Citation Nr: 21010881 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 10-03 362 DATE: February 26, 2021 ORDER A compensable rating for bilateral hearing loss is denied. A rating in excess of 10 percent for tinnitus is denied. Service connection for depressive disorder is granted. Service connection for sleep apnea is granted. FINDINGS OF FACT 1. For the entire appeal period, the Veteran had no worse than Level VII hearing in the right ear and Level I hearing in the left ear. 2. For the entire appeal period, the Veteran is in receipt of a 10 percent rating, which is maximum schedular rating, for his tinnitus and such disability does not result in symptomatology that is not contemplated by the rating criteria. 3. Resolving all doubt in the Veteran’s favor, his current acquired psychiatric disorder, diagnosed as depressive disorder, had its onset in service. 4. Resolving all doubt in the Veteran’s favor, his sleep apnea is aggravated by his now service-connected depressive disorder. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 2. The criteria for a rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.87, Diagnostic Code 6260; Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). 3. The criteria for service connection for depressive disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1961 to September 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in February 2009, April 2013, and September 2016 by a Department of Veterans Affairs (VA) Regional Office. In April 2011, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge regarding the issue of entitlement to service connection for an acquired psychiatric disorder. A transcript of the hearing is associated with the record. While he was scheduled for a Board hearing in connection with the other claims on appeal in December 2017, he withdrew his hearing request in a November 2017 statement. In August 2018, Board remanded the claims on appeal, as well as a claim for service connection for headaches. While on remand, an October 2020 rating decision granted service connection for migraine headaches. As such represents a full grant of the benefits sought with respect to such issue, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The remaining issues now return for further appellate review. A review of the claims file reveals that VA treatment records were added to the claims file after the issuance of the October 2020 supplemental statement of the case. However, in a January 2021 submission, the Veteran waived his right to have his case remanded to the Agency of Original Jurisdiction (AOJ) for review of such additional evidence. 38 C.F.R. § 20.1305(c). Therefore, the Board may properly consider such newly received records. Further, in December 2020, the Veteran submitted additional evidence in support of his appeal. 38 U.S.C. § 7105(e)(1). Increased Rating Claims Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. 1. Entitlement to a compensable rating for bilateral hearing loss. The appeal period before the Board begins on October 19, 2011, the date VA received the Veteran’s claim for an increased rating for his bilateral hearing loss, plus the one-year look back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For the entire appeal period, such disability has been evaluated as noncompensably disabling pursuant to Diagnostic Code 6100. In this regard, ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, or Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. Turning to the evidence of record, VA treatment records dated throughout the appeal period reflect the Veteran’s complaints of bilateral hearing loss and the use of hearing aids; however, such do not include audiometric findings that reflect a greater degree of hearing impairment than as reflected by the March 2012, December 2014, and October 2020 VA examinations. In this regard, at the March 2012 VA examination, the Veteran reported that he had difficulty hearing people talking. Audiometric testing revealed pure tone thresholds of 85, 70, 70, and 80 decibels in the right ear, and 35, 30, 35, and 35 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. An exceptional pattern of hearing loss was shown in the right ear. The examiner reported that the pure tone threshold average was 76 decibels in the right ear and 34 decibels in the left ear. Speech discrimination was 96 percent in the right ear and 94 percent in the left ear. These audiometry test results equate to Level II hearing in the right ear and Level I hearing in the left ear pursuant to Table VI. However, as the Veteran exhibited an exceptional pattern of hearing loss in the right ear, such resulted in Level VI hearing pursuant to Table VIA. Applying the percentage ratings for hearing impairment in Table VII, such impairment results in a noncompensable rating. The Veteran underwent additional VA examination in December 2014, at which time he reported he could not hear. Audiometric testing revealed pure tone thresholds of 105, 75, 70, and 80 decibels in the right ear, and 30, 35, 45, and 40 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. An exceptional pattern of hearing loss was shown in the right ear. The examiner reported that the pure tone threshold average was 83 decibels in the right ear and 38 decibels in the left ear. Speech discrimination was 92 percent in the right ear and 96 percent in the left ear. These audiometry test results equate to Level III hearing in the right ear and Level I hearing in the left ear pursuant to Table VI. However, as the Veteran exhibited an exceptional pattern of hearing loss in the right ear, such resulted in Level VII hearing pursuant to Table VIA. Applying the percentage ratings for hearing impairment in Table VII, such impairment results in a noncompensable rating. At a February 2016 VA examination, the Veteran reported a loss with respect to voices, television, and radio. Audiometric testing revealed pure tone thresholds of 100, 85, 70, and 80 decibels in the right ear, and 50, 55, 60, and 65 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. An exceptional pattern of hearing loss was shown in the right ear. The examiner reported that the pure tone threshold average was 83.75 decibels in the right ear and 57.5 decibels in the left ear. Speech discrimination was 78 percent in the right ear and 82 percent in the left ear. These audiometry test results equate to Level V hearing in the right ear and Level IV hearing in the left ear pursuant to Table VI. However, as the Veteran exhibited an exceptional pattern of hearing loss in the right ear, such resulted in Level VII hearing pursuant to Table VIA. Applying the percentage ratings for hearing impairment in Table VII, such impairment results in a 20 percent rating. At the October 2020 VA examination, the Veteran reported that he was unable to hear individuals when speaking one on one; and that individuals knew to communicate loudly with him. Audiometric testing revealed pure tone thresholds of 70, 60, 55, and 70 decibels in the right ear, and 45, 40, 40, and 40 decibels in the left ear, at 1000, 2000, 3000, and 4000 Hertz, respectively. An exceptional pattern of hearing loss was shown in the right ear. The examiner reported that the pure tone threshold average was 63.75 decibels in the right ear and 41.25 decibels in the left ear. Speech discrimination was 94 percent in the right ear and 96 percent in the left ear. These audiometry test results equate to Level II hearing in the right ear and Level I hearing in the left ear pursuant to Table VI. However, as the Veteran exhibited an exceptional pattern of hearing loss in the right ear, such resulted in Level V hearing pursuant to Table VIA. Applying the percentage ratings for hearing impairment in Table VII, such impairment results in a noncompensable rating. The Board acknowledges that the February 2016 VA examination demonstrates the Veteran to have hearing impairment in his left ear in excess of Level I; however, the Board finds such audiometric testing results to lack probative value. In this regard, the Veteran underwent audiometric testing in June 2015 (as detailed in a December 2015 VA treatment record) and such did not reveal left ear hearing impairment to the degree shown at the February 2016 VA examination. Further, a January 2018 VA treatment record reflects that a repeated audiogram from earlier that month was not significantly changed from the previous one in June 2015. Moreover, the prior March 2012 and December 2014 VA examinations and subsequent October 2020 VA examination does not show left ear hearing impairment consistent with the results shown on examination in February 2016. Accordingly, the Board finds that the February 2016 audiometric testing results are inconsistent with the remaining evidence of record. Thus, such results are not probative and cannot be used to support the assignment of a higher rating for the Veteran’s bilateral hearing loss. To the extent that the Veteran contends his bilateral hearing loss is more severe than currently evaluated, the Board observes that the Veteran, while competent to report symptoms capable of lay observation, such as difficulty hearing people, the television, and radio, is not competent to report that his hearing acuity is of sufficient severity to warrant a compensable rating under VA’s tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Despite the foregoing, the Board acknowledges the Veteran’s aforementioned reports of the difficulties associated with his bilateral hearing loss. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds the criteria for a compensable evaluation are not met. See Lendenmann, supra. In this regard, in Doucette v. Shulkin, 28 Vet. App. 366 (2017), the U.S. Court of Appeals for Veterans Claims held that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment as these are the effects that VA’s audiometric tests are designed to measure. The Veteran has not otherwise described functional effects that are considered exceptional or that are not otherwise contemplated by the assigned evaluation. Id. Thus, his complete disability picture is compensated under the rating schedule. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected bilateral hearing loss; however, the Board finds his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disability is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to such increased rating claim. Doucette, supra (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Therefore, the Board finds that a compensable rating for bilateral hearing loss is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and his claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to a rating in excess of 10 percent for tinnitus. The appeal period before the Board begins on December 17, 2015, the date VA received the Veteran’s claim for an increased rating for his tinnitus, plus the one-year look back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For the entire appeal period, such disability has been evaluated as 10 percent disabling pursuant to Diagnostic Code 6260. Diagnostic Code 6260 was revised effective June 13, 2003, to codify existing VA practice of assigning a single 10 percent rating for recurrent tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.187, Diagnostic Code 6260, Note (2). As the Veteran’s service-connected tinnitus has been assigned the maximum schedular rating available pursuant to 38 C.F.R. § 4.187, Diagnostic Code 6260, and there is no legal basis upon which to award separate schedular evaluations for tinnitus in each ear, there is no legal basis upon which to award a higher schedular rating. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Further, as the Veteran has not asserted, and the evidence does not suggest, that such disability results in symptomatology that is not contemplated by the rating criteria, referral for consideration for an extra-schedular rating is not warranted. 38 C.F.R. § 3.321; Thun v. Peake, 22 Vet. App. 111, 115-16 (2008) Moreover, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to such increased rating claim. Doucette, supra. Therefore, the Veteran’s claim for a rating in excess of 10 percent for tinnitus must be denied. Service Connection Claims Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability, in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). 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) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.R.F. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 3. Entitlement to service connection for an acquired psychiatric disorder. The Veteran maintains that he has an acquired psychiatric disorder related to his military service or, in the alterative, as secondary to his service-connected tinnitus, bilateral hearing loss, migraine headaches, and/or lung disability. As the Board herein grants service connection for such disorder as directly related to his military service, the Board need not address the secondary aspect of the Veteran’s claim. The Veteran’s service treatment records (STRs) are negative for any complaints, treatment, or diagnosis referable to an acquired psychiatric disorder. However, upon an April 1968 Report of Medical History, which was conducted during his Reserve service, he reported depression or excessive worry, nervous trouble of any sort, and nerves breakdown. VA treatment records reveal an assessment of depression in October 2005. Subsequent treatment records dated in 2006 reflect the Veteran’s complaint of depression (depressed mood, loss of interest, irritability, fragmented sleep, impaired concentration, low energy, occasional suicidal ideations without intent or plan) for approximately two years and an assessment of major depressive disorder. VA treatment records dated in 2007-2011 indicate assessments/impressions of depression and major depressive disorder, and the Veteran’s complaint of continued depression characterized by loss of interest, low energy, and irritability. At a November 2010 VA examination, the examiner noted the complaints of having problems with his nerves and feeling depressed at the time of the April 1968 Reserve examination; however, it was found that there were no disqualifying defects when the interview was completed about such items. Here, the Veteran stated that he did not recall ever seeking out mental health services while in the military as he did not want people to know what he thought or felt. Following a mental status examination, the examiner determined that she could not find evidence of a current depressive disorder that met the criteria for major depression based on the Veteran’s verbal account of symptoms. In April 2012, the Veteran was afforded another VA examination. At such time, the examiner found that he did not meet the DSM-IV diagnostic criteria for any mood disorder as he did not report symptoms that would be consistent with the diagnoses of depression, anxiety, posttraumatic stress disorder (PTSD), or any acquired psychiatric disorder. Here, the examiner reported that all of the Veteran’s previous treatment for depression had been based on minimal reported symptoms that did not meet the criteria for a DSM-IV mood disorder diagnosis and were based solely on his subjective reporting of symptoms with no objective evidence collected. She further reported that the Veteran’s test results regarding the Trauma Symptoms Inventory were invalid as a result of over-endorsement/exaggeration/malingering of symptoms and, due to his suboptimal effort on such objective testing measure, there was no objective evidence to support the symptoms of or diagnosis for PTSD, depression, or anxiety. In a July 2013 PTSD Disability Benefits Questionnaire (DBQ), the Veteran’s private treatment provider, Dr. E.B., reported diagnoses of PTSD and depression. Thereafter, a March 2015 VA examiner found that the Veteran did not have a mental disorder that confirmed with DSM-5 criteria, and previous diagnoses appeared to be based on the Veteran’s self-report. In a July 2015 PTSD DBQ, Dr. E.B. again reported diagnoses of PTSD and depression. Subsequently, a June 2016 VA examiner noted a diagnosis of very mild PTSD, and observed that the Veteran’s MMPI was extremely exaggerated. Thus, in light of the conflicting diagnoses of record, an addendum opinion was obtained in December 2016. At such time, the examiner considered the aforementioned evidence, but found that the Veteran did not meet the criteria for any acquired psychiatric disorder. In this regard, she reported that the Veteran did not meet the criteria for PTSD based on the lack of a valid claimed stressor and it was more likely than not that the Veteran’s self-reported symptoms of PTSD were unreliable. The examiner concluded that the Veteran was seen by multiple examiners between 2010 and 2015, all of whom indicated no formal mental disorder was present; on three different occasions, the Veteran was noted to have invalid testing (exaggeration, suboptimal effort); and, in 2016, he was diagnosed with “very mild PTSD” based on his self-report of a stressor which had since been found to be unverified. Thereafter, in an October 2017 mental disorders DBQ, a private psychologist, Dr. H.H-G., noted a diagnosis of unspecified depressive disorder, and opined that, based on an interview and review of the Veteran’s claims file, such disorder more likely than not began in military service and continued uninterrupted to the present. In support thereof, Dr. H.H-G detailed the Veteran’s medical treatment records, which supported his decline in behavior. Additionally, she reported that there was literature that: (1) detailed the emergence of mental health symptoms within active duty servicemen, and found that active military service impacted depression, anxiety, and quality of life satisfaction; (2) revealed that guilt was a salient feature in mental health diagnoses of active duty military personnel; and (3) detailed the connection between medical issues similar to the issues that the Veteran struggled with, and psychiatric disorders similar to his depressive disorder complaints. Further, Dr. H.H-G explained that the Veteran had minimized his symptoms over the years and had great difficulty asking for help as he preferred to remain as self-sufficient as possible. Here, she noted that the Veteran’s VA examinations painted one picture of the Veteran, while his mental health treatment records revealed different information. She also indicated that she deferred to the Veteran’s treating physicians as they had a solid continuous care relationship; it was unclear why there was no diagnosis of a mood disorder although the Veteran’s VA examinations showed symptoms of depression; and the Veteran was depicted as a malingerer and reluctant to offer personal information, although he had been engaged in mental health treatment since separation from the military. In addition to the foregoing medical evidence, the Veteran’s spouse offered a statement in support of his claim. Specifically, his spouse, L.E., who had known the Veteran since she was 15 and dated him while he was still in the Navy, indicated that, prior to entering service, the Veteran was funny, enjoyed going out, and had a lot of friends and had no mental health issues. She further indicated that, each time the Veteran came home on leave, he was more bitter and angry and, when the Veteran was discharged from service, he seemed to have lost interest in everything and started having issues with anxiety and nervousness. Here, she noted that the Veteran’s problems persisted to the point that he had a nervous breakdown and was admitted to the hospital for two weeks for a nervous disorder. Additionally, L.E. stated that the Veteran told her about the fear he had when refueling ships while in service and how tense he was for fear of being blown up, which put him into a constant depression. Clearly, this case entails a complicated medical history, with various conflicting medical opinions regarding the diagnoses and etiology of the Veteran’s acquired psychiatric disorders. In regard to the reported diagnosis of PTSD, none of the Veteran’s treatment providers have identified the stressor underlying such diagnosis, and all VA examiners have offered thorough support for the determination that the Veteran does not meet the diagnostic criteria for such diagnosis. Consequently, service connection for PTSD is not warranted. However, with respect to the Veteran’s diagnosis of depressive disorder, the Board finds the evidence to be in relative equipoise as to whether such disorder had its onset in, or is otherwise related to, his military service. Therefore, the Board resolves all doubt in the Veteran’s favor and finds that his current acquired psychiatric disorder, diagnosed as depressive disorder, had its onset in service. Consequently, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 4. Entitlement to service connection for sleep apnea. The Veteran is seeking service connection for sleep apnea, which he claims is related to his military service or, in the alterative, is secondary to his now service-connected depressive disorder. As an initial matter, the Board finds that the Veteran has a current diagnosis of sleep apnea. Here, the record shows that he was first diagnosed with obstructive sleep apnea in 2011 (see September 2011 VA treatment record). However, his STRs and post-service VA and private treatment records do not reflect that his sleep apnea manifested during service, or is otherwise directly related to service. Here, the Veteran’s STRs are silent for any complaints, treatment, or diagnoses referable to sleep apnea. Additionally, the earliest clinical evidence of sleep apnea is dated in 2011, approximately 48 years after his discharge from service. Furthermore, the lack of any lay or medical evidence of related symptoms during or continuing after service preponderates against a finding that the Veteran manifested sleep apnea in service or that such disorder is otherwise directly related to his military service. Thus, service connection on a direct basis is not warranted. As pertinent to whether the Veteran’s sleep apnea is secondary to his now service-connected depressive disorder. In this regard, a July 2018 sleep apnea DBQ completed by a private physician, Dr. M.B., reflects her opinion that the Veteran’s depression more likely than not aided in the development of, and permanently aggravated, his sleep apnea. Specifically, Dr. M.B. noted that the Veteran was diagnosed with obstructive sleep apnea in 2011 and prescribed a CPAP, and had a long history of depression, citing to treatment records dated in July 2005, June 2011, February 2015, and June 2016. Here, Dr. M.B. explained that research had shown that psychiatric disorders were commonly associated with obstructive sleep apnea, and a recent study found that subjects with depression compared with non-depressed controls had a higher prevalence of a sleep apnea diagnosis. Such study found that, with CPAP treatment, both obstructive sleep apnea and psychiatric symptoms decreased. She further explained that, when she spoke to the Veteran, he stated that he frequently could not use his CPAP due to his depressive disorder since, when his depression was bothering him, the CPAP made him feel claustrophobic and he could not tolerate it. Here, Dr. M.B. noted that the Veteran’s inability to use his CPAP every night aggravated the effects of his sleep apnea, and his tiredness also adversely affected his depression. Thus, she concluded that the Veteran’s sleep apnea was related to his depression based on an interview with him, a review of his claims file, and the aforementioned medical literature. The Board finds that Dr. M.B.’s July 2018 opinion regarding a connection between the Veteran’s sleep apnea and his now service-connected depressive disorder is entitled to great probative weight as such opinion considered all of the pertinent evidence of record, and provided a detailed rationale for the conclusions reached, relying on and citing to the records reviewed. Moreover, the Dr. D.B. offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Furthermore, there is no medical opinion to the contrary. Therefore, resolving all doubt in the Veteran’s favor, the Board finds that his sleep apnea was aggravated by his now service-connected depressive disorder. Consequently, service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. As a final matter, the Board notes that, although 38 C.F.R. § 3.310(b) indicates that service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability, the next sentence indicates that the rating activity will determine the baseline and current levels of severity and determine the extent of aggravation. Given that the Board does not assign ratings in the first place, the Board reads 38 C.F.R. § 3.310(b) as permitting the Board to determine whether service connection on an aggravation basis is warranted, with the AOJ having the responsibility for determining the degree of aggravation is assigning the rating. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, Associate 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.