judge_norm: G E WILKERSON

judge_role: Acting Veterans Law Judge

condition: kidney

condition: gi

condition: hypertension

condition: back

text:
Citation Nr: A26022000
Decision Date: 03/11/26	Archive Date: 03/11/26

DOCKET NO. 250127-513135
DATE: March 11, 2026

ORDER

Entitlement to service connection for a kidney disability is denied.

Entitlement to service connection for an eye condition, to include as due to diabetes mellitus, Type II (DM II) is denied.

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

Entitlement to service connection for left ear hearing loss is denied.

Entitlement to an initial disability rating in excess of 70 percent, but no higher, for adjustment disorder is granted.

Entitlement to an initial compensable disability rating for right ear hearing loss is denied.

Entitlement to an initial compensable disability rating for binge-eating disorder is denied.

Entitlement to an initial disability rating in excess of 10 percent for hypertension is denied.

Entitlement to an effective date earlier than July 21, 2021, for the award of service connection for right ear hearing loss is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for adjustment disorder is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for binge-eating disorder is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for lumbosacral strain is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for hypertension is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for IBS is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for right and left ankle strain is denied.

Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for right and left knee strain is denied

REMANDED

Entitlement to service connection for DM II, to include as due to service-connected flat feet and adjustment disorder with obesity as an intermediate step is remanded.

Entitlement to an initial compensable disability rating for irritable bowel syndrome (IBS) is remanded.

Entitlement to an initial disability rating in excess of 20 percent for lumbosacral strain is remanded.

Entitlement to initial disability ratings in excess of 10 percent each for right and left ankle strains is remanded.

Entitlement to initial disability ratings in excess of 10 percent for each for right and left knee strains is remanded.

FINDINGS OF FACT

1. A kidney condition was not diagnosed at any time during or approximate the pendency of the claim.

2.  An eye condition was not diagnosed at any time during or approximate the pendency of the claim.

3. GERD was not diagnosed at any time during or approximate the pendency of the claim.

4. The appellant's adjustment disorder is manifested with symptoms including difficulty in adapting to stressful circumstances (including work or a worklike setting), and occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. The severity, frequency, and duration of the appellant's symptoms do not more closely approximate total occupational and social impairment as the appellant is able to work and maintain relationships with his friends and family.

6. The appellant did not provide good cause for his failure to report for a VA examination of his left ear hearing loss.

7. The appellant did not provide good cause for his failure to report for a VA examination of his right ear hearing loss.

8. The appellant's binge-eating disorder does not manifest with binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder and incapacitating episodes of up to two weeks total duration per year.

9. The appellant's hypertension does not manifest in diastolic pressure predominately 110 or more, or; systolic pressure predominantly 200 or more.

10. The appellant submitted an Intent to File on July 12, 2021, followed by a claim for compensation for a bilateral ankle disability, a bilateral knee disability, a low back disability, hypertension, IBS, and a mental health disability; there are no earlier communications reflecting an intent to seek compensation for any of these disabilities.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a kidney disability are not met.  38 U.S.C. �� 1110, 5107; 38 C.F.R. �� 3.102, 3.303.

2. The criteria for entitlement to service connection for an eye disability, to include as due to DM II, are not met.  38 U.S.C. �� 1110, 5107; 38 C.F.R. �� 3.102, 3.303, 3.310.

3. The criteria for entitlement to service connection for GERD are not met.  38 U.S.C. �� 1110, 5107; 38 C.F.R. �� 3.102, 3.303.

4. The criteria for entitlement to service connection for left ear hearing loss are not met.  38?U.S.C. �?5108;?38?C.F.R. �?3.655(a), (b).

5. The criteria for entitlement to an initial disability rating in excess of 70 percent, but no higher, for adjustment disorder are met.  38 U.S.C. �� 1155, 5107; 38?C.F.R. ��?4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411.

6. The criteria for entitlement to an initial compensable disability rating for right ear hearing loss are not met.  38?U.S.C. �?5108;?38?C.F.R. �?3.655(a), (b).

7. The criteria for entitlement to an initial compensable disability rating for a binge-eating disorder are not met.  38 U.S.C. �� 1155, 5107; 38 C.F.R. � 4.1, 4.3, 4.7, 4.126, 4.130, DC 9521.

8. The criteria for entitlement to an initial disability rating in excess of 10 percent for hypertension are not met.  38 U.S.C. �� 1155, 5107. 38 C.F.R. �� 4.1, 4.3, 4.7, 4.104, DC 7101.

9. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for right ear hearing loss have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

10. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for adjustment disorder have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

11. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for binge-eating disorder have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

12. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for lumbosacral strain have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

13. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for hypertension have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

14. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for IBS have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

15. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for right and left ankle strain have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

16. The criteria for an effective date earlier than July 12, 2021, for the award of service connection for right and left knee strain have not been met. 38 U.S.C. �� 5107, 5110; 38 C.F.R. �� 3.102, 3.400.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant served on active duty in the United States Marine Corps from August 1993 to September 1995.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2024 Higher-Level Review (HLR) of May 2023 and September 2023 rating decisions, a September 2024 rating decision, and a December 2024 rating decision by the Department of Veterans Affairs' (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ), under the modernized review system.  See 38 C.F.R. � 3.2400.  VA received a timely January 2025 notice of disagreement (NOD) to the March 2024, September 2024, and December 2024 rating decisions, selecting the Direct Review Docket.

Of procedural note, in the September 2023 rating decision, the AOJ did not address whether new and relevant evidence was received sufficient to readjudicate the issue of entitlement to service connection for DM II but instead addressed the merits of the claim.  The addressing of the merits of the claim is interpreted as a favorable finding as to the receipt of new and relevant evidence.  The AOJ's finding that evidence submitted is new and relevant is a favorable finding binding on the Board.  See 38 U.S.C. � 5104A; 38 C.F.R. � 3.104(c).  Similarly, in the December 2024 and March 2024 rating decisions, the AOJ addressed the merits of the issues of entitlement to service connection for a kidney condition, GERD, and left ear hearing loss, respectively.  In the September 2024 rating decision, the AOJ made the favorable finding new and relevant evidence had been received sufficient to readjudicate the issue of entitlement to service connection for an eye condition.  In consideration of these favorable findings, new and relevant evidence has been received, and the appellant's claims can be readjudicated.

The issue of entitlement to a TDIU as a result of service-connected disabilities is part and parcel of an increased rating claim.  Rice v. Shinseki, 22 Vet. App. 447, 453 (2009).  However, the evidence during the appeal period does not show, nor does the appellant claim, that he was unemployable due to his service-connected disabilities.  As such, the appellant has not alleged that his service-connected disabilities impacted his ability to find and retain full-time employment during the appeal period, and TDIU is not implicated.

As the appellant has selected the Direct Review Docket, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issues on appeal.  See 38 C.F.R. �� 20.300(a), 301.  The Board will not consider evidence received after the AOJ decision unless the claimant files a timely request for a Board hearing or an opportunity to submit additional evidence on the NOD (VA Form 10182).  38 C.F.R. � 20.301.  The appellant has not filed such a request. If additional evidence was submitted after the AOJ decision, the Board will not consider it.

If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant 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.  See also Cook v. McDonough, 36 Vet. App. 175 (2023).

With respect to the claims of entitlement to service connection for DM II, entitlement to an initial compensable disability rating for IBS, entitlement to an initial disability rating in excess of 20 percent for lumbosacral strain, entitlement to an initial disability rating in excess of 10 percent for bilateral ankle strains, and entitlement to an initial disability rating in excess of 10 percent for bilateral knee strains, as they are remanded herein, any evidence the Board could not consider will be considered by the AOJ.  38 C.F.R. � 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.? 38?U.S.C. ��?1110, 1131, 5107; 38?C.F.R. �?3.303.? The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship also known as a "nexus" between the current disability and the in-service disease or injury.? Shedden v. Principi,?381 F.3d 1163, 1166-67?(Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  38 C.F.R. � 3.310(a)-(b).  The United States Court of Appeals for the Federal Circuit clarified the standard for secondary service connection in Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023), finding that secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain.  Id.  Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability.  Id. at 1364.

The inability to prevail on a secondary basis does not foreclose the opportunity to prevail on a direct basis.  Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Circ. 1994).

1. Entitlement to service connection for a kidney disability

2. Entitlement to service connection for an eye disability to include as due to DM II

3. Entitlement to service connection for GERD

The appellant contends that he is entitled to service connection for a kidney disability, an eye disability, and GERD.

At the outset, the Board notes that the Veteran also seeks service connection for a left ear hearing loss disability, and that matter will be addressed with the claim for increased rating for right ear hearing loss.

The first element required for any theory of service connection is a current disability.  After a thorough review of the record, the claims file does not show a current diagnosis of a kidney disability, an eye disability or GERD, nor does it show a diagnosis of any such disabilities at any time during the pendency of the claim or recent to the filing of the claim.  See Romanowsky v. Shinseki,?26?Vet. App.?289, 294?(2013); McClain v. Nicholson, 21 Vet. App.?319, 321?(2007).

As to a kidney disability, a September 2020 VA treatment record noted that the appellant's kidney blood tests did not show significant abnormalities, even though the clinician stated the appellant had protein in his urine which is a sign of damage to the kidneys.  See VA Treatment Record, Administrative Note, September 10, 2020.  No other evidence suggests a diagnosis of a kidney condition, including a March 2024 VA diabetes examination, which revealed no kidney complications outside of the service-connected DM II. See VA Diabetes Mellitus DBQ, March 19, 2024

As to an eye disability, a January 2024 VA medical record noted the appellant's eye screening results presented normal findings.  See VA Treatment Record, Telemedicine Consult, January 28, 2024.  No diabetic complications, including complications related to the eye, were noted on March 2004 VA diabetes examination. See VA Diabetes Mellitus DBQ, March 19, 2024. An April 2024 VA medical examination confirmed there to be no eye diagnosis.  See VA Eye Conditions DBQ, April 25, 2024.  No other evidence suggests a diagnosis of an eye disability

As to GERD, a July 2021 VA treatment record noted a past history including GERD but did not provide a diagnosis of GERD.  See VA Treatment Record Discharge Summary, July 22, 2021.  No other evidence suggests a diagnosis of GERD during the pendency of the appeal

While the appellant believes that he has a current kidney disability, an eye disability, and GERD, and he is competent to relate his lay observations, he is not competent to provide diagnoses in this case.  The issues are medically complex, as it requires specialized medical education.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4?(Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011).

In addition, the Board acknowledges that sometimes symptoms, even without an underlying diagnosis, can still constitute a current disability, for VA compensation purposes, if such symptoms reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). However, the Veteran has not reported any symptoms resulting in functional impairment.

In light of the above, the evidence persuasively weighs against the claims of entitlement to service connection for a kidney disability, an eye disability, and GERD, and the benefit-of-the-doubt doctrine is not for application.  The claims therefore must be denied.  38 U.S.C. � 5107(b); see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc); 38 C.F.R. � 3.102.

Increased Rating

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule).? The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes.? 38?U.S.C. �?1155;?38?C.F.R. �?4.1.

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern.? Francisco v. Brown, 7?Vet. App.?55, 58 (1994).? Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous."? Fenderson v. West, 12?Vet. App.?119, 126 (1999).? In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time.? Fenderson, 12 Vet. App. at 126; see also Hart v. Mansfield, 21?Vet. App.?505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings).? When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed.? Hart, 21 Vet. App. at 509.

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits.  38 U.S.C. � 1154(a).  Competent lay evidence means any evidence not requiring that the proponent has specialized education, training, or experience. 38 C.F.R. � 3.159(c)(2).  Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.  Id.  The Board finds that the appellant is competent to report his symptoms and there is no evidence that his reports are not credible.  See Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007).

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating.? Otherwise, the lower rating will be assigned.? 38?C.F.R. �?4.7.? Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran.? 38?C.F.R. �?4.3.

4. Entitlement to an initial disability rating in excess of 50 percent for adjustment disorder

The appellant contends that he is entitled to a disability rating in excess of 50 percent for his adjustment disorder.

The appellant's adjustment disorder is assigned a 50 percent disability rating under 38 C.F.R. � 4.130, DC 9440.  DC 9440 assigns rating based upon the General Rating Formula for Mental Disorders (General Formula).? 38?C.F.R. �?4.130.

A 50 percent evaluation is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id.????

A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to suicidal ideation; obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation, neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships.? Id.????

A maximum 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; disorientation to time and place; memory loss for names of close relatives, own occupation, or own name.? Id.

Under the General Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria.? Bankhead v. Shulkin, 29?Vet. App.?10, 22 (2017); 38?C.F.R. �?4.130.? The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages.? Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating.? Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).? In that regard, the symptoms listed in the General Formula are not intended to constitute an exhaustive list.? Rather, the symptoms serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.? Mauerhan v. Principi, 16?Vet. App.?436 (2002).

The evidence of record includes a July 2021 VA treatment record in which the appellant stated that he had good interest in doing things, that he moved or spoke so slowly that people have noticed nearly every day, and that these problems made somewhat difficult to do work, take care of things at home, or get along with others.  See VA Treatment Record, Mental Health Diagnostic Study Note, July 30, 2021.  December 2021 VA treatment records noted the appellant was taking a leave of absence from his work because of stress but denied suicidal ideation.  See VA Treatment Record, Mental Health Note, December 1, 2021.  December 2022 VA treatment records noted the appellant had little interest in things more than half the days, had trouble concentrating nearly every day, and was easily annoyed nearly every day.  See VA Treatment Record, Mental Health Diagnostic Study Note, December 13, 2022.  He also explained these problems made it very difficult to do work, take care of things at home, or get along with others.  Id.

The appellant was afforded March 2023 VA examination of his adjustment disorder in which he explained that he had a great relationship with his wife and teenage son.  See VA Mental Disorders Disability Benefits Questionnaire (DBQ), March 20, 2023.  He further explained that he had friends and socialized and was currently working.  The clinician documented the appellant's symptoms as depressed mood, anxiety, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work like setting. The Veteran presented as adequately groomed and maintained eye contact. He displayed a flat affect and congruent mood.

On review of all the evidence addressing the appellant's disability during the period on review, the appellant's adjustment disorder more closely approximates occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood.  The evidence notes the named symptom of difficulty in adapting to stressful circumstances including work or a work like setting, further documented by treatment records indicating difficulties in work and getting along with others at work.  The overall effect of the appellant's symptoms impairs his ability to process stress, an occurrence both during and outside of work.

The appellant's adjustment disorder does not more closely approximate total occupational and social impairment.  The evidence does not show the listed symptoms of gross impairment in thought processes or communication, persistent delusions or hallucinations, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, grossly inappropriate behavior, disorientation to time or place, or memory loss for names of close relatives, own occupation, or own name.  No other listed or unlisted symptoms approximate symptoms in the 100 precent rating criteria.

As to social impairment, the appellant has consistently noted strong connections with his wife and son.  He was also documented on continuing to be able to socialize with friends.  As to occupational impairment, the appellant generally maintained employment throughout the period on review.  As such, the appellant's symptoms do not render him totally occupationally and socially impaired.

In summary, an initial disability rating of 70 percent, but no higher, for adjustment disorder is warranted.

5. Entitlement to service connection for left ear hearing loss.

6. Entitlement to an initial compensable disability rating for right ear hearing loss.

The appellant contends that he is entitled to service connection for left ear hearing loss and a compensable disability rating for his right ear hearing loss.

For procedural context, the appellant submitted an original claim for entitlement to service connection for left ear hearing loss in July 2021, which was denied in a December 2021 rating decision.  The appellant submitted a supplemental claim for service connection for left ear hearing loss in December 2021.  As such, his claim for service connection for left ear hearing loss is a supplemental claim and his claim for a compensable disability rating for his right ear hearing loss is a claim for increase.

While pursuing his claims, the appellant missed a February 2023 examination of his hearing.  See Exam Scheduling Request Contention Cancellation, February 9, 2023.  In March 2023, the appellant contacted the AOJ requesting to reschedule his examination but did not provide any cause as to why he missed the February 2023 examination.  See Report of General Information, March 8, 2023.  Subsequently, the appellant missed the rescheduled examination set in April 2023.  See Exam Scheduling Request Contention Cancellation, April 6, 2023.  No good cause was provided for failing to report for the examination.

Under 38 C.F.R. � 3.655(a), when entitlement to a benefit cannot be established without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination or reexamination, action shall be taken in accordance with 38 C.F.R. � 3.655(b) or (c) as appropriate.  38 C.F.R. � 3.655(b) applies to original or reopened claims or claims for increase, and 38 C.F.R. � 3.655(c) applies to running awards, when the issue is continuing entitlement. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, and death of an immediate family member.  38 C.F.R. � 3.655(a).  38 C.F.R. � 3.655(b) holds that when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record.  When the examination was scheduled in conjunction with any other original claim, a supplemental claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied.

As the appellant failed to report for examinations regarding his supplemental claim and claim for increase and did not present good cause for his failures to report, the claims must be denied.  Entitlement to service connection for left ear hearing loss and entitlement to an initial compensable disability rating for right ear hearing loss is not warranted.

7. Entitlement to an initial compensable disability rating for binge-eating disorder.

The appellant contends that he is entitled to a compensable disability rating for binge-eating disorder.

The appellant's binge-eating disorder is currently rated as noncompensable under DC 9521.  38 C.F.R. � 4.130.

DC 9521 is rated based on the Rating Formula for Eating Disorders.  Id.  A 10 percent rating applies to binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder and incapacitating episodes of up to two weeks total duration per year.

Upon review of the evidence, the appellant's binge-eating disorder does not manifest with the appellant self-inducing vomiting or using other measures to prevent weight gain or with incapacitating episodes.  The appellant underwent a VA examination of his eating disorders in March 2023.  See VA Eating Disorders DBQ, March 20, 2023.  The clinician noted the appellant had gained over 100 pounds over the course of 28 years and determined the appellant frequently ate copious amounts of food.  No vomiting or other measures to prevent weight gain or incapacitating episodes were noted.  No other evidence in the record indicates the appellant presented with such symptoms.

The Board has considered whether rating under another diagnostic code is appropriate, but has not found any other applicable code.

As such, entitlement to an initial compensable disability rating for binge-eating disorder is not warranted.

8. Entitlement to an initial disability rating in excess of 10 percent for hypertension.

The appellant contends that he is entitled to an initial disability rating in excess of 10 percent for hypertension.

Hypertension is rated pursuant to 38 C.F.R. � 4.104, DC 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension).  Under DC 7101, a 20 percent disability rating is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common."  See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

The Board may consider blood pressure readings taken while a veteran is using medication.  McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (holding that DC 7101 contemplates the effects of medication and therefore Jones v. Shinseki, 26 Vet. App. 56 (2012) does not apply).

Of note, the criteria for rating cardiovascular disabilities were amended, effective November 14, 2021.  However, there were no changes to the criteria for DC 7101.

The evidence of record includes numerous blood pressure reading.  See VA Treatment Record, Discharge Summary, July 22, 2021 (noting 142/95); VA Treatment Record, Nursing Note, December 7, 2021 (noting 138/90); VA Treatment Record, General Medicine Note, December 6, 2022 (noting 136/84); VA Treatment Record, Emergency Department Triage Note, January 22, 2023 (noting 148/97); VA Treatment Record, Emergency Department Triage Note, February 26, 2023 (noting 142/87); VA Treatment Record, Emergency Department Triage Note, May 1, 2023 (noting 124/77); VA Treatment Record, Internal Medicine Note, May 2, 2023 (noting 127/79); VA Treatment Record, Nursing Triage Note, January 5, 2024 (noting 122/78); VA Treatment Record, Otolaryngology Consult, February 20, 2024 (noting 177/96); VA Hypertension DBQ, March 19, 2024 (noting 153/103, 155/104, and 148/98).

Upon review of the evidence, the evidence does not show the appellant's diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more.  As shown in the above readings, the appellant's diastolic pressure never reached 110 or systolic pressure 200, let alone predominantly reaching those numbers.

As such, entitlement to an initial disability rating in excess of 10 percent for hypertension is not warranted.

Effective Dates

Under VA laws and regulations, a specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual under laws administered by the VA. 38 U.S.C. � 5101(a); 38 C.F.R. � 3.151(a).

In general, the effective date of an award based on an original claim or a claim reopened after final adjudication of compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of the receipt of the application. 38 U.S.C. � 5110 (a); 38 C.F.R. � 3.400. However, if the claim is received within one year after separation from service, the effective date of an award of disability compensation shall be the day following separation from active service. 38 U.S.C. � 5110(b)(1); 38 C.F.R. � 3.400(b)(2)(i).

"Claim" is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38C.F.R. �3.1(p); Brannon v. West,12 Vet. App. 32, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Effective on March 24, 2015, VA amended its regulations as to what constitutes a claim for benefits. The amendment requires that claims be made on a standard form prescribed by the Secretary, effectively eliminating informal claims. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The changes, however, are only effective for claims and appeals filed on or after March 24, 2015.

A claimant, or certain other individuals as specified in section 3.155(b), may indicate a claimant's intent to file a claim for benefits by submitting an intent to file a claim to VA. 38 C.F.R. � 3.155(b). An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. Upon receipt of the intent to file a claim, VA shall furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, as defined in 38 C.F.R. � 3.160(a), appropriate to the benefit sought within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date of the intent to file a claim was received. 38 C.F.R. � 3.155(b).

9. Entitlement to an effective date earlier than July 21, 2021, for the award of service connection for right ear hearing loss

10. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for adjustment disorder

11. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for binge-eating disorder

12. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for lumbosacral strain

13. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for hypertension

14. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for IBS

15. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for right and left ankle strain

16. Entitlement to an effective date earlier than July 12, 2021, for the award of service connection for right and left knee strain

In this case, VA received a VA Form 21-0966, Intent to File, on July 12, 2021, followed by a VA Form 21-526EZ, identifying various claims, including claims for hearing loss, a bilateral ankle disability, a bilateral knee disability, hypertension, IBS, and a mental health disorder.

In December 2021 rating decision, the AOJ granted service connection for right ear hearing loss and assigned an effective date of July 12, 2021, while denying the remaining claims. The Veteran filed a supplemental claim in December 2022, and in a May 2023 rating decision, the AOJ granted service connection for adjustment disorder and assigned an effective date of December 14, 2022; the AOJ later assigned an effective date of July 12, 2021, following the Veteran's filing of higher-level review in October 2023. In a December 2024 rating decision, the remaining claims were granted, and effective dates of July 12, 2021, for each claim were granted, given the Veteran's continuous pursuit of these issues since the filing of the July 12, 2021, Intent to File. See 38 C.F.R. � 3.2500(h).

The Board has reviewed the claims file, and has found no earlier communication reflecting an intent to seek compensation for his hearing loss, bilateral knee, bilateral ankle, psychiatric, hypertension, and IBS disabilities. In his 1995 and 2014 VA Form 21-526, Application for Compensation, the Veteran did not identify any related disabilities.

To the extent that the Veteran's claim for service connection for a sleep disorder can be interpreted as a claim for a psychiatric disability, that matter was denied in a November 2014 rating decision; he did not appeal that decision nor submit new and material evidence within one year of the decision and that decision is therefore final. See 38 U.S.C. � 7105(c); 38 C.F.R. �� 3.156(b), 20.1103.The next communication regarding the claims is the Intent to File and subsequent claim.

The applicable law and regulations clearly make it the Veteran's responsibility to initiate a claim for compensation with VA if he seeks that benefit. While VA has a duty to assist a claimant in developing facts pertinent to a claim, it is the claimant who must bear the responsibility for coming forth with the submission of a claim for benefits under the laws administered by VA. See 38 U.S.C. � 5101(a); 38 C.F.R. � 3.151(a).

The Veteran has not advanced any other specific contentions in support of his claim for earlier effective dates. To the extent that he asserts that the disabilities were present prior to the claim/since service, the Board reiterates that what is material in this case is when the records show that the claim for compensation for disability relating to the right hip and back was filed, despite the fact that the Veteran's disabilities may have been present at an earlier time point.

Accordingly, the claims for earlier effective dates must be denied.

REASONS FOR REMAND

An appellant's claims must be remanded to the AOJ to correct pre-decisional duty to assist errors, including when the AOJ fails to make reasonable efforts to obtain VA treatment records, relevant federal or private treatment records; fails to obtain a VA examination; or provides an inadequate VA examination or opinion. 38 C.F.R. � 20.802(a).

1. Entitlement to service connection for DM II, to include as due to service-connected flat feet and adjustment disorder with obesity as an intermediate step.

Generally, a precedential opinion of VA's General Counsel, VAOPGCPREC 1-2017, explains that obesity may be an "intermediate step" between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. � 3.310(a).  In such cases, the question is (1) whether the service-connected disability caused a veteran to become obese; (2) if so, whether the obesity was a substantial factor in causing the disability for which service connection is sought; and (3) whether the disability for which service connection is sought would not have occurred but for obesity caused by the service-connected disability.

The appellant was afforded a number of VA medical opinions in October 2024 regarding the connection between the appellant's service-connected disabilities and his obesity and the connection between his obesity and his DM II.  See VA Medical Opinion DBQs, October 13, 2024.  In each opinion, the clinician concludes that the appellant's service-connected bilateral pes planus and adjustment disorder caused the appellant to become obese, which in turn caused the appellant to develop DM II.  However, the rationales for the opinions did not address the required questions in determining whether the appellant's obesity serves as an intermediate step, specifically, whether the appellant's obesity was a substantial factor in causing or aggravating the appellant's DM II and whether the appellant's DM II would not have occurred or been aggravated but for the appellant's obesity.  As such, the opinions are conclusory.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (concluding that a medical opinion is not entitled to any weight "if it contains only data and conclusions") see also Stefl v. Nicholson, 21 Vet. App. 120, 124(2007) (an adequate medical examination must provide a rationale and explanation for its conclusions).  For this reason, a remand for a new VA medical opinion is warranted.

2. Entitlement to an initial compensable disability rating for IBS

3. Entitlement to an initial disability rating in excess of 20 percent for lumbosacral strain

4. Entitlement to initial disability ratings in excess of 10 percent each for right and left ankle strains

5. Entitlement to initial disability ratings in excess of 10 percent for right and left knee strains

To the extent that medications are not contemplated by the rating criteria, the adjudicator must assess the effects of the medications and determine the severity of the symptoms in the absence of medications.  See Ingram v. Collins, 38 Vet. App. 130 (2025); Jones v. Shinseki, 26 Vet. App. 56, 61 (2012).

The appellant's IBS is currently assigned a noncompensable disability rating under DC 7319.  38 C.F.R. � 4.114.  While the rating criteria for Digestive Conditions was amended effective May 19, 2024, both pre- and post-amendment criteria do not contemplate the effects of medication.  In March 2024, the appellant was afforded a VA examination of his IBS which noted the use of Immodium, meant to reduce the severity of the symptoms of his IBS.  See VA Intestinal Conditions DBQ, March 19, 2024.  It is unclear from the present record the severity of the appellant's IBS discounted the beneficial effects of the medication, which is needed in order to properly assess the severity of the appellant's disability more accurately.  See Ingram, supra; Jones, supra.

Similarly, March 2024 examinations of the appellant's back disability, ankle disabilities, and knee disabilities all note the use of medication but do not provide insight as to the severity of the disabilities discounted the beneficial effects of the medication.  As such, a remand for new VA examinations is warranted.

The matters are REMANDED for the following action:

1. Obtain an addendum VA medical opinion from an appropriate clinician regarding the nature and etiology of the appellant's DM II.  The claims file should be made available for the clinician to review, and the report should reflect that such review was accomplished.  The clinician should review the entire claims file.  Thereafter, the clinician should address the following:

(a.) State whether, but for the appellant's service-connected bilateral pes planus and/or adjustment disorder, he would not have been obese or that his obesity would have been less severe and resulted in less functional impairment.

(b.) State whether the obesity resulting from or aggravated by the service-connected bilateral pes planus and/or adjustment disorder was a substantial factor in causing or aggravating his DM II.

(c.) State whether the appellant's DM II would not have occurred or would have been less severe and result in less functional impairment but for the obesity that was caused or aggravated by his service-connected bilateral pes planus and/or adjustment disorder.

(d.) If the clinician opines that the appellant's DM II would have resulted in less functional impairment but for his service-bilateral pes planus and/or adjustment disorder causing or aggravating his obesity, the clinician must attempt to establish a baseline level of severity of the diagnosed DM II prior to aggravation by the obesity that was caused or aggravated by his service-connected disabilities.

2. Schedule the appellant for a VA examination with an appropriate clinician to determine the nature and severity of the appellant's IBS.  The claims file and a copy of this?Remand must be made available and be reviewed by the examiner.  All indicated testing should be accomplished and all symptomatology associated with the disability should be identified.  The examiner should respond to the following:

(a.) State whether the appellant's IBS manifested with frequent episodes of bowel disturbance with abdominal distress.

(b.) State whether the appellant's IBS manifested diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.

(c.) State whether the appellant's IBS manifested with abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension

(d.) State whether the appellant's IBS manifested with abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

(e.) State whether the appellant's IBS manifested with abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

(f.) The examiner must address what, if any, are the ameliorating effects of medication the appellant is taking on the severity of his disability, if possible.

1.	The examiner should specify what specific symptoms are ameliorated by the medication (i.e. frequency of bowel disturbances of abdominal pain related to defecation).

3. Schedule the appellant for a VA examination with an appropriate clinician to determine the nature and severity of the appellant's lumbosacral strain, bilateral ankle strains, and bilateral knee strains.  The claims file and a copy of this?Remand must be made available and be reviewed by the examiner.  All indicated testing should be accomplished and all symptomatology associated with the disability should be identified.  The examiner should respond to the following:

(a.) Test the appellant's range of motion on active and passive motion, on weight-bearing and non-weight-bearing, if possible, and record the range of motion measurements.??

(b.) If there is evidence of pain on motion, the examiner must indicate the degree of range of motion at which such pain begins, and whether such pain on movement, as well as weakness, excess fatigability, or incoordination results in any loss of range of motion.  If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain so in the report.??

(c.) The examiner must estimate the appellant's range of motion during a flareup and after repeated use over time.  In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flareups, and the degree of functional loss during flareups.  If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flareups based on the other evidence of record and the appellant's statements.  If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).??

(d.) If, in estimating the ranges of motion during flareups and after repeated use over time, the examiner states that additional facts are required, attempt to obtain such facts.  If the examiner states that he or she does not have the knowledge or training to perform the estimate, obtain an estimate from a clinician who does have the appropriate knowledge or training.?

(e.) The examiner must address what, if any, are the ameliorating effects of medication the appellant is taking on the severity of his disability, if possible.

1.	The examiner should specify what specific symptoms are ameliorated by the medication (i.e. range of motion).

The Board does not make any credibility determinations at this time with respect to the appellant's lay statements.

All opinions?must be supported by a clear rationale.? The clinician should explain in detail the underlying reasoning?for his or her opinion, to include citing to relevant evidence, supporting factual data, prior medical opinions, and medical literature, as appropriate.???? ??????

If any requested opinion cannot be provided without resorting to mere speculation, the clinician must explain why a more definitive response is not possible or feasible.? In other words, merely saying he or she cannot respond will not suffice.

G. E. Wilkerson

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Lee N. Feldman, 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.


series: ama

judge_norm: DONNIE R HACHEY

judge_role: Veterans Law Judge

disposition: remanded

condition: hip

text: Entitlement to disability compensation under the provisions of 38 U.S.C. § 1151 for bilateral hip replacement is remanded.

text:
Citation Nr: A26023000
Decision Date: 03/13/26	Archive Date: 03/13/26

DOCKET NO. 250519-539516
DATE: March 13, 2026

REMANDED

Entitlement to service connection for partial gastrectomy, due to marginal ulcer, is remanded.

Entitlement to disability compensation under the provisions of 38 U.S.C. � 1151 for bilateral hip replacement is remanded.

REASONS FOR REMAND

The Veteran served on active duty from June 1955 to June 1959.  He appeals February 2025 and March 2025 rating decisions by the Agency of Original Jurisdiction (AOJ).  See May 2025 VA Form 10182.

In his May 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket.  In July 2025, he withdrew the hearing request.  See July 11, 2025 representative correspondence.  Therefore, the Board may only consider the evidence of record at the time of the AOJ decisions on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal.  38 C.F.R. � 20.302(b).

1. Partial Gastrectomy, Due to Marginal Ulcer

The Veteran seeks service connection for a partial gastrectomy, due to marginal ulcer.  Given the Veteran's conceded exposure to toxic exposure risk activities (TERAs) during service, the AOJ ordered a VA TERA examination and opinion.  See November 2024 VA TERA Memorandum; see also December 2024 VA TERA opinion and February 2025 VA addendum opinion.

However, upon VA examination in December 2024, the Veteran explained that his stomach symptoms had onset during active service, around 1958.  He reported episodic stomach pain but cannot remember if he went to sick bay.  Thereafter, his stomach pain continued and progressively got worse, and he went to the hospital in 1965 where he was diagnosed with an ulcer requiring a partial gastrectomy.  See December 2024 VA examination report.  The Veteran is competent to report that he experienced these stomach symptoms in service and has continued to suffer from similar symptoms through the present.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  His statements are credible and entitled to probative weight.

Despite the Veteran's clear assertion that his stomach symptoms had onset during service, the record only contains a TERA opinion.  Ultimately, the AOJ erred when it did not obtain a direct service connection opinion for the Veteran's claim.  Accordingly, remand for same is warranted.  Robinson v. Mansfield, 21 Vet. App. 545 (2008) (VA is obligated to develop and consider all theories of entitlement that are raised by the record or by the claimant).  As the above constitutes a predecisional duty to assist error, remand is appropriate.  38 C.F.R. � 20.802(a).

2. Bilateral Hip Replacement

The Veteran seeks disability compensation under the provisions of 38 U.S.C. � 1151 for his bilateral hip replacement.  The record shows that the Veteran is in receipt of disability benefits from the Social Security Administration (SSA).  The Veteran was awarded SSA benefits under both Title II and Title XVI.  See July 2022 SSA Inquiry Results.  However, the Veteran's SSA records, including the underlying determination and associated medical records, are not of record.  As these records are potentially relevant to the Veteran's appeal, VA must undertake efforts to obtain any outstanding Social Security records.  38 C.F.R. � 3.159(c)(2); Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010).  A predecisional duty to assist error was made when these pertinent records were not associated with the claims file.  38 C.F.R. � 20.802(a).

The matters are REMANDED for the following action:

1. Obtain any SSA records pertaining to the Veteran's claims for benefits.  All obtained records should be associated with the evidentiary record.  If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented.

2. Obtain an opinion by an appropriately qualified clinician to determine the nature and etiology of the Veteran's partial gastrectomy, caused by marginal ulcer.  The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician.  It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion.

Following review of the record and examination of the Veteran, if deemed necessary, the reviewing clinician should answer the following:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's partial gastrectomy, caused by marginal ulcer, was incurred in, or is otherwise related to, the Veteran's time on active service?

The reviewing clinician shall specifically consider the Veteran's statements at his December 2024 VA examination regarding onset of stomach problems while in service.

In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history.  Such reports must be acknowledged and considered in formulating any opinion.  If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection.  The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions.

The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.

(Continued on the next page)

?

If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered.  In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question.

DONNIE R. HACHEY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Poe, 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.


judge_norm: MICHAEL MARTIN

disposition: granted

text:
Citation Nr: A26024000
Decision Date: 03/17/26	Archive Date: 03/17/26

DOCKET NO. 250605-551833
DATE: March 17, 2026

ORDER

Entitlement to service connection for obstructive sleep apnea is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not that his current obstructive sleep apnea is due to, caused by, or the result of, or aggravated by his service-connected disabilities of status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis, including through the intermediate step of obesity.

CONCLUSION OF LAW

The criteria for entitlement to service connection for obstructive sleep apnea have been met. 38 U.S.C. �� 1110, 1131, 5107; 38 C.F.R. �� 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from April 2009 to January 2013.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

Previously in an April 2024 rating decision, the RO denied entitlement to service connection for obstructive sleep apnea. In October 2024, the Veteran filed a supplemental claim for entitlement to service connection for obstructive sleep apnea. The RO adjudicated the Veteran's supplemental claim, and in the February 2025 rating decision on appeal, the RO found that new and relevant evidence had been received to reconsider the Veteran's claim, but the RO continued the denial of service connection for obstructive sleep apnea. The Veteran timely appealed the matter to the Board.

In the June 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 2025 RO decision on appeal. 38 C.F.R. � 20.301. Any evidence submitted after the RO 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

Entitlement to service connection for obstructive sleep apnea is granted.

The Veteran claims entitlement to service connection for obstructive sleep apnea as secondary to the service-connected disabilities, including obesity as an intermediate step between the service-connected disabilities and sleep apnea. In the November 2022 and June 2023 statements in support of claim, the Veteran stated that he cannot exercise due to the service-connected lumbar spine condition, right knee condition, and left tibial condition. He also stated that he has sleep apnea symptoms of snoring, daytime fatigue, and poor concentration. He stated that he weighed 220 pounds at military entrance, 235 pounds on separation, and currently he weighs 265 pounds.

In a June 2025 correspondence, the Veteran's representative argued that the service-connected disabilities of left tibia, right knee, and lower back resulted in the Veteran's substantial weight gain, which caused or aggravated his obstructive sleep apnea.

Initially, the Board notes that the Veteran has established service connection for lumbar strain with degenerative disc disease and scoliosis, right knee sprain, and status post left tibial stress fracture. Also, a July 2023 VA treatment record noted the Veteran's weight as 258 pounds and body mass index (BMI) as 37, and a February 2024 VA treatment record noted the Veteran's weight as 255 pounds and BMI as 36.7. The service treatment records reflect that the Veteran's weight was 209 pounds in April 2009, 199 pounds in August 2011. A post-service treatment record from March 2013 noted the Veteran's weight as 216 pounds and BMI as 29.4. Thus, the record reflects that the Veteran progressively gained weight after his military service.

Generally, service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. �� 1110, 1131; 38 C.F.R. � 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be granted for a disability that is due to, caused by, or resulted from, or aggravated by, service-connected disease or injury. 38 C.F.R. � 3.310. Secondary service connection requires: (1) a service-connected disability; (2) a nonservice-connected disability; and (3) evidence that the nonservice-connected disability is either (a) due to, caused by, or the result of the service-connected disability or (b) aggravated (increased in severity) by the service-connected disability. Id.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt should be given to the claimant. 38 U.S.C. � 5107; 38 C.F.R. � 3.102. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt should be resolved in favor of the claimant. 38 C.F.R. � 3.102.

Regarding assessing the issue of obesity, VA's Office of General Counsel (OGC) issued a precedential opinion in 2017. One of the primary holdings of the opinion is that obesity is not a disability for purposes of VA benefits; hence, it cannot be the subject of service connection. VAOPGCPREC No. 1-2017 (Jan. 6, 2017); see also Marcelino v. Shulkin, 29 Vet. App. 155, 157-158 (2018). However, the Court has recently held that obesity could be considered a disability if it results in a functional impairment of earning capacity, a finding that requires an "individualized assessment" of the "degree of impairment" caused by a claimant's obesity. See Adams v. Collins, 38 Vet. App. 273, 284 (July 8, 2025). Thus, the Court invalidated VAOPGCPREC No. 1-2017 to the extent it determined obesity per se is not a disability.

Nonetheless, obesity may still act as an "intermediate step" between a service-connected disability and another disability for the purposes of secondary service connection. OGC recognized that obesity may act as an "intermediate step" between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. � 3.310(a). VAOPGCPREC No. 1-2017 (Jan. 6, 2017).

OGC further explained that adjudicators would have to resolve the following issues: (1) whether the service-connected disability caused the veteran to become obese; (2) if so, whether the obesity as a result of the service-connected disability was a substantial factor in causing the claimed disability; and (3) whether the claimed disability would not have occurred but for obesity caused by the service-connected disability. Id. If these questions are answered in the affirmative, the service connection for the claimed disability may be granted on a secondary basis. Id.

In Walsh v. Wilkie, the Court held that the Board needs to consider the obesity-intermediate step theory based on aggravation where appropriate. See Walsh v. Wilkie, 32 Vet. App. 300, 306-07 (2020). Thus, the Court held that proper interpretation of G.C. Prec. Op. 1-2017 requires consideration of both proximate causation and aggravation in its analytical framework: (1) whether the service-connected disability caused the veteran to become obese or aggravated the veteran's obesity; (2) if so, whether the obesity or aggravation of obesity as a result of the service-connected disability was a substantial factor in causing the current disability; and (3) whether the current disability would not have occurred but for obesity caused or aggravated by the service-connected disability. Id.

Thus, the first question for the Board is whether the Veteran currently has a diagnosis of obstructive sleep apnea, which is due to, caused by, or the result of, or aggravated (increased in severity) by a service-connected disability.

The second question for the Board is whether (i) the Veteran's service-connected disabilities caused the Veteran to become obese or aggravated his obesity, (ii) if so, whether the obesity or aggravation of obesity resulted from the service-connected disabilities was a substantial factor in causing obstructive sleep apnea, and (iii) whether the current obstructive sleep apnea would not have occurred but for the obesity caused or aggravated by the service-connected disabilities.

The existence of a current disability of obstructive sleep apnea is not in question because in the April 2024 VA disability benefits questionnaire (DBQ) for sleep apnea, the examiner noted the diagnosis of obstructive sleep apnea with date of diagnosis as February 2016. Also, the February 2016, September 2023, and January 2024 sleep study reports noted the diagnosis of obstructive sleep apnea. Thus, the requirement of a current disability for service connection is met.

Regarding secondary service connection, in a November 2022 private medical opinion, the examiner stated that it is at least as likely as not that the Veteran's weight gain and obesity is due to and/or related to his service-connected status post left tibial stress fracture, right knee sprain, and lumbar spine strain with degenerative disc disease and scoliosis. The examiner stated that it is at least as likely as not that the Veteran's obstructive sleep apnea is secondary to, related to, and/or aggravated by the weight gain and obesity from the service-connected status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis. The examiner also stated that it is at least as likely as not that without the Veteran's weight gain and obesity his obstructive sleep apnea would not have occurred. As a supporting rationale, the examiner stated that the Veteran weighed 220 pounds upon military entrance, 235 pounds upon military separation, and has a current weight of 265 pounds with a BMI of 37, meeting the national standard by the CDC (Centers for Disease Control and Prevention) for obesity. This is evidence of overall progressive weight gain and a current obesity condition which chronologically developed after the musculoskeletal symptomatology related to the Veteran's service-connected disabilities.

The examiner explained that due to the persistent pain of his service-connected status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis, the Veteran was unable to be as active as he was before his musculoskeletal conditions and subsequently began to progressively gain weight. Weight gain has been established as secondary sequelae of a more sedentary lifestyle related to "joint pain, knee stiffness, and muscle weakness." The examiner referred to a study and stated that the veterans with chronic lower back pain have reduced aerobic fitness levels for fear of re-injury which would lead to obvious weight gain.

Regarding pathophysiology of obstructive sleep apnea related to obesity, the examiner referred to a study and stated that the study has found that the upper airway anatomy plays a major role in obstructive sleep apnea pathogenesis. An inferiorly displaced hyoid as measured by the mandibular plane to hyoid distance (MPH) has been consistently associated with obstructive sleep apnea. The hyoid is also a common landmark for pharyngeal length, upper airway volume, and tongue base. Tongue dimensions, pharyngeal length, and obesity are associated with obstructive sleep apnea severity, although the link between these anatomical variables and pharyngeal collapsibility is less well known. Obesity as measured by BMI, neck and waist circumferences, and variables associated with hyoid position (pharyngeal length, upper airway volume, and tongue dimensions) have been found in the medical literature to be associated with passive pharyngeal critical closing pressure.

The examiner stated that another study documented the pathophysiological processes that occur in obstructive sleep apnea due to obesity. The deposition of fat around the pharyngeal airway is likely to increase the collapsibility of the pharyngeal airway. Fat deposition around the abdomen leads to reductions in functional residual capacity which would be predicted to reduce lung volume tethering effects on the upper airway. Low lung volumes are also associated with diminished oxygen stores, which would contribute to ventilatory control instability (high loop gain). Finally, obesity has been associated with functional impairment and weakening in the upper airway muscles.

The examiner also explained the effects of chronic musculoskeletal pain on sleep. The examiner stated that studies document that chronic musculoskeletal pain causes sleep disturbances such as difficulty falling and staying asleep and less restful sleep. Evidence suggests that pain and sleep exist in a bidirectional relationship in which pain causes sleep disturbance and sleep disturbance intensifies pain. This association can impair a patients daily function and decrease quality of life.

The examiner explained in detail that laboratory and epidemiological studies indicate that chronic partial sleep loss may increase the risk of obesity and weight gain. Laboratory evidence indicates that sleep curtailment in adults results in a constellation of metabolic and endocrine alterations, including decreased glucose tolerance, decreased insulin sensitivity, elevated sympathovagal balance, increased evening concentrations of cortisol, increased levels of ghrelin, decreased levels of leptin, and increased hunger and appetite. Review of cross-sectional epidemiological studies associating short sleep with increased BMI and prospective epidemiological studies that have shown an increased risk of weight gain and obesity in adults who have sleep disturbances to include insomnia and frequent awakenings. Altogether, the evidence points to a possible role of decreased sleep duration in the current epidemic of obesity.

Thereafter, the examiner explained in detail that weight gain/obesity is a major risk factor associated with obstructive sleep apnea. The examiner referred to several studies and included the excerpts from these studies.

After including more excerpts from medical literature and studies, the examiner concluded that it is at least as likely as not that the Veteran's weight gain and obesity is due to and/or related to his service-connected status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis; it is at least as likely as not that the Veteran's obstructive sleep apnea is secondary to, related to, and/or aggravated by the weight gain and obesity from the service-connected status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis; and it is at least as likely as not that without the Veteran's weight gain and obesity his obstructive sleep apnea would not have occurred.

The Board finds that the above noted November 2022 private medical opinion is adequate 2022 and has great probative value because the examiner provided adequate explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board notes that there are two VA medical opinions on secondary service connection for sleep apnea that are against the claim, which include the September 2023 and October 2023 opinions. In the September 2023 VA medical opinion, the examiner stated that the claimed condition of obstructive sleep apnea is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the Veteran's service connected conditions. As a supporting rationale, the examiner stated that obstructive sleep apnea is a common disorder characterized by repetitive narrowing or collapse of the pharyngeal airway during sleep. The disorder is associated with major comorbidities including excessive daytime sleepiness and increased risk of cardiovascular disease. The underlying pathophysiology is multifactorial and may vary considerably between individuals. Important risk factors include obesity, male sex, and aging. Therefore, no causal relationship of obstructive sleep apnea with lumbar strain with degenerative disc disease and scoliosis, right knee sprain, and status post left tibial stress fracture could be established.

The Board finds the September 2023 VA medical opinion inadequate because the examiner did not provide an opinion as to whether the Veteran's service-connected disabilities aggravated his obstructive sleep apnea, including obesity as an intermediate step between obstructive sleep apnea and service-connected disabilities.

In the October 2023 VA medical opinion, the examiner stated that there is no pathophysiologic connection between sleep apnea and status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis. As a supporting rationale, the examiner stated that sleep apnea is an entirely separate disorder caused by genetic propensity, age, and obesity. Obesity is caused by an imbalance between caloric intake and output, complicated by the general tendency of modern humans to eat more and exercise less. This is the natural result of evolving in an environment of scarcity, it is not caused or influenced by any specific orthopedic disorder. The decision to eat more calories than one burns is a conscious decision over which we have specific control. This element of free will is not removed by any specific orthopedic or psychiatric

disorder. This also applies to aggravation, with no evidence of aggravation by any of the above orthopedic disorders, in the absence of an aggravating event or circumstance which would provide a pre-and post-baseline.

The Board also finds the October 2023 VA medical opinion inadequate because the examiner did not provide an adequate opinion and supporting rationale on the claimed aggravation of obstructive sleep apnea by the Veteran's service-connected disabilities, including obesity as an intermediate step between obstructive sleep apnea and the service-connected disabilities.

Thus, upon review of the record, the Board finds that the evidence of record is in favor or at least in equipoise as to whether the Veteran's current obstructive sleep apnea is due to, caused by, or the result of, or aggravated by the service-connected disabilities of status post left tibial stress fracture, right knee sprain, and lumbar strain with degenerative disc disease and scoliosis, including through the intermediate step of obesity.

Accordingly, after resolving reasonable doubt in favor of the Veteran, the Board finds that entitlement to service connection for obstructive sleep apnea as secondary to the service-connected disabilities is warranted. 38 U.S.C. � 5107; 38 C.F.R. � 3.102.

Consequently, entitlement to service connection for obstructive sleep apnea is granted.

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Nadeem Tariq, 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.


judge_norm: T MAINELLI

disposition: denied

text:
Citation Nr: A26025000
Decision Date: 03/19/26	Archive Date: 03/19/26

DOCKET NO. 240507-441278
DATE: March 19, 2026

ORDER

Entitlement to an earlier effective date for the grant of benefits under the Program of Comprehensive Assistance for Family Caregivers (PCAFC) is denied.

FINDING OF FACT

1. The appellants initially filed a June 2022 application for PCAFC benefits that was denied by the Veterans Health Administration (VHA) later that month; after an October 2022 first level clinical appeal and a November 2022 clinical review, VHA continued to deny the claim in an unappealed January 2023 decision.

2. The appellants filed a new application for PCAFC benefits in October 2023, and VHA subsequently issued a January 2024 decision awarding benefits from the date of the October 2023 application; the appellants then filed a May 2024 Department of Veterans Affairs (VA) Form 10182 seeking "reconsideration of my initial application for the caregiver program," and "retroactive payment" from June 2022.

CONCLUSION OF LAW

The criteria for entitlement to an effective date prior to October 17, 2023, for the award of PCAFC benefits have not been met.  38 U.S.C. � 1720G; 38 C.F.R. �� 71.10, 71.15, 71.20, 71.25, 71.40.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Navy from May 1984 to July 1984 and from May 1987 to December 1988, as well as in the Army from December 1988 to March 1994 and from September 1999 to July 2009.  He is the first appellant; the second appellant is his spouse, who is now his primary family caregiver under the PCAFC.  This case comes before the Board of Veterans' Appeals (Board) on appeal of a January 2024 VHA decision granting eligibility for PCAFC benefits from October 2023.  As such, the procedures of the Appeals Modernization Act apply.  In their May 2024 VA Form 10182 Board Appeal, the appellants elected the evidence submission docket.  Therefore, the Board may only consider the evidence of record at the time of the VHA decision on appeal as well as that submitted with or within 90 days after VA receipt of the Form 10182.  38 C.F.R. � 20.303.

1. Entitlement to an effective date prior to October 17, 2023, for the grant of benefits under the PCAFC

PCAFC is a VA program that provides certain benefits to eligible veterans who have incurred or aggravated serious injuries during military service, and to their caregivers.  38 C.F.R. � 71.10(a).  Specifically, it is designed to provide benefits for veterans who require personal care services for at least six continuous months.  Id.  An "eligible veteran" means a veteran, or a servicemember, who is found eligible for a family caregiver under � 71.20.  38 C.F.R. � 71.15.  Primary family caregivers will receive a monthly stipend for each month's participation as a primary family caregiver.  38 C.F.R. � 71.40(c)(4).

In this case, the Veteran, with his spouse acting as primary family caregiver, previously received benefits under PCAFC from 2013 until 2018.  They reapplied to the program in early June 2022 and VHA issued a decision denying benefits later that month.  The notification letter informed the appellants that if they disagreed with the decision, they had the right to request a VHA review or appeal to the Board; instructions on how to do so were included in the correspondence.  The appellants elected to request a VHA review in October 2022, and after a November 2022 clinical review VHA continued to deny eligibility to PCAFC benefits in a January 2023 decision.  The appellants subsequently filed a new PCAFC application in October 2023 and, after further development, VHA issued a January 2024 decision granting PCAFC benefits from October 17, 2023, the date VHA received their latest application.

The appellants filed a May 2024 VA Form 10182 Board Appeal identifying "17 November 2022" as the date of the decision and specifying "denial from the [PCAFC]."  In a statement attached to the 10182, the Veteran's spouse reported that she had continued to provide "around the clock" care for her husband from 2020 to 2022 while they lived in Germany, and that upon returning to the U.S. they applied for and were denied caregiver benefits in June 2022.  She indicated that after a clinical review continued to deny the claim she reapplied for the program in October 2023 and was approved.  She concluded by stating: "based on the unchanged circumstances of my husband's need for care and the approval of my [October 2023] application for the caregiver program, I am requesting reconsideration of my initial application for the caregiver program, that the application dated 07 June 2022 be approved, and that I receive retroactive payment from the date of the application until the approval dated 17 October 2023."

The Board initially notes that the November 2022 date listed in the May 2024 VA Form 10182 Board Appeal appears to be the date VHA accepted the appellants' October 2022 VHA clinical review request of the June 2022 denial of PCAFC benefits.  However, as explained in the June 2022 VHA decision letter, the appellants had the option of either appealing the decision to the Board or requesting a VHA clinical review.  In this case, they chose the latter option, and VHA continued to deny the claim in a January 2023 clinical review decision.  The Board observes that construing the May 2024 Form 10182 as an appeal of either the initial June 2022 VHA decision or January 2023 clinical review would result in the appeal being received over one year after the appellants received notice of the decisions, and as such would be considered untimely.  38 U.S.C. 7105(b)(1)(A).

Therefore, the Board will view the May 2024 VA Form 10182 and attached statement in the light most favorable to the appellants and conclude that their disagreement is with the effective date assigned by the January 2024 VHA decision granting PCAFC benefits.  The relevant portion of the statute provides that caregiver benefits under paragraphs (b)(6) and (c)(3) and (4) are effective on the latest of the following dates: The date the joint application that resulted in approval and designation of the Family Caregiver is received by VA; the date the eligible veteran begins receiving care at home; the date the Family Caregiver begins providing personal care services to the eligible veteran at home; the day after the date a joint application is denied.  See 38 C.F.R. � 71.40(d) [emphasis added].

As discussed above, the appellants initially reapplied for PCAFC benefits in June 2022, a claim that was denied by VHA in June 2022 initial and January 2023 clinical review decisions.  The appellants then reapplied to the program by filing a new joint application in October 2023 and were granted benefits from this date in a separate January 2024 VHA decision.  The facts are clear that the date the October 2023 joint application was approved, and the date the Veteran's spouse was granted eligibility to be a primary family caregiver, was in January 2024.

According to the file associated with the Veteran's PCAFC claim as well as the statements of his spouse, she was already providing at-home care for him prior to VA receipt of the October 2023 joint application.  However, VHA did not find the Veteran eligible for PCAFC benefits under 38 C.F.R. � 71.20 prior to January 2024.  The previous June 2022 application was twice rejected by VHA on the basis that the Veteran did not meet the eligibility criteria.  As a result, the June 2022 joint application was not processed, and the applicants were not enrolled in PCAFC.

The January 2024 VHA decision found the Veteran eligible for PCAFC benefits and accepted the October 2023 joint application; it is not the result of a second level VHA review of the June 2022 application that was denied initially in June 2022 and after a first level clinical review in January 2023.  Therefore, the date of VA receipt of the October 2023 joint application is the earliest possible effective date for PCAFC benefits based on the January 2024 VHA granting decision.  See 80 Fed. Reg. 1375 (January 9, 2015) (Family Caregiver benefits are effective as of the date that the signed joint application is received by VA or the date the eligible veteran begins receiving care at home (whichever is later), but these benefits are not provided until a Family Caregiver has been designated.  Family Caregivers must complete all required training and instruction to become so designated).

In sum, an effective date prior to October 2023, is not warranted because 38 C.F.R. � 71.40(d) does not allow for an effective date to run from a prior application that did not result in PCAFC approval and caregiver designation.  Caregiver benefits are effective on the latest of the dates found in 38 C.F.R. � 71.40(d).  Thus, the effective date can be no earlier than October 17, 2023, the date the Veteran and his caregiver applicant reapplied for PCAFC benefits.  Id.  While the Board empathizes with the caregiver's contentions, it finds no potential avenue by which the eligibility requirements for PCAFC benefits could be granted prior to October 2023.  As such, there is no reasonable doubt left to resolve in the appellants' favor, and entitlement an earlier effective date for the grant of PCAFC benefits is denied.

T. MAINELLI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Schumacher, Kyle C.

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.


judge_norm: MARTIN T MITCHELL

disposition: dismissed

benefit: caregiver

text:
Citation Nr: A26026000
Decision Date: 03/24/26	Archive Date: 03/24/26

DOCKET NO. 220804-279466
DATE: March 24, 2026

ORDER

The issue of eligibility for enrollment into the Program of Comprehensive Assistance for Family Caregivers (PCAFC) is dismissed.

FINDING OF FACT

On March 4, 2026, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran, through his appointed representative, that a withdrawal of the appeal regarding eligibility for enrollment into the PCAFC is requested.

CONCLUSION OF LAW

The criteria for withdrawal of the appeal regarding eligibility for enrollment into the PCAFC have been met.  38 U.S.C. � 7105; 38 C.F.R. � 20.205.

REASONS AND BASES FOR FINDING AND CONCLUSION

The first appellant in this matter is the Veteran who served on active duty with the Army from October 2003 to June 2013, to include meritorious service in both Iraq and Afghanistan.

The second appellant in this matter is S.H., the Veteran's parent who applied to become the Veteran's Primary Family Caregiver.

The Board also takes notice of the fact that there is a Secondary Family Caregiver applicant, K.H., the Veteran's other parent, who also applied as a joint claimant for PCAFC enrollment.

The Veterans Health Administration (VHA) decision on appeal was issued in February 2022.

In the August 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the appellants elected the Hearing docket.  On March 4, 2026, the appellants withdrew the hearing request.  See BVA Hearing Withdrawal, March 4, 2026.

The issue of eligibility for enrollment into the PCAFC

The Board may dismiss any appeal which fails to identify the specific determination with which the claimant disagrees.  38 U.S.C. � 7105(d).  An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. � 20.205.  Withdrawal may be made by an appellant or an appellant's authorized representative.  Id.

A written withdrawal must include (1) the name of the Veteran, the name of the claimant or appellant if other than the Veteran, (2) the applicable VA file number, and (3) a statement that the appeal is withdrawn.  If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal.  38 C.F.R. � 20.205(b)(1); Hembree v. Wilkie, 33 Vet. App. 1 (2020).

In a March 4, 2026, Statement in Support of Claim, the Veteran, through his authorized representative, withdrew the issue of eligibility to enroll into the PCAFC.  See BVA Hearing Withdrawal, March 4, 2026.  All of the aforementioned requirements have been met.  Therefore, no case or controversy remains for the Board to adjudicate.  Accordingly, the Board does not have jurisdiction to review the appeal as to eligibility to enroll into the PCAFC and it is dismissed.

Martin T. Mitchell

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M.H.

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.