Case A26041006

R. BISIGNANI · 2026 · Case ID: A26041006

MIXED

Summary

The Veteran served from December 2015 to May 2016. The Veteran appeals the denial of service connection for bilateral hearing loss, tinnitus, bilateral feet, muscle pain, and a sleep disturbance disability. The Veteran also appeals the denial of an earlier effective date for the grant of service connection for eczema, but the Board granted an initial 10 percent rating for eczema. The Board found that the Veteran's service treatment records were negative for hearing loss, tinnitus, bilateral feet, muscle pain, and sleep disturbance. While the Veteran had some elevated blood pressure readings in service, the Board found no evidence of hypertension or asthma that met VA standards, and no specific claim for these conditions was clearly established. The Board also found the Veteran's lay testimony regarding continuity of symptoms for hearing loss and tinnitus not credible. The February 2024 VA examiner opined unfavorably on the nexus for hearing loss and tinnitus, while later examinations provided conflicting results, ultimately leading the Board to favor the unfavorable opinions. The claims for acquired psychiatric disorder (including PTSD, depression, and anxiety), hypertension, and asthma were remanded for further development, including new VA examinations to determine the nature and etiology of these conditions and their relationship to service.

Rationale

Service connection granted for eczema; 10 percent rating assigned; Based on VA exam findings of lesions covering 5-20% of body

Special Benefit

EARLIER EFFECTIVE DATE

Diagnostic Code

7806

Docket No.

250226-527484

Full Decision Text

Citation Nr: A26041006
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250226-527484
DATE: April 30, 2026

ORDER

Entitlement to an earlier effective date than November 5, 2024, for the grant of service connection for eczema is denied.

Entitlement to an initial 10 percent rating for eczema is granted.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for tinnitus is denied.

Entitlement to service connection for bilateral flat feet is denied.

Entitlement to service connection for muscle pain is denied.

Entitlement to service connection for a sleep disturbance disability is denied.

REMANDED

Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder and anxiety disorder is remanded.

Entitlement to service connection for hypertension, claimed as high blood pressure, is remanded.

Entitlement to service connection for asthma is remanded.

FINDINGS OF FACT

1. A February 2025 rating decision granted service connection for eczema, effective November 5, 2024. The effective date was the date of the claim of the Veteran's Intent to File for service connection.

2. The Veteran's eczema manifests as eczema lesions covering at least 5 percent, but less than 20 percent, of exposed areas affected during the period on appeal.

3. A bilateral hearing loss disability was not shown during service or for many years thereafter, and the weight of the probative evidence is against a finding that a current bilateral hearing loss disability is related to active military service.

4. Tinnitus was not shown during service or for many years thereafter, and the weight of the probative evidence is against a finding that tinnitus is related to active military service.

5. The Veteran's bilateral feet, muscle pain and sleep disorder disabilities are not related to an in-service injury, disease, or event.

CONCLUSIONS OF LAW

1. The criteria for an effective date, earlier than November 5, 2024, for the grant of service connection for eczema have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.114(a), 3.400 (2021).

2. The criteria for an initial 10 percent evaluation, but no higher, for eczema with have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Code 7806 (2021).

3. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2021).

4. Tinnitus was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2021).

5. The criteria for service connection for a bilateral foot disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 5103, 5103(A); 38 C.F.R. §§ 3.303, 3.310 (2021).

6. The criteria for service connection for a muscle pain disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 5103, 5103(A); 38 C.F.R. §§ 3.303, 3.310 (2021).

7. The criteria for service connection for a sleep disorder disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 5103, 5103(A); 38 C.F.R. §§ 3.303, 3.310 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from December 2015 to May 2016.

These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2024, October 2024, November 2024 and February
§§ 3.303, 3.310 (2021).

7. The criteria for service connection for a sleep disorder disability have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 5103, 5103(A); 38 C.F.R. §§ 3.303, 3.310 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from December 2015 to May 2016.

These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2024, October 2024, November 2024 and February 2025 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

In October 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for bilateral hearing loss, which was most recently addressed in a May 2024 rating decision. In November 2024, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal.

In November 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for depression and anxiety most recently addressed in a February 2024 rating decision. In February 2025, the AOJ issued the supplemental claim decision on appeal.

In the February 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 February 2024, October 2024, November 2024 and February 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions 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.

However, because the Board is remanding the claims of service connection for an acquired psychiatric disability, hypertension and asthma, any evidence the Board could not consider will be considered by the AOJ in the adjudication of these claims. 38 C.F.R. § 3.103.

The Board notes that the appealed February 2025 rating decision denied entitlement to service connection for an anxiety condition and denied entitlement to service connection for depression.

However, the Board notes that the United States Court of Appeals for Veterans Claims (Court) has held that claims for service connection for PTSD encompass claims for service connection for all psychiatric disabilities. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record).

As a result, in conjunction with Clemons and as addressed below, the claim has been characterized as entitlement to service connection for an acquired psychiatric disorder, to include PTSD.

Earlier Effective Date

Generally, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400.

The terms "claim" and "application" mean a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action that demonstrates intent to apply for an identified benefit may be considered an informal claim. 38 C.F.R. § 3.155(a).

VA or uniformed services medical records may form the basis of an informal claim for increased benefits where a formal claim for service connection has already been allowed. 38 C.F.R. § 3.157. Under the provisions of 38 C.F.R. § 3.157(b)(1), the date of outpatient or hospital examination or date of admission to a VA or uniform
mean a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action that demonstrates intent to apply for an identified benefit may be considered an informal claim. 38 C.F.R. § 3.155(a).

VA or uniformed services medical records may form the basis of an informal claim for increased benefits where a formal claim for service connection has already been allowed. 38 C.F.R. § 3.157. Under the provisions of 38 C.F.R. § 3.157(b)(1), the date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim. The provisions of this regulation apply only when such reports relate to examination or treatment of a disability for which service connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. 38 C.F.R. § 3.157(b).

Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155.

Generally, the date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r).

Effective March 24, 2015, in order for benefits to be paid to any individual under the laws administered by VA, a specific claim in the form prescribed by VA must be filed. 38 C.F.R. § 3.151 (a). A claimant may indicate a desire to file a claim by submitting an intent to file a claim to VA. 38 C.F.R. § 3.155 (b). Upon receipt of the intent to file, VA will furnish the claimant with the appropriate form. Id. If VA receives a complete application form within a year, it will consider the complete claim filed as of the date of the intent to file. Id.

Upon receipt of an incomplete application form, VA must notify the claimant of the information necessary to complete the application. 38 U.S.C. § 5102 (b); 38 C.F.R. § 3.155 (c). If a complete claim is then submitted within one year of the incomplete application form, VA will consider it filed as of the date VA received the incomplete application. 38 C.F.R. § 3.155 (c). In the event that VA receives both an intent to file a claim and an incomplete application before the complete claim is filed, the complete claim will be considered filed as of the date of whichever was filed first provided it is perfected within the necessary timeframe, but in no event will the complete claim be considered filed more than one year prior to the date of receipt of the complete claim. Id. § 3.155(d)(1)(ii).

The Veteran filed an Intent to File via a Claim for Compensation and/or Pension, or Survivor's Pension and/or DIC (VA Form 21-0996) for eczema on November 5, 2024.

VA then received the Veteran's VA 21-526EZ Fully Developed Claim (specifically claiming entitlement to service connection for eczema on November 5, 2024.

In a February 2025 rating decision, the RO granted service connection for eczema at an initial noncompensable disability rating, effective November 5, 2024, which was noted as the day VA received the Veteran's Intent to File.

As noted above, if VA receives a complete application form prescribed by the Secretary, as defined in paragraph (a) of § 3.160, appropriate to the benefit sought within 1 year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155.

Based on the evidence, the Board finds that an effective date earlier than November 5, 2024, for the grant of service connection for an eczema disability is not warranted as the
compensable disability rating, effective November 5, 2024, which was noted as the day VA received the Veteran's Intent to File.

Based on the evidence, the Board finds that an effective date earlier than November 5, 2024, for the grant of service connection for an eczema disability is not warranted as the claims file does not reflect that any communication filed prior to that date could be construed as a formal or informal claim for these specific benefits.

As the Veteran's claim for service connection for an eczema disability was not received within one year of his May 2016 separation from service, the effective possible effective date is the date of receipt of the Veteran's Intent to File, November 5, 2024. 38 C.F.R. § 3.400(b) (2) (i).

Accordingly, the Board finds that there otherwise is no basis for the assignment of an effective date earlier than November 5, 2024, for the award of entitlement to service connection for an eczema disability. The claims file does not reflect that any communication filed prior to that date could be construed as a formal or informal claim for these specific benefits.

Under these circumstances, the claim for an earlier effective date must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the most persuasive evidence is against assignment of an effective date earlier than November 5, 2024, for the award of entitlement to service connection for an eczema disability, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53- 56 (1990).

Higher Initial Rating

Laws and Regulations

The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2012). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2021). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2021).

The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2021). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the
in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008).

In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his eczema disability. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities.

Eczema

The February 2025 rating decision granted service connection for an eczema disability at an initial noncompensable rating, effective November 5, 2024, under Diagnostic Code 7806.

As a result, the Veteran currently has an initial noncompensable disability rating for eczema pursuant to Diagnostic Code 7806.

Under the General Rating Formula for the Skin, Diagnostic Code 7806 governs dermatitis and eczema. For the purpose of evaluating skin conditions, systemic therapy is treatment administered through any route (orally, injection, in a suppository, intranasally) other than the skin. 38 C.F.R. § 4.118 (a). Topical therapy is a treatment that is administered through the skin. Id.

Under Diagnostic Code 7806, a noncompensable disability rating is warranted with no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected; or rate as disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7804, or 7805), depending upon the predominant disability.

A 10 percent evaluation is warranted with characteristic lesions involving at least 5 percent but less than 20 percent of the entire body affected or at least 5 percent but less than 20 percent of exposed areas affected; or intermittent systemic therapy, including, but not limited to, corticosteroids, phototherapy retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs for a total duration of less than 6 weeks over the past 12-month period.

A 30 percent rating is warranted with at least one of the following: characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration 6 weeks or more, but not constantly, over the past 12-month period.

A 60 percent rating is warranted with at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period.

The Veteran underwent a VA examination in February 2025. The diagnosis was dermatitis or eczema. He had used over the counter eczema cream as needed. Flares occurred intermittently with weather changes. The Veteran had not had any treatments or procedures other than systemic or topical medications in the past 12 months for any skin condition. The eczema and dermatophytosis covered 5 percent to less than 20 percent of his total body area and none of his exposed area. None of the Veteran's skin conditions caused scarring and the examiner noted that the Veteran's skin disability did not impact his ability to work.

When affording the Veteran the benefit of the doubt, the Board
over the past 12-month period.

When affording the Veteran the benefit of the doubt, the Board finds that the Veteran is entitled to an initial 10 percent rating for his eczema disability.

Based on the February 2025 VA examination, the evidence of record reflects that the Veteran has characteristic lesions involving at least 5 percent but less than 20 percent of the entire body affected which warrants an initial 10 percent rating under Diagnostic Code 7806.

However, the Board finds that the evidence persuasively weighs against assignment of an initial disability rating in excess of 10 percent. At no point during the period on appeal has the Veteran's eczema covered 20 percent or more of exposed areas or total body area, and the Veteran has not contended otherwise. Further, there is no evidence of record reflecting that the Veteran's eczema has required systemic treatment. Given the above, a higher rating under the General Formula for Rating the Skin is not warranted.

The Board has considered other potentially applicable diagnostic codes and finds that a higher and/or separate disability rating under another diagnostic code is not warranted.

Therefore, the Board finds that an initial 10 percent rating, but no higher, under Diagnostic Code 7806 for the Veteran's eczema with skin lesions is warranted. 38 C.F.R. § 4.3, 4.118.

Service Connection

Laws and Regulations

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).

To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain diseases, such as bilateral hearing loss and tinnitus, are presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2021).

Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden for certain chronic disabilities such as bilateral hearing loss and tinnitus is through a demonstration of continuity of symptomatology.

In relevant part, 38 U.S.C. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the prob
Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b).

Bilateral Hearing Loss

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Tests are less than 94 percent. 38 C.F.R. § 3.385. Additionally, it is noted that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993).

Factual Background and Analysis

The Veteran's service treatment records are negative for complaints of, treatment for, or findings of bilateral hearing loss.

The Veteran underwent a VA examination in February 2024.

The February 2024 VA examination revealed pure tone thresholds, obtained by air conduction, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 50 50 50 60 70

LEFT 50 50 50 60 75

Speech audiometry revealed speech recognition ability of 98 percent in the right ear and 94 in the left ear.

The examiner opined that it was less likely than not that the Veteran's current bilateral hearing loss was incurred in or caused by the Veteran's military noise exposure. The examiner noted that the Veteran's hearing in-service did not experience a change in thresholds.

An October 2024 private audiologist conducted a hearing test which revealed pure tone thresholds, obtained by air conduction, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 30 30 20 15 15

LEFT 35 30 25 20 25

Speech audiometry revealed speech recognition ability of 92 percent in the right ear and 96 in the left ear.

The Veteran underwent a VA examination in October 2024.

The October 2024 VA examination revealed pure tone thresholds, obtained by air conduction, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 25 25 15 25 20

LEFT 25 25 20 25 30

Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 96 in the left ear.

When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for bilateral hearing loss is not warranted.

The Board initially notes that there is some question as to whether the Veteran has demonstrates bilateral hearing loss disability by VA standards. While the February 2024 VA examination demonstrates bilateral hearing loss per the VA standards, the audiogram results are markedly different from the subsequent October 2024 private audiogram and October 2024 VA examination. Notably, the October 2024 private examination does not demonstrate left ear hearing loss by VA standards while the October 2024 VA examination does not demonstrate bilateral hearing loss in accordance with VA standards.

However, when affording the Veteran the benefit of the doubt, the Board finds that there is competent evidence reflective of bilateral hearing loss disability as defined by 38 C.F.R. § 3.85.

Accordingly, the record shows that the Veteran currently has right ear and left ear hearing loss for VA compensation purposes
by VA standards. While the February 2024 VA examination demonstrates bilateral hearing loss per the VA standards, the audiogram results are markedly different from the subsequent October 2024 private audiogram and October 2024 VA examination. Notably, the October 2024 private examination does not demonstrate left ear hearing loss by VA standards while the October 2024 VA examination does not demonstrate bilateral hearing loss in accordance with VA standards.

However, when affording the Veteran the benefit of the doubt, the Board finds that there is competent evidence reflective of bilateral hearing loss disability as defined by 38 C.F.R. § 3.85.

Accordingly, the record shows that the Veteran currently has right ear and left ear hearing loss for VA compensation purposes. Accordingly, as there is a current bilateral hearing loss disability, the first element of service connection is satisfied.

However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000).

Turning to in-service injury, the Board notes that the Veteran has asserted that he sustained acoustic trauma during service. In this regard, the Veteran is competent to give evidence about what he experienced, and acoustic trauma is subject to lay observation. See e.g., Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). Therefore, the Board finds that the Veteran was exposed to hazardous noise during service and noise exposure has been conceded.

However, the Veteran's service treatment records are negative for findings of a bilateral hearing loss disability.

Additionally, the Board notes that there are no clinical findings or diagnoses of bilateral hearing loss during service or for several years thereafter.

None of the private or VA treatment records show that the Veteran was diagnosed with bilateral hearing loss to a compensable degree within one year of service. To the extent that the Veteran is asserting a continuity of symptomatology since service, the Board does not find the Veteran to be credible with regard to any assertions that he has had symptoms of bilateral hearing loss disability since service. There was no indication in the record, to include any statements from the Veteran of hearing trouble within one year of his separation. On the contrary, the lack of any findings pertaining to hearing loss during service weigh against a finding that the Veteran's current bilateral hearing loss disability was originally manifested during service and have continued since service.

As the Veteran's service treatment records were negative for any complaints, treatment, or diagnoses of a hearing loss disability, he was not diagnosed with a hearing loss disability until many years after service, and there was a significant period between his service and his post-service complaints where the medical record was silent for complaints of a hearing loss disability, the Board concludes that the weight of the evidence is against a finding of continuity of symptomatology since service.

Additionally, the most probative opinions do not show a relationship between a bilateral hearing loss disability and the Veteran's in-service noise exposure.

As noted above, the February 2024 examiner determined that it was less likely as not that the Veteran's hearing loss disability was caused by or a result of military noise exposure.

None of the competent medical evidence currently of record refutes this conclusion, and the Veteran has not presented any such existing medical evidence or opinion.

The report of the February 2024 VA examination again reflects that the examiner reviewed the Veteran's past medical history, recorded his current complaints, conducted appropriate evaluations of the Veteran, and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record. Thus, the Board finds that the February 2024 VA examination report is adequate for purposes of rendering a decision in the instant appeal. See 38 C.F.R. § 4.2 (2016); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

As a result, the Board finds that the competent evidence of record, while showing the currently diagnosed disability of bilateral hearing loss, does not demonstrate hearing loss manifested to a compensable degree within one year of separation. Additionally, given that the most probative opinion is against a finding of a relationship between a claimed hearing loss disability and service, the Board finds that service connection is not warranted.

For the foregoing reasons, the Board concludes that the most persuasive evidence is against
2024 VA examination report is adequate for purposes of rendering a decision in the instant appeal. See 38 C.F.R. § 4.2 (2016); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

For the foregoing reasons, the Board concludes that the most persuasive evidence is against the claim of entitlement to service connection for a bilateral hearing loss disability. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

Tinnitus

The Veteran's service treatment records were negative for treatments or complaints related to tinnitus.

The Veteran underwent a VA examination in February 2024. The examiner opined that it was less likely than not that the Veteran's current tinnitus was incurred in or caused by the claimed in-service noise exposure. The examiner, however, noted that a July 2018 report was positive for tinnitus and as a result, it was at least as likely as not that the Veteran's tinnitus was related to his military noise exposure.

The Veteran underwent a VA examination in October 2024. The Veteran reported that the ringing of his ears began in January 2016. The examiner opined that it was less likely than not that the Veteran's current tinnitus was incurred in or caused by the claimed in-service noise exposure. The examiner noted that the Veteran's Military Occupational Specialty (MOS) of Supply Specialist was associated with a low probability of hazardous noise. The Veteran's hearing also remained within normal limits throughout his service. There was no evidence that the Veteran's military noise exposure caused a permanent noise injury affecting hearing sensitivity.

When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for a tinnitus disability is not warranted.

Accordingly, the record shows that the Veteran currently has a diagnosis of bilateral tinnitus. As a result, the first element of service connection is satisfied.

However, the Veteran's service treatment records are negative for complaints or treatments regarding a bilateral hearing loss or tinnitus disability.

Additionally, the Board notes that there are no clinical findings or diagnoses of tinnitus during service or for several years thereafter.

None of the VA treatment records show that the Veteran was diagnosed with tinnitus to a compensable degree within one year of service. To the extent that the Veteran is asserting a continuity of symptomatology since service, the Board does not find the Veteran to be credible with regard to any assertions that he has had symptoms of tinnitus since service. There was no indication in the record, to include any statements from the Veteran of hearing trouble or tinnitus within one year of his separation. On the contrary, the lack of any findings pertaining to hearing loss during service weigh against a finding that the Veteran's current tinnitus was originally manifested during service and have continued since service.

As the Veteran's service treatment records were negative for any complaints, treatment, or diagnoses of a hearing loss disability or tinnitus and there was a period between his service
able degree within one year of service. To the extent that the Veteran is asserting a continuity of symptomatology since service, the Board does not find the Veteran to be credible with regard to any assertions that he has had symptoms of tinnitus since service. There was no indication in the record, to include any statements from the Veteran of hearing trouble or tinnitus within one year of his separation. On the contrary, the lack of any findings pertaining to hearing loss during service weigh against a finding that the Veteran's current tinnitus was originally manifested during service and have continued since service.

As the Veteran's service treatment records were negative for any complaints, treatment, or diagnoses of a hearing loss disability or tinnitus and there was a period between his service and his post-service complaints where the medical record was silent for complaints of tinnitus, the Board concludes that the weight of the evidence is against a finding of continuity of symptomatology since service.

Additionally, the most probative opinions do not show a relationship between the tinnitus disability and the Veteran's in-service noise exposure.

The Board notes that there are conflicting medical opinions of record addressing the possibility of a relationship between the Veteran's current tinnitus disability and his service.

Notably, a the February 2024 VA examiner opined that it was less likely than not that the Veteran's current tinnitus was incurred in or caused by the claimed in-service noise exposure but also noted that a July 2018 report was positive for tinnitus and as a result, it was at least as likely as not that the Veteran's tinnitus was related to his military noise exposure.

Conversely, the October 2024 VA examiner opined that it was less likely than not that the Veteran's tinnitus disability was incurred in or caused by the Veteran's in-service noise exposure.

In this regard, the Board may favor the opinion of one competent medical professional over that of another so long as an adequate statement of reasons and bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). An evaluation of the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the examiner's knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. Guerrieri v. Brown, 4 Vet. App. 467 (1993).

Greater weight may be placed on one physician's opinion over another depending on factors such as reasoning employed by the physicians and whether or not and the extent to which they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. Sklar v. Brown, 5 Vet. App. 140 (1993).

In this instance, the Board finds that the October 2024 opinions of the VA examiner to be the most probative.

Regarding the February 2024 VA examination, the Board again notes that the examiner attributed the Veteran's current tinnitus to his military noise exposure. However, the examiner seemingly based this positive nexus opinion on the Veteran being diagnosed with tinnitus in July 2018, which was more than 2 years after his separation from service.

In contrast, the October 2024 VA examiner provided detailed medical opinions supported by pertinent rationales based upon a review of the Veteran's claims file, when concluding that the Veteran's claimed tinnitus disability was less likely than not incurred during the Veteran's active military service to include military noise exposure.

Notably, the October 2024 VA examiner specifically noted that the Veteran's Military Occupational Specialty (MOS) of Supply Specialist was associated with a low probability of hazardous noise and the Veteran's hearing also remained within normal limits throughout his service. The examiner concluded that there was no evidence that the Veteran's military noise exposure caused a permanent noise injury affecting hearing sensitivity.

The Board finds the October 2024 VA examiner's opinion to be adequate and reliable and affords it probative weight. See id. The examiner again considered the Veteran's relevant medical history and contentions when formulating the opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). The October 2024 VA examiner's opinion also contains sufficient rationale for the conclusion reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate
concluded that there was no evidence that the Veteran's military noise exposure caused a permanent noise injury affecting hearing sensitivity.

The Board finds the October 2024 VA examiner's opinion to be adequate and reliable and affords it probative weight. See id. The examiner again considered the Veteran's relevant medical history and contentions when formulating the opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). The October 2024 VA examiner's opinion also contains sufficient rationale for the conclusion reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion).

For these reasons the Board finds the October 2024 VA examiner's opinion to be the most probative regarding the issue of whether the Veteran's current tinnitus disability was related to his service. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) ("It is the responsibility of the BVA to assess the credibility and weight to be given the evidence.") (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Guerrieri v. Brown, supra, (the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board).

Given that the most probative opinion is against a finding of a relationship between a claimed tinnitus disability and service, the Board finds that service connection is not warranted.

For the foregoing reasons, the Board concludes that the most persuasive evidence is against the claim of entitlement to service connection for tinnitus. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

Bilateral Feet, Muscle Pain and Sleep Disorder

The Veteran contends that he has current bilateral feet, muscle pain and sleep disorder disabilities that were incurred in service.

The Veteran's service treatment records are negative for treatments or complaints related to bilateral feet, muscle pain and sleep disorder disabilities.

When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for bilateral feet, muscle pain and sleep disorder disabilities is not warranted.

The Veteran reports that he has bilateral foot pain, muscle pain and sleeping difficulties. As a result, and when affording the Veteran the benefit of the doubt, the Board finds that there is a current low back disability and the first element of service connection is satisfied. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000).

Notably, the Veteran's service treatment records are negative for complaints, treatment or diagnoses related to bilateral feet, muscle pain and sleep disorder disabilities.

Further, there is no competent evidence or opinion even suggesting that there exists a medical nexus between current bilateral feet, muscle pain and sleep disorder disabilities and the Veteran's service and the Veteran has not presented or identified any such existing medical evidence or opinion.

The Board finds that the competent evidence of record, while showing the currently diagnosed muscle pain, does not demonstrate that the Veteran's muscle pain is related to the Veteran's service.

The Board notes that the Veteran was not provided with a VA examination and opinions to assess the current nature and etiology of his claimed bilateral feet, muscle pain and sleep disorder disabilities. However, VA need not conduct an examination with respect to the claims on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claims. See 38 C.F.R. § 3.159(c) (4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when 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, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as there is no credible evidence that the bilateral feet, muscle pain and sleep disorder disabilities manifested in service. There is also no competent evidence suggesting that these disabilities are otherwise associated to service. Thus, remand for VA examinations is not necessary.

All Disabilities

Notably, on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) was enacted. 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 a toxic exposure risk activity ("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 gastrointestinal disabilities and the toxic exposure risk activities during service. Pub. L. 117-168, § 303 (to be codified at 38 U.S.C. § 1168).

However, pursuant to the PACT Act, VA issued TERA memorandum in December indicating no participation in a TERA during service.

The Board also notes the Veteran's contentions regarding the etiology of his claimed bilateral hearing loss, tinnitus, bilateral feet, muscle pain and sleep disorder disabilities. To the extent that the Veteran himself contends that a medical relationship exists between his claimed bilateral hearing loss, tinnitus, bilateral feet, muscle pain and sleep disorder disabilities and service, the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In the instant case, however, the Board finds that bilateral hearing loss, tinnitus, bilateral feet, muscle pain and sleep disorder disabilities are not disabilities subject to lay diagnosis as these diagnoses require medical training.

More significantly, the Veteran and his representative do not have the medical expertise to provide an opinion regarding the claimed bilateral hearing loss, tinnitus, bilateral feet, muscle pain and sleep disorder disabilities etiologies. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999).

In sum, for the reasons and bases expressed above the Board finds that the most persuasive evidence is against the Veteran's claim of entitlement to service connection for bilateral hearing loss, tinnitus, bilateral feet, muscle pain and sleep disorder disabilities. The benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b).

REASONS FOR REMAND

The Board finds that more development is necessary prior to final adjudication of the claims remaining on appeal.

Regarding the Veteran's claim for an acquired psychiatric disorder, to include PTSD, depression and anxiety, the Veteran contends that he has an acquired psychiatric disorder as a result of active service.

The Veteran underwent a VA examination in December 2024. The examiner opined that it was less likely than not that the
is against the Veteran's claim of entitlement to service connection for bilateral hearing loss, tinnitus, bilateral feet, muscle pain and sleep disorder disabilities. The benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b).

REASONS FOR REMAND

The Board finds that more development is necessary prior to final adjudication of the claims remaining on appeal.

The Veteran underwent a VA examination in December 2024. The examiner opined that it was less likely than not that the Veteran's diagnosed unspecified depressive disorder was incurred in or caused by the Veteran's claimed in-service injury, event or illness. However, while the December 2024 VA examiner indicated that the Veteran had a diagnosis of unspecified depressive disorder, the examiner did not indicate whether the Veteran met the criteria for a diagnosis of PTSD under DSM-5.

As a result, the Board finds that the December 2024 opinions do not adequately address whether the Veteran has a current PTSD diagnosis that is related to any incident of the Veteran's active-duty service, to include a fear of hostile military or terrorist activity.

The Board also notes that a February 2024 private treatment report reflects a diagnosis of PTSD. However, there is no current diagnosis of PTSD that specifically conforms to the DSM-5 criteria.

An examination or opinion is necessary to make a decision on a claim if the evidence of record contains competent evidence that the claimant has a current disability, and indicates that the disability or symptoms may be associated with the claimant's active military history, but does not contain sufficient medical evidence to make a decision on the claim. See 38 U.S.C. § 5103A (d) (2); 38 C.F.R. § 3.159(c) (4).

As a result, the Board finds that further development is warranted so an examiner can provide an opinion to determine whether the Veteran has a current acquired psychiatric disorder to include PTSD disability, that is related to his service. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c) (4).

Regarding the claim for entitlement to service connection for hypertension, the Board notes that for hypertension, regulations provide that hypertension for VA purposes means that the diastolic blood pressure is predominantly 90 or more or systolic blood pressure is predominantly 160 or more. Hypertension must be confirmed by readings taken two or more times on three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1).

Notably, the Veteran's service treatment records contain instances of elevated blood pressure readings to include blood pressure readings of 124/84 in January 2016 and 130/88 in February 2016.

As reflected above, for hypertension, regulations provide that hypertension for VA purposes means that the diastolic blood pressure is predominantly 90 or more or systolic blood pressure is predominantly 160 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1).

Notably, the Veteran has yet to undergo a VA examination for his claimed hypertension disability.

Thus, the Board finds that the evidence currently of record is insufficient to resolve the claim for entitlement to service connection for hypertension and that further development is warranted so an examiner can provide an opinion to determine whether the Veteran has a current hypertension disability that is related to his service. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991); 38 C.F.R. § 3.159(c) (4).

Regarding the claim for entitlement to service connection for asthma, the Veteran's service treatment records contain instances of breathing related complaints as the Veteran presented with reports of an upper respiratory infection in February 2016 which impacted his breathing.

Notably, the Veteran has yet to undergo a VA examination for his claimed asthma disability.

Thus, the Board finds that the evidence currently of record is insufficient to resolve the claim for entitlement to service connection for asthma and that further development is warranted so an examiner can provide an opinion to determine whether the Veteran has a current asthma disability that is related to his service. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991); 38 C.F.R. § 3.159(c) (4).

The Board noted that AMA provides that remands are warranted based on VA's duty to assist prior to the AOJ decision. Pub. L. No. 115-55, § 2(d)(2). The AMA structure allows remand only where VA has committed error in the duty
the Board finds that the evidence currently of record is insufficient to resolve the claim for entitlement to service connection for asthma and that further development is warranted so an examiner can provide an opinion to determine whether the Veteran has a current asthma disability that is related to his service. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991); 38 C.F.R. § 3.159(c) (4).

The Board noted that AMA provides that remands are warranted based on VA's duty to assist prior to the AOJ decision. Pub. L. No. 115-55, § 2(d)(2). The AMA structure allows remand only where VA has committed error in the duty-to-assist (DTA) prior to the decision on appeal. The Board finds that the basis for this remand arises from deficiencies in the record existing prior to the appealed AMA decision. Notably, prior to the rating decisions, there was possible evidence of an acquired psychiatric disorder to include PTSD disability as treatment records have demonstrated psychiatric symptomatology and the February 2024 private treatment report noted a diagnosis of PTSD. Despite the possible current diagnosis, the Veteran was not provided with an adequate VA examination with etiological opinions regarding the acquired psychiatric disorder to include PTSD disability prior to the appealed AMA decision. Regarding the Veteran's claimed hypertension and asthma disabilities, the Veteran was not provided with VA examinations despite possible in-service incurrences of these disabilities.

Thus, the Board finds that a remand is necessary in order to provide the Veteran with etiological opinions with respect to these claimed conditions as there exists a pre-decisional duty to assist error and the claims must be remanded.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an appropriate VA examination, to determine the nature and etiology of his acquired psychiatric disorder disability.

Based on a review of the record, the examiner should provide an opinion as to whether the Veteran has/has had during the appeal period a current acquired psychiatric disorder disability in accordance with DSM-V.

If so, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran currently has an acquired psychiatric disorder, to include PTSD if diagnosed, that is related to any incident of the Veteran's active duty service, to include a fear of hostile military or terrorist activity?

Adequate reasons and bases for any opinion must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail.

The claims file, including a copy of this remand, should be made available to the examiner, who should review the entire claims folder in conjunction with this examination.

2. Schedule the Veteran for an appropriate VA examination, to determine the nature and etiology of his claimed hypertension disability.

Based on a review of the record, the examiner should provide an opinion 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 has a current hypertension disability that is related to any incident of the Veteran's service.

All opinions expressed by the examiner must be accompanied by a complete rationale.

Adequate reasons and bases for any opinion rendered must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail. The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination.

3. Schedule the Veteran for an appropriate VA examination, to determine the nature and etiology of his claimed asthma disability.

Based on a review of the record, the examiner should provide an opinion 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 has a current asthma disability that is related to any incident of the Veteran's service.

All opinions expressed by the examiner must be accompanied by a complete rationale.

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board James A. DeFrank

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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