Citation Nr: 24011908 Decision Date: 03/13/24 Archive Date: 03/13/24 DOCKET NO. 21-00 324 DATE: March 13, 2024 ORDER Service connection for sleep apnea is granted. Service connection for hypertension is granted. REMANDED Entitlement to a compensable disability rating for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The Veteran's sleep apnea is related to his active service. 2. The Veteran's hypertension is related to his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1979 to July 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ) in February 2022. A transcript of the hearing is of record. Service Connection Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury and a causal relationship between the current disability and the in-service incurrence, disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Sleep Apnea and Hypertension The record reflects that the Veteran has current diagnoses of sleep apnea and hypertension. The Veteran contends that sleep apnea is related to bronchitis incurred in service and that his hypertension is related to an incident of chest pain that occurred during service. The Veteran's service treatment records (STRs) confirm that the Veteran was diagnosed with bronchitis in July 1979 and was treated for chest pain in July 1979. Based on the foregoing, the Veteran is able to satisfy the first two elements for service connection. The remaining question is thus whether the Veteran's current disabilities are related to his active service. With respect to the nexus element, the Veteran submitted a February 2022 opinion from a private physician. The private physician reviewed the Veteran's medical records and concluded that the Veteran had a classic presentation of sleep apnea in service when he experienced disrupted sleep, snoring and stopped breathing after his bronchitis. The private physician noted that the Veteran's symptoms continued throughout the remainder of his service and continued after his discharge. The private physician cited medical studies regarding a connection between respiratory disorders and sleep apnea and concluded that the Veteran's sleep apnea began in service. With respect to hypertension, the private physician indicated that the Veteran's episode of chest pain and collapse in 1979 was indicative of the early stages of hypertension. The private physician based his opinion on the Veteran's testimony and the records reflecting that the Veteran had marginal blood pressure readings at a young age. The Board finds the opinions of the private physician adequate for adjudicative purposes as they were based on consideration of the Veteran's medical history, described the Veteran's condition and included explanatory rationales, with reference to relevant medical literature to support the sleep apnea opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). There are no contradictory opinions of record as the Veteran has not been afforded a VA examination for his sleep apnea and hypertension disabilities. As the Veteran is able to meet the elements for service connection for sleep apnea and hypertension, the claims are granted. 38 C.F.R. § 3.303. REASONS FOR REMAND Entitlement to a compensable disability rating for bilateral hearing loss is remanded. VA has a duty to provide a contemporaneous examination when the evidence indicates that the current rating may be incorrect, including when a Veteran alleges that his condition has worsened since the last VA examination. Snuffer v. Gober, 10 Vet. App. 400 (1997). Here, the Veteran testified at the February 2022 Board hearing that his hearing loss was worse than at his VA examination in February 2021. A VA examination conducted in June 2022 documented worsening of the Veteran's hearing when measured by the Maryland CNC Word List speech discrimination test, but also reflected puretone threshold results that were better than the results in the February 2021 VA examination. The Board finds that remand is required to provide the Veteran with a VA examination to assess the current state of his disability. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Snyder, M. 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.