ERECTILE DYSFUNCTION

NATHANIEL DOAN · 2026 · Case ID: 26003861

MIXED

Summary

The Veteran, a veteran who served from July 1984 to March 1987, appeals the denial of service connection for residuals of penile implant surgeries (IPP surgeries) and loss of sight, while also seeking service connection for a right femur disorder. The Board reopened the claim for residuals of IPP surgeries based on new and material evidence, including lay statements and VA treatment records from a December 2000 surgery, which raised a reasonable possibility of substantiating the claim. However, the Board denied compensation under 38 U.S.C. § 1151 for these residuals, finding that while the Veteran experienced complications and multiple surgeries, the evidence did not establish that VA's actions were negligent or that an unforeseeable event occurred. The Board accorded probative weight to VA examiner opinions from September and November 2024, which ultimately concluded that any additional disability was due to known surgical complications or was not the result of VA fault, and that the Veteran's complaints of vision loss were not medically documented. The Board also declined to expand the § 1151 claim to include erectile dysfunction as a separate issue. For the right femur disorder, the Board granted service connection on a secondary basis, finding that the Veteran's reported pain was referred pain from his service-connected right knee disability, resolving doubt in the Veteran's favor based on a favorable VA opinion. The claim for loss of sight due to refractive error was denied, as refractive errors are considered developmental defects not eligible for service connection, and the Veteran's lay reports of vision loss were not supported by medical documentation or competent diagnosis.

Rationale

No additional disability resulted from VA carelessness, negligence, lack of proper skill, error in judgment, or similar fault.; Any additional disability was due to a known complication and risk of surgery.; No medical opinion of record contrary to VA examiner's opinions.

Special Benefit

§1151

Docket No.

16-49 915A

Full Decision Text

Citation Nr: 26003861
Decision Date: 03/26/26 Archive Date: 03/26/26

DOCKET NO. 16-49 915A
DATE: March 26, 2026

ORDER

New and material evidence having been received, the petition to reopen the claim of entitlement to compensation under 38 U.S.C. § 1151 for residuals of penile implant surgeries (IPP surgeries) is granted.

Entitlement to compensation under 38 U.S.C. § 1151 for residuals of IPP surgeries (to include erectile dysfunction (ED), pain, and loss of vision) is denied.

Entitlement to service connection for a right femur disorder is granted.

Entitlement to service connection for loss of sight is denied.

FINDINGS OF FACT

1. The Veteran did not appeal the June 2009 rating decision that denied his claim of entitlement to compensation under 38 U.S.C. § 1151 for residuals of IPP surgeries.

2. The evidence received since the final June 2009 rating decision is not cumulative or redundant of the evidence of record and raises a reasonable possibility of substantiating the Veteran's claim.

3. The Veteran did not incur an additional disability as a result of carelessness, negligence, or a lack of skill by Department of Veterans Affairs (VA) personnel.

4. Resolving reasonable doubt in the Veteran's favor, the evidence supports a finding that his right leg femur/hip disorder was caused or aggravated by his service-connected right knee disability.

5. Refractive error, the only bilateral eye disability diagnosed proximate to the appeal, is not a disability for which service connection can be granted.

CONCLUSIONS OF LAW

1. New and material evidence has been received to reopen the claim of entitlement to compensation under 38 U.S.C. § 1151 for residuals of IPP surgeries. 38 U.S.C. § 5108; 38 C.F.R. § 3.156.

2. The criteria for compensation under 38 U.S.C. § 1151 for residuals of IPP surgeries have not been met. 38 U.S.C. § 1151; 38 C.F.R. §§ 3.102, 3.159, 3.361.

3. The criteria for entitlement to service connection for a right femur/hip disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for service connection for loss of vision have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.9.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1984 to March 1987.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision by a VA Regional Office (RO).

The Board remanded the instant claims in January 2020, June 2020, and October 2023 for procurement of outstanding records and VA opinions. Pursuant to development ordered on remand, the record contains records from the Social Security Administration (SSA) and from all four of the Veteran's thus-completed IPP surgeries. Additionally, updated records have been associated and etiological opinions and examination reports that adequately address the instant claims are of record; each examination is discussed below. Thus, the Board finds there has been substantial compliance with the prior remands and that appellate review is proper at this time.

The Board notes that in a relatively recent submission, the Veteran's representative newly argued that the Board should expand the Veteran's 38 U.S.C. § 1151 claim to include entitlement to service connection for ED on other theories. The Board notes that neither the Veteran nor his representative have ever submitted ambiguous statements regarding the 1151 claim - such has always been phrased as seeking non-service connection benefits under 38 U.S.C. § 1151 for residuals from IPP surgeries. Indeed, the appeal has been pending for nearly 14 years and at no time did the Veteran express confusion as to the issue he was pursuing, nor discuss service connection for ED. Thus, the Board declines to expand the claim and instead encourages the Veteran to file a claim for ED if he so desires. Notably, the Veteran is represented by an attorney accredited by VA and has been throughout the course of the appeal; the attorney should well be aware of the proper course by which to seek a new claim for service connection, to wit, filing a claim.

New and Material Evidence

In general, an RO's determination that
non-service connection benefits under 38 U.S.C. § 1151 for residuals from IPP surgeries. Indeed, the appeal has been pending for nearly 14 years and at no time did the Veteran express confusion as to the issue he was pursuing, nor discuss service connection for ED. Thus, the Board declines to expand the claim and instead encourages the Veteran to file a claim for ED if he so desires. Notably, the Veteran is represented by an attorney accredited by VA and has been throughout the course of the appeal; the attorney should well be aware of the proper course by which to seek a new claim for service connection, to wit, filing a claim.

New and Material Evidence

In general, an RO's determination that is not appealed within one year becomes a final decision, which may only be reopened with a showing of new and material evidence. 38 U.S.C. §§ 5108, 7105.

New evidence is evidence not previously submitted to agency decision makers. Material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a).

The Board must review all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. Evans v. Brown, 9 Vet. App. 273 (1996). For purposes of determining whether new evidence is material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). New and material evidence is not required as to each previously unproven element of a claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of determining whether new and material evidence has been presented to reopen a claim, the evidence for consideration is that which has been presented or secured since the last time the claim was finally disallowed on any basis. Evans, 9 Vet. App. at 285. The Board proceeds with the merits of this claim. As the AOJ has addressed the merits of the evidence, there is no due process concern in proceeding.

1. Whether new and material evidence has been received to reopen the claim

The Veteran's claim of entitlement to compensation under 38 U.S.C. § 1151 for residuals of IPP surgery was denied in a June 2009 rating decision on the basis that the evidence failed to establish that VA medical or educational services were the proximate cause of an additional disability. The Veteran was informed of the decision in writing and did not appeal the decision or submit pertinent evidence during the appeal period. 38 C.F.R. § 3.156 (b), (c). Accordingly, the June 2009 rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103.

The Board finds that there is a sufficient evidentiary basis to reopen the claim of entitlement to compensation under 38 U.S.C. § 1151 for residuals of IPP surgeries. New evidence received since the last final denial includes lay statements from the Veteran as well as the VA treatment records associated with the Veteran's December 2000 IPP surgery; the Veteran claims this particular IPP surgery is what led to a reduction in his visual acuity. The Board finds that this evidence constitutes new and material evidence which directly relates to an unestablished fact necessary to substantiate the Veteran's claim. Accordingly, the Board finds that the claim of entitlement to compensation under 38 U.S.C. § 1151 for residuals of IPP surgery is reopened.

38 U.S.C. § 1151

2. Entitlement to compensation under 38 U.S.C. § 1151 for IPP surgeries.

The Veteran asserts that he experienced worse ED, pain, and a loss of vision following IPP surgeries performed by VA.

By way of background, treatment records indicate that after medicinal treatment failed to treat the Veteran's impotence, he underwent an IPP surgery at a VA facility in September 2000. Shortly thereafter, the Veteran complained regarding the the first implant, and that he was experiencing intermittent pain with urination, chronic left testicular pain, and improper distal seating of the implant.

A second surgery was performed at a VA facility in December 2000 during which a different type of penis implant was used. After the second surgery, a hematocrit was noted as well as significant acute anemia; a computed tomography (
The Veteran asserts that he experienced worse ED, pain, and a loss of vision following IPP surgeries performed by VA.

A second surgery was performed at a VA facility in December 2000 during which a different type of penis implant was used. After the second surgery, a hematocrit was noted as well as significant acute anemia; a computed tomography (CAT) scan revealed a significant well contained retropubic hematoma with no evidence of expansion. This finding was treated with a transfusion of blood. Despite medical documentation of the foregoing, the Veteran has repeatedly stated to new health care providers and to VA adjudicators that his femoral artery was "nicked" or "lacerated" during the second surgery; he has claimed that he almost "bled to death" and that he was pronounced as dead.

Following the second surgery, the Veteran sought VA treatment in 2001 stating that he did not feel his second penile pump was working properly. Physical examination revealed the pump worked properly and the Veteran was reinstructed on deflating the device. Then, in April 2001 the Veteran returned complaining of soreness, and burning, but physical examination again revealed a normal, well-operating pump. Next, in October 2001 the Veteran again returned for treatment reporting that the implantation created an asymmetric appearance; the clinician noted the Veteran's complaints were cosmetic and the pump was working properly. At no time during these visits or after the first or second surgery did the Veteran report a loss of vision.

More than eight years after the second surgery, a third surgery was conducted in January 2009; again, the Veteran did not report that he experienced a loss of vision prior to or immediately after this surgery. Indeed, it was not until a July 2012 submission from the Veteran's representative that the issue of his IPP surgeries causing vision loss was first raised. In any event, treatment records since that time do not reveal medical documentation of vision loss, nor lay complaints thereof, though they do sometimes include the Veteran's statements that the surgeries caused loss of vision.

Returning to his surgical history, the Veteran underwent a fourth IPP surgery in November 2017. Since then, the Veteran has consulted with clinicians regarding having a fifth surgery done, but it does not appear that one has been completed. In any event, the Veteran's complaints primarily revolve around the first two surgeries and his claim that if the first surgery were successfully completed, he would never have had to undergo the subsequent surgeries. Thus, he believes he is entitled to compensation under the provisions of 38 U.S.C. § 1151.

Compensation under 38 U.S.C. § 1151 is awarded for a qualifying additional disability caused by improper VA treatment. A disability is a qualifying additional disability if the disability was not the result of the veteran's willful misconduct and the disability was caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by the Secretary of the VA, either by a Department employee or in a Department facility and the proximate cause of the disability was carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or an event not reasonably foreseeable. 38 U.S.C. § 1151; 38 C.F.R. § 3.361.

In Viegas v. Shinseki, the United States Court of Appeals for the Federal Circuit noted that section 1151 delineates three prerequisites for obtaining disability compensation. First, a putative claimant must incur a "qualifying additional disability" that was not the result of his own "willful misconduct." 38 U.S.C. § 1151 (a). Second, that disability must have been "caused by hospital care, medical or surgical treatment, or examination furnished the Veteran" by VA or in a VA facility. Finally, the "proximate cause" of the Veteran's disability must be "carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part" of VA, or "an event not reasonably foreseeable." See Viegas v. Shinseki, 705 F.3d 1374 (Fed. Cir. 2013); § 1151(a)(1)(A), (a)(1)(B). Thus, section
misconduct." 38 U.S.C. § 1151 (a). Second, that disability must have been "caused by hospital care, medical or surgical treatment, or examination furnished the Veteran" by VA or in a VA facility. Finally, the "proximate cause" of the Veteran's disability must be "carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part" of VA, or "an event not reasonably foreseeable." See Viegas v. Shinseki, 705 F.3d 1374 (Fed. Cir. 2013); § 1151(a)(1)(A), (a)(1)(B). Thus, section 1151 contains two causation elements-a Veteran's disability must not only be caused by the hospital care or medical treatment he received from VA, but also must be proximately caused by the VA's fault or an unforeseen event.

In determining whether a veteran has an additional disability, VA compares the Veteran's condition immediately before the beginning of the hospital care or medical or surgical treatment upon which the claim is based to the Veteran's condition after care or treatment is rendered. 38 C.F.R. § 3.361 (b).

To establish causation, the evidence must show that the hospital care or medical or surgical treatment resulted in the Veteran's additional disability. Merely showing that a Veteran received care or treatment and that the Veteran has an additional disability does not establish causation. 38 C.F.R. § 3.361 (c)(1).

Hospital care or medical or surgical treatment cannot cause the continuance or natural progress of a disease of injury for which the care or treatment was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R.

§ 3.361 (c)(2).

To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance on VA's part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a Veteran's additional disability, it must be shown that the hospital care or medical or surgical treatment caused the Veteran's additional disability; and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider, or (ii) VA furnished the hospital care or medical or surgical treatment without the Veteran's informed consent. Determinations of whether there was informed consent involve consideration of whether the health care providers substantially complied with the requirements of 38 C.F.R. § 17.32. Minor deviations from the requirements of 38 C.F.R. § 17.32 that are immaterial under the circumstances of a case will not defeat a finding of informed consent. 38 C.F.R. § 3.361 (d)(1).

Whether the proximate cause of a veteran's additional disability was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of 38 C.F.R. §§ 17.32. 38 C.F.R. § 3.361(d)(2).

After a review of the record, the Board finds that compensation under 38 U.S.C. § 1151 is not warranted because an additional disability did not result from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable.

Turning to whether an additional disability resulted from carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable, following the Board's most recent remand, a September 2024 VA examiner reviewed the Veteran's medical records and rendered several opinions. In the first opinion, the examiner stated that the Veteran's penile disability was caused by or became worse as a result of the VA treatment. The examiner went on to provide incorrect facts regarding the Veteran's surgical history and acknowledged that the timeline of the Veteran's procedures was not clear. In any event, the clinician stated that any additional disability was the result of an event that could not have been foreseen and/or that it was a known complication of the surgeries. The examiner then seemed to reverse her opinion and stated that VA had diagnosed and treated the Veteran's initial ED.

In the second opinion, the clinician referenced different medical records than
September 2024 VA examiner reviewed the Veteran's medical records and rendered several opinions. In the first opinion, the examiner stated that the Veteran's penile disability was caused by or became worse as a result of the VA treatment. The examiner went on to provide incorrect facts regarding the Veteran's surgical history and acknowledged that the timeline of the Veteran's procedures was not clear. In any event, the clinician stated that any additional disability was the result of an event that could not have been foreseen and/or that it was a known complication of the surgeries. The examiner then seemed to reverse her opinion and stated that VA had diagnosed and treated the Veteran's initial ED.

In the second opinion, the clinician referenced different medical records than those identified in the first opinion, and stated that the Veteran did not have any additional disability. Similarly, in a third opinion rendered that day, the examiner again stated that the Veteran did not have an additional disability. Put simply, the examiner noted that the Veteran had ED before and after the surgeries indicating the same level of functioning, not a new disorder.

Given the somewhat contradictory findings of the September 2024 opinions, the RO sought clarification in November 2024. At that time, the examiner re-reviewed the evidence and stated that any additional disability was not a result of carelessness, negligence, or a lack of skill by the VA personnel and was due to a known complication and risk of surgery. Here, the Board notes that the Veteran has not argued, and the record does not suggest that he was ill informed about the risks of surgery, or that he did not consent.

The Board accords probative weight to the September and November 2024 opinions as they were predicated on a review of the record, which includes medical records concerning the treatments in question. Indeed, while some clarification was needed by VA to confirm the examiner's stated opinion, the examiner ultimately reviewed the associated medical records that documented the Veteran's pre and post-surgical report of symptoms and the course of treatment. Moreover, the opinion considered all the pertinent evidence of record and provided a complete rationale, relying on and citing to the records received and the clinician offered clear conclusions with supporting analysis. 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").

Notably, there is no medical opinion of record to the contrary of the September and November 2024 examiner's opinions.

The Board understands the Veteran's sincerely held belief that had his first IPP surgery been completed to his satisfaction, he would not have had subsequent surgeries that he claims led to pain, loss of vision, and ED. The Board is sympathetic to these concerns.

While the Veteran, as a lay person, may report on observable symptoms and discomfort and the nature of the treatment he received, an assessment of the severity and proper course of treatment during his IPP surgeries is a complex, medical matter requiring training and clinical experience that lay persons do not possess. Similarly, he is not competent to diagnose any additional disability that was allegedly caused by VA treatment as opposed to the progression of his ED generally. In short, his lay assessment of the presence of an additional disability, and/or the required course of action during his IPP surgeries are not competent as such are complex medical questions and the statements in this regard are non-probative. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis).

Ultimately, the Board places greatest probative weight on the opinions rendered by the September and November 2024 VA examiner. Again, the examiner considered the Veteran's contentions and summarized the medical history. The assessment of the symptoms and their severity is consistent with the available medical records, which do not show any vision loss or additional ED following the surgery. The record does not contain any opinion from a medical professional indicating that VA care caused the Veteran to incur an additional disability or increased an existing disability as a result of improper care or an event not reasonably foreseeable. If the Board finds that there is no "actual causation," it is unnecessary to address the next step of proximate causation (i.e., negligence and reasonable foreseeability). That is, because the evidence of record does not demonstrate any additional disability caused by VA treatment, examination, or surgery, the analysis need not advance to the question of proximate cause, including negligence and reasonable foreseeability. Mangham v. Shinseki, 23 Vet. App. 284, 287-88 (
the surgery. The record does not contain any opinion from a medical professional indicating that VA care caused the Veteran to incur an additional disability or increased an existing disability as a result of improper care or an event not reasonably foreseeable. If the Board finds that there is no "actual causation," it is unnecessary to address the next step of proximate causation (i.e., negligence and reasonable foreseeability). That is, because the evidence of record does not demonstrate any additional disability caused by VA treatment, examination, or surgery, the analysis need not advance to the question of proximate cause, including negligence and reasonable foreseeability. Mangham v. Shinseki, 23 Vet. App. 284, 287-88 (2009); Loving v. Nicholson, 19 Vet. App. 96, 99-100 (2005); see also 38 U.S.C. § 1151 (a)(1); 38 C.F.R. § 3.361 (d).

Based on the foregoing, the Board finds that the criteria for entitlement to compensation under 38 U.S.C. § 1151 have not been met. As the evidence of record persuasively weighs against the claim, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

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. §§ 1131, 5107; 38 C.F.R.

§ 3.303. The three-element test for direct 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 shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder has caused or aggravated a nonservice connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995).

3. Entitlement to service connection for a right femur disorder.

The Veteran asserts that his right femur/hip pain is related to his service connected right knee disability.

The record in this case establishes the Veteran has a right femur/hip disorder. Specifically, the Veteran has reported right femur pain which a November 2024 VA examiner has explained is referred pain from his right knee and hip. Resolving doubt in the Veteran's favor, the Board finds that this pain causes functional loss and that the first element of service connection has been met. Additionally, the Veteran is service connected for a right knee disability. Thus, the remaining question is whether there is a nexus between the Veteran's right femur/hip disorder and his right knee disorder.

Notably, in the Board's prior remands the November 2012, and September 2021 opinions were found to be inadequate to adjudicate the claim. As such, the only opinion of record is in favor of a grant of service connection. Specifically in September 2024 a VA examiner reviewed the Veteran's records and opined that it was at least as likely as not that a right femur/hip disorder was caused by the Veteran's right knee disorder. As no rationale was provided, an addendum opinion was obtained in November 2024. At that time the examiner explained that a femur disability per se did not exist, but that the Veteran experienced pain in this area of his body. It was explained that the arthritis in the Veteran's right hip and knee caused referred pain, which the Veteran experienced in his right femur. The medical professional stated that referred pain from the knee can subjectively manifest as pain in the femur, which was happening in the Veteran's case. There is no opinion of record against the claim.

The Board affords the September and November 2024 VA opinions that the Veteran has a right femur/hip diagnosis that was caused by his service-connected right knee disorder probative weight as they were supported by rationales specific to the Veteran's health history and focused on his reports of pain. Further, remanding to obtain another opinion would constitute ordering negative development, which, as a matter of course, VA should not do. 38C.F.R. § 3.304 (c) ("The development of evidence in connection with claims
medical professional stated that referred pain from the knee can subjectively manifest as pain in the femur, which was happening in the Veteran's case. There is no opinion of record against the claim.

The Board affords the September and November 2024 VA opinions that the Veteran has a right femur/hip diagnosis that was caused by his service-connected right knee disorder probative weight as they were supported by rationales specific to the Veteran's health history and focused on his reports of pain. Further, remanding to obtain another opinion would constitute ordering negative development, which, as a matter of course, VA should not do. 38C.F.R. § 3.304 (c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination").

Given the foregoing, the Board will resolve reasonable doubt in the Veteran's favor and finds that all elements of service connection have been met. Therefore, service connection for a right femur/hip disorder is granted. See 38 U.S.C. § 5107 (b).

4. Entitlement to service connection for loss of sight.

The Veteran has claimed service connection for refractive error (claimed as bilateral vision loss/loss of sight). While refractive error has been shown, service connection for an eye disorder based on refractive error is denied because the reduced vision is correctable refractive error and is not a disability for the purposes of service connection. 38 C.F.R. §§ 3.303(c), 4.9.

Refractive errors, such as myopia, presbyopia, hyperopia, and astigmatism, are considered developmental defects not eligible for service connection. Actual pathology, other than refractive error, is required to support impairment of visual acuity. The Veteran does not have any other such diagnosis. Indeed, the Veteran was afforded a VA examination in November 2024, and the only defect of his eyes was presbyopia - a refractive error.

The Board has considered the Veteran's lay reports that he experiences a loss of visual acuity. While the Veteran is competent to report symptoms as this requires only personal knowledge as it comes to him through his senses, he is not competent to diagnose an eye disorder or to differentiate any eye symptoms from his refractive error. Jandreau, 492 F.3d at 1376.

The Board finds the November 2024 VA examination report to be of great probative value. Specifically, the report was rendered by an ophthalmologist based on an in-person examination of the Veteran, and a comprehensive review of the Veteran's file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

In this case, the most probative evidence does not show an eligible current disability under VA regulations. As stated, the record indicates the Veteran's only eye condition to be refractive error, a developmental defect that is not eligible for service connection.

As the most probative evidence is against the claim for service connection, the benefit of the doubt doctrine is not for application, and the Veteran's claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Sosna, Counsel

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

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