is related to his service. See VA 21-526EZ, Fully Developed Claim (Compensation), November 2024.

The Board finds that service connection is not warranted for the reasons outlined below.

A December 2024 VA treatment record reflects that the Veteran reported having an "ulcer in lower stomach," that he had been to the emergency department 3-4 times over the past year, and he gets acid reflux every night. The treatment record notes a diagnosis of GERD. See CAPRI, December 2024. Thus, the first element of service connection, a current disability, has been met.

The Board next turns to the second element of direct service connection, the in-service incurrence of an injury or disease.

STRs do not show any treatment for, complaints of, or diagnosis related to GERD or symptoms consistent with such. See STRs generally.

The Veteran explicitly denied having frequent ingestion, heartburn, stomach, intestinal trouble or an ulcer in June 2015 and July 2017 reports of medical history. The contemporaneous reports of medical examination are devoid of any abnormalities related to a gastrointestinal issue. See STR, June 2015 and July 2017.

A March 2024 VA Memorandum regarding Toxic Exposure Risk Activity (TERA) determined that the Veteran did not participate in a TERA while in service. See Other, March 6, 2024.

The Board finds that service connection is not warranted based upon the foregoing evidence. A VA treatment record shows a diagnosis for GERD in December 2024 and reported symptoms in the year prior. However, a review of the available evidence shows no in-service event or other evidence to link the Veteran's GERD to service. STRs are devoid of symptomology consistent with GERD and there no evidence of continuity of symptoms since service or within several years after service. The Board finds that such a large temporal gap in treatment after separation from service weighs heavily against the Veteran's claim. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014).

Ultimately, the claim fails based on the second criteria of service connection, more specifically, there is no evidence of any in-service incident or injury to which the present GERD disability may be etiologically linked. The Board similarly concludes that the third element is also not met as the claims file contains no medical opinion linking any of the Veteran's diagnosed GERD with his military service.

In denying service connection, the Board is aware that the Veteran was not afforded a VA examination or medical opinion related to GERD. VA is obliged to provide an examination or obtain a medical opinion in a claim for service connection when the record contains competent evidence that the claimant has a current disability or persistent or recurrent symptoms of disability, the record indicates that the disability or symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App
element is also not met as the claims file contains no medical opinion linking any of the Veteran's diagnosed GERD with his military service.

The Board finds that no VA examination is required here because there is no credible evidence establishing that an event, injury, or disease occurred in-service, or manifested during any applicable presumptive period, and there is no competent and credible evidence of a causative link between GERD and service so as to trigger the duty to provide a VA examination. McLendon supra; Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Moreover, a TERA examination was not required as the Veteran did not participate in a TERA during service.

Therefore, the Board finds that there was no pre-decisional duty to assist error by not obtaining a VA examination or opinion, and there is sufficient evidence to decide the claim.

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for GERD. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection for GERD must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for left lower extremity radiculopathy (claimed as sciatica) is denied.

The Veteran claims entitlement to service connection for left lower extremity radiculopathy (claimed as sciatica), contending that such is related to an in-service injury. See C&P Exam, Peripheral Nerves Conditions, DBQ.

The Board finds that service connection is not warranted for the reasons outlined below.

The Board will first address service connection on a direct basis.

The AOJ made a favorable finding in the March 2025 rating decision that the Veteran has a diagnosis of left lower extremity radiculopathy. This finding is consistent with the medical evidence of record. Thus the first element of direct service connection, a current disability, has been met.

The Board turns to the second and third elements of direct service connection, the in-service incurrence of an injury or disease and nexus.

STRs do not show any treatment for, complaints of, or diagnosis related to lower extremity radiculopathy or symptoms consistent with such. See STRs generally.

The Veteran explicitly denied having any back problems, numbness or tingling in a June 2015 report of medical history. The contemporaneous reports of medical examination is devoid of any abnormalities related to a lower extremity or radicular condition. A clinical evaluation of the Veteran's spine and lower extremities was noted as normal. See STR, June 2015.

A May 2017 STR reflects that the Veteran reported having pain in his hip flexor and groin area for six days after kicking a door. The Veteran did not report experiencing pain radiating down into his lower extremities. The medical provider noted a diagnosis of groin strain, prescribed motion, and told the Veteran to make an appointment if symptoms persisted. See STR, May 2017.

The Veteran explicitly denied having any back problems, numbness or tingling, and reported he had "no health issues" in a July 2017 report of medical history. The contemporaneous report of medical examination is devoid of any abnormalities related to a lower extremity or radicular condition. A clinical evaluation of the Veteran's spine and lower extremities was noted as normal. See STR, July 2017.

A March 2024 VA Memorandum regarding TERA determined that the Veteran did not participate in a TERA while in service. See Other, March 6, 2024.

A December 2024 VA treatment record reflects that the Veteran reported having lower back pain with flare ups of the sciatic nerve. The treatment record notes a diagnosis of back pain and sciatica. See CAPRI, December 2024.

A March 2024 VA Memorandum regarding TERA determined that the Veteran did not participate in a TERA while in service. See Other, March 6, 2024.

The Veteran underwent a VA peripheral nerves conditions examination in December 2024. The Veteran reported he experienced a hip/groin injury during his service in California and that he also slipped on some black ice in New York causing pain to his back and left side. The Veteran also reported that he had been to the emergency room twice in the past two years due to flare-ups and that the condition causes problems as a truck driver due to symptoms with sitting. The examiner noted a diagnosis of radiculopathy involving the left lower extremity sciatic nerve, with a diagnosis date of December 2024. See Peripheral Nerves Conditions DBQ, December 2024.

The examiner provided a negative nexus opinion, determining that the Veteran's left lower extremity radiculopathy was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner explained that a review of the Veteran's STRs showed no radicular defects or diagnosis to include at the time of his entrance examination, during service, or in the separation examination; there was no in-service evidence to establish service connection; there was no chronic condition developed during the Veteran's term of service; without chronicity during or after service, a post-service event, illness, or injury was a more likely etiology for the condition; and thus, a nexus to service was not established at this time. See Medical Opinion DBQ, December 2024.

After a review of the foregoing evidence, the Board finds there is no probative medical opinion or other competent and credible evidence indicating that the Veteran's left lower radiculopathy began during service or is otherwise related to service. As there is no competent evidence that the Veteran's current radicular condition is related to an in-service occurrence, the second element of direct service connection is not met.

The Board similarly concludes that the third element is also not met. In this regard, the claims file contains no medical opinion or other competent evidence linking the Veteran's current radicular condition to service. Moreover, the Board finds that such a large temporal gap in treatment after separation from service weighs heavily against the Veteran's claim. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014). Given the absence of medical evidence to establish a relationship between active duty and the Veteran's current left lower extremity radiculopathy, the Board finds his disability is not amenable to service connection.

The Board affords significant probative weight to the negative nexus opinion rendered by the VA examiner. The opinion was provided by a qualified medical professional after review of the claims file and application of the facts to current medical knowledge. The examiner's opinion included sufficient rationale and was supported with a reasoned medical explanation. Thus, the opinion is probative and persuasive See Nieves-Rodriguez, 22 Vet. App. at 302- 22 Vet. App. 295, 301 (2008).

There is no opposing medical opinion of record, nor is there any competent evidence establishing a causal relationship between the Veteran's left lower extremity radiculopathy and his active-duty service.

To the extent that the Veteran asserts that his left lower radiculopathy is related to his service, including an in-service injury, such an opinion requires medical expertise, and that determination cannot simply be made by lay observation alone. The Veteran is competent to the extent that he can provide information regarding what he experienced through his senses, but he is not competent (meaning medically qualified through training or expertise) to provide a medical opinion, such as the etiology of sciatic radiculopathy. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence of record.

As to presumptive service connection for a chronic disease, there is no assertion or competent evidence that the Veteran's left lower extremity radiculopathy was chronic in service or manifested to a compensable degree within one year after separation from service in December 2017. The diagnosis of left lower extremity radiculopathy was rendered in December 2024, although the Veteran reported that he received treatment on two occasions in the two years prior to 2024.

Finally, the Board has considered service connection on
ulopathy. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence of record.

Finally, the Board has considered service connection on a secondary basis as the Veteran reported flare ups of sciatica associated with his back pain. However, the Veteran is not service-connected for a back disability. Therefore, service connection for left lower extremity radiculopathy, as secondary to a back condition, is not possible as a matter of law. See 38 C.F.R. § 3.310. Moreover, there is no competent evidence linking the Veteran's current radicular condition to a service-connected disability.

In sum, the Board concludes that, while the Veteran has a current left lower extremity radiculopathy disability, the evidence persuasively weighs against finding that the disability began during service or is otherwise related to an in-service injury, event, or disease. Furthermore, the condition was not shown as chronic in service, did not manifest to a compensable degree during the first post-service year, and continuity of symptomology is not established. Finally, secondary service connection is not available as the Veteran is not service connected for a back disability and there is no evidence linking the Veteran's current radicular condition to a service-connected disability. Accordingly, entitlement to service connection must be denied.

Based on the foregoing, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for left lower extremity radiculopathy. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; 3.310; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Entitlement to service connection for migraines, to include as secondary to service-connected tinnitus, is remanded.

The Veteran seeks service connection for migraines, to include as secondary to service-connected disabilities.

As discussed below, the Board finds that there is a pre-decisional duty-to-assist error in this case, and an addendum VA medical opinion is required on remand to cure the error. 38 C.F.R. § 20.802(a).

The AOJ made the following favorable findings in the March 26, 2025 rating decision: (1) the Veteran has a current diagnosis of migraines; (2) a qualifying event, injury, or disease had its onset during the Veteran's service, specifically, he was treated for a headache on May 3, 2017; and (3) The Veteran is service connected for tinnitus. The Board is bound these favorable findings absent clear and unmistakable error. 38 C.F.R. § 3.104(c).

The Veteran underwent a VA examination in December 2024. The Veteran reported his headaches began in 2015/2016 while on active duty serving in the infantry; he lost hearing protection during drills causing tinnitus; he feels his headaches are triggered by the ringing; he listens to loud music to counter the ringing; and he has chronic pain which seems to trigger the pain. The examiner noted a diagnosis of migraines including migraine variants with a diagnosis date concurrent with the date of the examination. See C&P Exam, Headaches DBQ, December 2024.

The examiner provided a negative direct service connection nexus opinion, concluding that the Veteran's migraine condition was less likely than not caused by an in-service injury, event, or illness. The examiner did not provide a nexus opinion addressing secondary service connection. See C&P Exam, Medical Opinion DBQ, December 2024.

A March 3, 2025 Exam Scheduling Request reflects that the AOJ requested a medical opinion addressing whether the Veteran's migraines are secondary to his tinnitus. See Exam Request, March 3, 2025.

A VA examiner reviewed records and addressed secondary service connection on March 7, 2025. The examiner generally discussed the association between tinnitus and migraines and how they can aggravate the impact of each other. The examiner concluded that the Veteran's migraine condition was less likely than not
less likely than not caused by an in-service injury, event, or illness. The examiner did not provide a nexus opinion addressing secondary service connection. See C&P Exam, Medical Opinion DBQ, December 2024.

A March 3, 2025 Exam Scheduling Request reflects that the AOJ requested a medical opinion addressing whether the Veteran's migraines are secondary to his tinnitus. See Exam Request, March 3, 2025.

A VA examiner reviewed records and addressed secondary service connection on March 7, 2025. The examiner generally discussed the association between tinnitus and migraines and how they can aggravate the impact of each other. The examiner concluded that the Veteran's migraine condition was less likely than not caused by his service-connected tinnitus. See C&P Exam, Medical Opinion DBQ, March 2025.

VA has a duty to assist Veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist includes providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159 (c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

Upon review, the Board finds the March 2025 VA medical opinion is inadequate for adjudicative purposes, and, consequently, remand is required to correct a pre-decisional duty to assist error. See 38 C.F.R. § 20.802(a).

The March 2025 VA examiner opined as to whether the Veteran's service-connected tinnitus caused his migraines. While the examiner raised and generally discussed aggravation, they never provided a specific opinion regarding aggravation. Secondary service connection on the basis of direct causation and on the basis of aggravation are separate concepts, and both must be addressed. See Atencio v. O'Rourke, 30 Vet. App. 74, 8991 (2018); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). As such, the VA medical opinion addressing secondary service connection is deficient.

Additionally, the Veteran reported that his migraines were triggered by his tinnitus and chronic pain. The Board observes the Veteran was service connected for right knee patellar tendonitis and instability at the time of the March 2025 rating decision. While the AOJ developed the Veteran's migraine claim on a secondary basis related to service-connected tinnitus, the AOJ did not develop secondary service connection as related to the Veteran's service-connected right knee disability.

The Board finds that it was a pre-decisional error in this case for the AOJ to have limited the scope of secondary service to only the Veteran's tinnitus. Thus, a remand is also required in order to rectify this error and allow the AOJ to properly develop the full scope of the Veteran's claim in this regard. See Robinson v. Peake, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009) (recognizing VA's duty to consider all issues raised either by the claimant or by the evidence of record).

The matter is REMANDED for the following action:

1. Obtain an addendum medical opinion from a qualified examiner addressing the nature and etiology of the Veteran's migraines. An in-person examination is not required unless deemed necessary by the examiner.

The claims file, including a copy of this remand must be made available and reviewed by the examiner.

The examiner is asked to address the following:

(a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's migraine condition was caused by his service-connected tinnitus and/or chronic pain associated with his service-connected right knee patellar tendonitis and instability?

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's migraine condition was aggravated by his service-connected tinnitus and/or chronic pain associated with his service-connected right knee patellar tendonitis and instability?

Please note, causation and aggravation are separate concepts and must be addressed independently.

The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the examiner should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation.

Any opinion expressed by the examiner should be accompanied by a complete rationale.

If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation
least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's migraine condition was aggravated by his service-connected tinnitus and/or chronic pain associated with his service-connected right knee patellar tendonitis and instability?

Please note, causation and aggravation are separate concepts and must be addressed independently.

Any opinion expressed by the examiner should be accompanied by a complete rationale.

If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided.

(continued on next page)

If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized.

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board P. S. Rubin, Counsel

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

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