POSTTRAUMATIC STRESS DISORDER (PTSD)

KRISTY L. ZADORA · 2026 · Case ID: 26005061

DENIED

Summary

The veteran, who served in the United States Army from July 1973 to October 1990, appeals the denial of service connection for an acquired psychiatric disorder, including PTSD, adjustment disorder, anxiety disorder, and major depressive disorder, as well as a seizure disorder claimed as secondary to service-connected concussion with headaches. The veteran also appeals the denial of special monthly compensation (SMC) for aid and attendance, specially adapted housing (SAH), and a special home adaptation (SHA) grant. The Board denied service connection for the psychiatric disorder, finding no verified in-service stressor and that the veteran's lay testimony was not credible due to inconsistencies with contemporaneous records and failure to provide sufficient details for corroboration. The Board also denied service connection for the seizure disorder, noting the lack of in-service treatment or diagnosis, a significant delay between service and onset, and that the most probative medical opinions attributed the seizures to a non-service-related head injury in 2015. The Board denied SMC, SAH, and SHA, finding that the veteran's service-connected disabilities, while significant, did not meet the specific criteria for these benefits, particularly regarding the need for aid and attendance or the specific types of functional loss required for housing benefits. The veteran's failure to attend scheduled VA examinations for the psychiatric and seizure disorder claims also impacted the Board's decision-making process.

Rationale

No verified in-service stressor for PTSD.; Lay testimony regarding stressors found not credible due to inconsistencies and lack of detail.; No in-service treatment or diagnosis for psychiatric conditions.; Post-service diagnosis occurred more than one year after discharge.

Service Branch

ARMY

Special Benefit

SMC - AID & ATTENDANCE

Docket No.

09-23 059A

Full Decision Text

Citation Nr: 26005061
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 09-23 059A
DATE: April 29, 2026

ORDER

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

Entitlement to service connection for a seizure disorder, to include as secondary to service-connected concussions with headaches, is denied.

Entitlement to special monthly compensation based on the need for aid and attendance of another person is denied.

Entitlement to a certificate of eligibility for assistance in acquiring special adapted housing is denied.

Entitlement to a certificate of eligibility for special home adaptation grant is denied.

FINDINGS OF FACT

1. The Veteran failed to report to scheduled VA examinations and has not shown good cause for his failure to appear and has not requested that the examinations be rescheduled.

2. There is no evidence corroborating the Veteran's claimed in-service stressors and he does not have a diagnosis of PTSD based on a verified in-service stressor.

3. The Veteran's acquired psychiatric disorder was not shown as chronic in service and psychosis did not manifest to a compensable degree within the applicable presumptive period; a continuity of symptomatology is not established; the disability is not otherwise etiologically related to an in-service injury or disease.

4. The Veteran's seizure disorder first manifested many years after service, is not etiologically related to any injury, event, or illness during service and is not proximately due to or aggravated by service-connected concussion with headaches.

5. The Veteran is service connected for concussion with headache, bilateral hearing loss, residuals of low back injury with strain, burn scar, right lower extremity, with underlying tissue damage associated with residuals of low back injury with strain, peptic ulcer disease with history of chronic gastritis and irritable bowel syndrome, tinnitus, painful burn scars, bilateral lower extremities associated with residuals of low back injury with strain, multiple scars from shell fragment wound, left arm and surgical excision, ganglion cyst, left wrist, ganglion left wrist, erectile dysfunction associated with residuals of low back injury with strain, and burn scar, left lower extremity, associated with residuals of low back injury with strain.

6. The Veteran's service-connected disabilities do not result in loss or loss of use of a hand or foot, permanent impairment of both eyes with central visual acuity of 20/200 or less, severe burn injury, amyotrophic lateral sclerosis, or ankylosis of a knee or hip.

7. Throughout the appeal, the Veteran did not require aid and assistance of another person solely due to his service-connected disabilities.

8. The Veteran's service-connected disabilities do not include or result in loss or loss of use of the lower extremities, blindness in both eyes, loss or loss of use of one lower extremity with residual organic disease or injury affecting balance or propulsion, loss or loss of use of one lower extremity with loss or loss of use of one upper extremity affecting balance and propulsion, loss or loss of use of both upper extremities to preclude use of arms at or above the elbow, or full thickness or subdermal burns.

9. The Veteran's service-connected disabilities do not result in blindness in both eyes with 5/200 visual acuity or less, involve the anatomical loss or loss of use of both hands, certain deep partial and full thickness or subdermal burns, or residuals of an inhalation injury.

CONCLUSIONS OF LAW

1. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, adjustment disorder, anxiety disorder and major depressive disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655.

2. The criteria for service connection for a seizure disorder, to include as secondary to service-connected concussions with headaches, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.655.

3. The criteria for special monthly compensation based on the need for aid and attendance of another person. 38 U.S.C. §§ 1114, 1502, 1521, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352, 3.655.

4. The
as secondary to service-connected concussions with headaches, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.655.

3. The criteria for special monthly compensation based on the need for aid and attendance of another person. 38 U.S.C. §§ 1114, 1502, 1521, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352, 3.655.

4. The criteria for a certificate of eligibility for assistance in acquiring special adapted housing have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. § 3.809.

5. The criteria for a certificate of eligibility for special home adaptation grant have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. § 3.809a.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from July 1973 to October 1990.

These matters come before the Board of Veterans' Appeals (Board) on appeal from April 2008, March 2014, May 2015 and February 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO).

Many of the issues on appeal were remanded by the Board for further development in November 2015. Following the requested development, a supplemental statement of the case (SSOC) was issued in January 2018.

In October 2018, the Board denied the Veteran's claim of entitlement to service connection for a seizure disorder; in that decision, the Board remanded the claims listed above. The Veteran appealed the October 2018 decision to the Court. In January 2020, the Court issued an order that granted a Joint Motion for Partial Remand filed by counsel for both parties, which vacated the Board's October 2018 decision, and remanded the case to the Board for readjudication in compliance with directives specified in the Joint Motion for Partial Remand.

In May 2020, the Board remanded the issue of entitlement to service connection for a seizure disorder to the Agency of Original Jurisdiction (AOJ) for additional development. Following the requested development, a supplemental statement of the case was issued in July 2020. In November 2020, the Board again remanded the claim of entitlement to service connection for a seizure disorder the AOJ for further evidentiary development namely to obtain an etiology opinion. Such an opinion was obtained in December 2020, February 2021 and June 2021. Following the requested development, a supplemental statement of the case was issued in October 2021.

In August 2022, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the electronic record.

In January 2023, the Board again denied the claim of entitlement to service connection for a seizure disorder, including as secondary to service connected concussion with headaches. The Veteran subsequently appealed the Board's January 2023 decision to the Court. In October 2023, the Court issued an order that granted a Joint Motion for Remand filed by counsel for both parties, vacated the Board's January 2023 decision, and remanded the case to the Board for compliance with directives specified in the Joint Motion for Remand.

In December 2023, the Board denied the claim of entitlement to service connection for a seizure disorder, including as secondary to concussion with headaches. The Veteran appealed the Board's December 2023 decision to the Court. In March 2025, the Court granted a Joint Motion for Remand of the parties, vacating and remanding the matter to the Board. The parties to the Joint Motion for Remand agreed that remand was required because the Board failed to provide an adequate statement of reasons or bases for its determinations. The matter is now again before the Board for action consistent with the terms of the Joint Motion for Remand.

With respect to the issues remanded by the Board in October 2018, following the requested development, the AOJ issued a July 2020 supplemental statement of the case. The Veteran then filed a Decision Review Request: Board Appeal (VA Form 10182) and Decision Review Request: Higher-Level Review (VA Form 20-0996) seeking review of the claims adjudicated in the July 2020 supplemental statement of the
the matter to the Board. The parties to the Joint Motion for Remand agreed that remand was required because the Board failed to provide an adequate statement of reasons or bases for its determinations. The matter is now again before the Board for action consistent with the terms of the Joint Motion for Remand.

With respect to the issues remanded by the Board in October 2018, following the requested development, the AOJ issued a July 2020 supplemental statement of the case. The Veteran then filed a Decision Review Request: Board Appeal (VA Form 10182) and Decision Review Request: Higher-Level Review (VA Form 20-0996) seeking review of the claims adjudicated in the July 2020 supplemental statement of the case under the Appeals Modernization Act (AMA). The Board dismissed these issues in June 2024 by finding that the Veteran simultaneously opted into two separate lanes with the AMA system. The Veteran indicated that he wanted his appeal to remain in the Legacy system in a June 2024 submission.

Relevant to the Veteran's claim of entitlement to service connection for an acquired psychiatric disorder, such was originally adjudicated by the AOJ as entitlement to service connection for PTSD. However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Court held that, in determining the scope of a claim, the Board must consider the claimant's description of the claim; symptoms described; and the information submitted or developed in support of the claim. In light of the Court's decision in Clemons, the Board has recharacterized the issue on appeal as entitlement to service connection for an acquired psychiatric disorder, to include PTSD.

A June 2025 Board decision denied a rating in excess of 40 percent for residuals of a low back injury; denied entitlement to a total disability rating based on individual unemployability (TDIU) for the appeal period prior to April 23, 2015; denied the petition to reopen the claim of entitlement to service connection for heart disease; and denied entitlement to residuals of a stroke, diabetes mellitus type II, hypertension, a right knee disorder and a left knee disorder. The June 2025 Board decision also remanded the instant claims to the AOJ for additional development. Specifically, the Board directed the AOJ to obtain outstanding treatment records, to attempt to verify the Veteran's reported stressors and to obtain an etiology opinions as to the Veteran's claimed disorders. Updated VA treatment records have been associated with the claims file and a July 2025 letter requested that the Veteran complete an appropriate authorization form to allow VA to obtain treatment records on his behalf. The AOJ scheduled VA examinations to determine the nature and etiology of the Veteran's claimed seizure disorder and acquired psychiatric disorder in August 2025 and September 2025; however, the Veteran failed to appear for the scheduled examinations, has not requested that the examinations be rescheduled and has not provide good cause for his failure to appear for the examination. A September 2025 Report of General Information (VA Form 27-0820) indicates that that the Veteran called to cancel his examination appointment for his claimed seizure disorder, that the Veteran does not wish to attend the examination and that the remaining information or evidence that will support his appeal has already been included in the file. The February 2026 Supplemental Statement of the Case informed the Veteran that he had failed to report for his scheduled examinations, that he had submitted no evidence showing that he had good cause for his failure to report for the examinations and that evidence expected from these examinations which might have been material to the outcome of these claims could not be considered. Thus, the Board finds that the AOJ substantially complied with the June 2025 remand directives. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The case has now been returned to the Board for appellate action.

Service Connection Criteria

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in
connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be established for a current disability on the basis of the presumption that certain chronic diseases, including psychosis, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). Generally, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3).

For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). When the disease identity is established, there is no requirement of evidentiary showing of continuity. Id. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. Continuity of symptomatology is only applicable to those diseases recognized as chronic for VA purposes. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309.

In addition to the general principles governing service connection, to establish entitlement to service connection for PTSD the evidence must satisfy three basic elements. There must be: 1) medical evidence diagnosing PTSD; 2) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and 3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a). In this regard, the Board notes that, for cases certified to the Board after August 4, 2014, as is the case here, the diagnosis of PTSD must be in accordance with the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed. 2013) (DSM-5).

Effective July 13, 2010, VA amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor. Specifically, the final rule amends 38 C.F.R. § 3.304(f) by redesignating current paragraphs (f)(3) and (f)(4) as paragraphs (f)(4) and (f)(5), respectively, and by adding a new paragraph (f)(3) that reads as follows:

(f)(3) If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or
related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.

The provisions of this amendment apply to applications for service connection for PTSD that are appealed to the Board on or after July 13, 2010, but have not yet been decided by such date, as is the case here. 75 Fed. Reg. 39, 843 (July 13, 2010), with correcting amendments at 75 Fed. Reg. 41, 092 (July 15, 2010).

Once the claimed stressor has been verified, the veteran's personal exposure to the event may be implied by the evidence of record. A veteran need not substantiate his actual presence during the stressor event; the fact that the veteran was assigned to and stationed with a unit that was present while such an event occurred strongly suggests that he was, in fact, exposed to the stressor event. See Pentecost v. Principi, 16 Vet. App. 124 (2002); Suozzi v. Brown, 10 Vet. App. 307 (1997).

PTSD may be granted if the evidence of record satisfies three basic elements. There must be: 1) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125 (a); 2) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and 3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

If the evidence establishes that a veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary and provided that the claimed stressor is consistent with circumstances, conditions, or hardships of a veteran's service, a veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1). See also 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat veterans). A finding that a veteran engaged in combat with the enemy, however, requires that a veteran participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality, and does not apply to veterans who served in a general "combat area" or "combat zone" but did not themselves engage in combat with the enemy. See VAOPGCPREC 12-99 (October 18, 1999).

A veteran must present "credible supporting evidence" establishing the occurrence of a recognizable stressor during service. See 38 C.F.R. § 3.304(f). If a stressor claimed by a veteran is related to that veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of that veteran's service, a veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3).

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., See also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

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. Under 38 C.F.R. § 3.655(b), 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, but when a claimant fails to report without good cause for an examination scheduled in conjunction with a reopened claim or a claim for increase, the claim shall be denied. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, and death of an immediate family member, etc. 38 C.F.R. § 3.655(a). As detailed above, the instant claims will be rated based on the evidence of record.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, adjustment disorder, anxiety disorder, and major depressive disorder, is denied.

The Veteran contends that his acquired psychiatric disorder was related to multiple in-service stressors. The Veteran essentially contends that service connection is warranted for PTSD, which he developed as a result of a truck accident during service in Erwin California in 1984. See September 2014 Notice of Disagreement. The Veteran reported witnessing an incident during which a number of soldiers were killed when they were fired upon by a tank in Germany in 1974 or 1975. See May 2019 Statement in Support of Claim (VA Form 21-4138). The Veteran also reported witnessing the death of a friend in a live firing exercise during basic training, as well as the electrocution of two solders at Fort Hood in the early 1980s. See June 2020 Correspondence. The Veteran indicated that he currently experiences flashbacks as a result of those inservice incidents.

The Veteran's service treatment records are negative for treatment of, diagnoses for, or complaints of PTSD or any acquired psychiatric disorder during service.

Post service treatment records show that the Veteran has received ongoing clinical evaluation and treatment for an acquired psychiatric disorder, variously diagnosed as PTSD, adjustment disorder, anxiety disorder and major depression.

The Veteran's service treatment records are negative for treatment of, diagnoses for, or complaints of PTSD or any acquired psychiatric disorder during service.

A May 2013 VA examiner stated that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-IV criteria. The examiner noted a diagnosis of depression not otherwise specified and adjustment disorder with mixed anxiety and depression. The examiner indicated that treatment records indicate that the Veteran was diagnosed with depression prior to his stroke in 2001, and treatment records show depression as far back as 1995. The examiner opined that it was as likely as not that the Veteran's depression was a result, at least in part, of his reported stressors from military service and are related to fear of hostile military terrorist activity. As for the diagnosis of adjustment disorder, the examiner opined that this diagnosis represents his psychological difficulty adjusting to that diagnosis and its accompanying functional impairments both a psychological and cognitive functioning. This diagnosis is not related to his military service.

Received in July 2015 was an undated statement from a VA physician, J. M., certifying that the Veteran had been seen in mental health treatment since June 2001, and he has been receiving ongoing treatment through the years. The provider indicated that the Veteran was currently receiving treatment at the mental health outpatient department for depression related to generalized medical conditions and anxiety. The provider indicated that documentation in the record indicate that the Veteran has reported since 2002, sleep disturbance, nightmares from trauma in the military.

During a clinical visit in February 2018, it was noted that the Veteran complained of depression, anxiety and PTSD. It was reported that the Veteran continued to feel depressed and anxious about his current situation and maintaining his legal rights to manage his own finance; other stressors were chronic health problems. The impression was depression, secondary to medical conditions, PTSD, and multiple medical conditions.

A June 2018 report of a psychological evaluation from Dr. K. R. S. indicated that PTSD features are evident. The provider noted that the Veteran indicated that, during the course of his military service, he was exposed to traumatic events beginning in his service in Vietnam from 1970 to 1972, where he was in special forces and was exposed to traumatic events which involved the threat of imminent death or serious injury. The provider noted that the Veteran reported seeing a man killed right next to him by a machine gun during training a training exercise. The provider noted that the Veteran also recalled seeing two more soldiers killed during filed exercises in Germany; on another occasion, he saw two men get electrocuted simultaneously as they were trying to get combat boots off of an electrified wire. The provider stated that the Veteran exhibits signs of PTSD, including being exposed to actual and threatened death and/or serious injury and that the Veteran began experiencing recurrent, involuntary and intrusive distressing memory of the traumatic events, and recurrent distressing dreams in which the content and/or effect of the dreams are associated with traumatic events occurring every night. The provider noted that the Veteran experienced persistent negative emotional states, including fear, horror, anger, guilt and shame, marked diminished interest and/or participation in significant activities, as the Veteran indicated that he was no longer interested in social activities. The provider reported a diagnosis of PTSD, chronic and severe; the provider stated that the Veteran suffers from chronic and severe posttraumatic stress disorder, which is seen to be service connected, stemming from the psychological trauma aforementioned in this evaluative report.

A January 2020 private PTSD examination report reflected a diagnosis of chronic PTSD. The provider noted that the Veteran was initially diagnosed with PTSD in September 2016 and has been under mental health care since such time for PTSD. However, the provider did not provide an opinion as to the etiology of the Veteran's PTSD.

In June 2025, the Board remanded the case to the afford the Veteran a VA examination in order to determine the nature and etiology of his claimed psychiatric disorder, including his PTSD. However, in September 2025, the Veteran requested that examination be cancelled, indicating that he did not wish to attend another examination and that the case should be decided on the evidence currently of record. As noted above, the Veteran failed to appear for the scheduled examination, has not requested that the examination be rescheduled and has provided good cause for his failure to appear for the scheduled examination.

In February 2026, the AOJ determined that it had found no evidence to support documentation of the claimed stressors.
the Veteran's PTSD.

In February 2026, the AOJ determined that it had found no evidence to support documentation of the claimed stressors. It was found that the Veteran failed to provide enough details of the claimed stressors to allow for an adequate search of official records, and no evidence was located in the service treatment or personnel records with the Veteran's file. The AOJ further found that the Veteran's claimed stressors were impossible to verify as the Veteran did not provide enough details for an adequate.

With regards to the claim for service connection for PTSD, the record does not demonstrate a verified stressor for purposes of 38 C.F.R. § 3.304. The Veteran has asserted that he experienced several stressful incidents in-service, including witnessing a man killed right next to him by a machine gun during training a training exercise, seeing two more soldiers killed during filed exercises in Germany, seeing two men get electrocuted simultaneously as they were trying to get combat boots off of an electrified wire, and being involved in a truck accident. The Board notes that the Veteran's reported stressors are not combat related and not related to fear of hostile military activity; thus, lay testimony alone is not sufficient to corroborate them. To establish service connection on the basis of non-combat stressors, the Veteran must present credible supporting evidence establishing the occurrence of his claimed stressors. See 38 C.F.R. § 3.304(f).

In this regard, the Veteran's service records are negative for any indication or documentation corroborating the Veteran's stressors. The VA attempted to obtain enough information to corroborate the stressor but was unable to confirm the stressor. Generalized descriptions of stressors do not lend themselves to meaningful corroboration efforts. While a lay witness is competent to testify as to the occurrence of an in-service injury or incident where that issue is factual in nature, the Board finds that the lay statements submitted by the Veteran do not constitute competent evidence of the Veteran's claimed stressor. Moreover, the AOJ determined in February 2026 that the Veteran's claimed stressors were impossible to verify as the Veteran did not provide enough details for an adequate research request. As such, the Veteran's reported non-combat stressors have not been verified and service connection for PTSD cannot be granted.

Therefore, as the evidence of record shows that the Veteran does not have a verified non-combat in-service stressor for the claim of entitlement to service connection for PTSD, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury, or a disease incurred in service."); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection).

With regards to service connection for an acquired psychiatric disorder other than PTSD, the Board has considered whether service connection for psychosis is warranted on a presumptive basis, to include on the basis of continuity of symptomatology. In this regard, the clinical evidence of record fails to show that the Veteran manifested such disease to a compensable degree within the year following his discharge from active duty service. The Veteran's post-service treatment record did not reflect any complaints for an acquired psychiatric disorder until 1995, more than one year after service discharge. Moreover, the Veteran has not been diagnosed with psychosis. Therefore, the Board finds that presumptive service connection for psychosis, to include on the basis of continuity of symptomatology, is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.

With regards to direct service connection, the Board notes that the service treatment records are negative for diagnoses, treatment, or complaints related to an acquired psychiatric disorder. Additionally, the Veteran's service records are negative for any indication or documentation corroborating the Veteran's stressors. In fact, in February 2026, the AOJ determined that the Veteran's
than one year after service discharge. Moreover, the Veteran has not been diagnosed with psychosis. Therefore, the Board finds that presumptive service connection for psychosis, to include on the basis of continuity of symptomatology, is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.

With regards to direct service connection, the Board notes that the service treatment records are negative for diagnoses, treatment, or complaints related to an acquired psychiatric disorder. Additionally, the Veteran's service records are negative for any indication or documentation corroborating the Veteran's stressors. In fact, in February 2026, the AOJ determined that the Veteran's claimed stressors were impossible to verify as the Veteran did not provide enough details for an adequate research request.

Moreover, following a May 3013 VA examination, the examiner opined that it was as likely as not that the Veteran's depression was a result, at least in part, of his reported stressors from military service and are related to fear of hostile military terrorist activity. As for the diagnosis of adjustment disorder, the examiner opined that this diagnosis represents his psychological difficulty adjusting to that diagnosis and its accompanying functional impairments both a psychological and cognitive functioning, but the diagnosis is not related to his military service. Therefore, the VA examiner concluded that the Veteran's adjustment disorder was less likely than not related to his military service. While the VA examiner suggested that the diagnosed depression was a result of the reported military stressors, those stressors have not been corroborated.

As such, the Veteran was scheduled for a VA examination in August 2025 in order to obtain an opinion regarding the likely etiology of the claimed acquired psychiatric disorder; however, the Veteran canceled that scheduled examination, did not request that the examination be rescheduled and has not provided good cause for his failure to appear for the scheduled examination. See September 2025 Exam Scheduling Request Contention Cancellation. A February 2026 Supplemental Statement of the Case informed the Veteran that VA had received notice that he had canceled his scheduled August 2025 examination, that evidence expected from this examination might have been material to the outcome of this claim that could not be considered and that the claim shall be rated based on the evidence of record when a claimant does not report for an examination scheduled in conjunction with a compensation claim. The Veteran did not respond to the February 2026 Supplemental Statement of the Case, did not provide good cause for his failure to appear for the scheduled examination and has not requested that the scheduled examination be rescheduled. When a veteran 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. 38 C.F.R. § 3.655.

After a review of the evidence of record, the Board finds that service connection is not warranted for an acquired psychiatric disorder as the only post-service etiology opinion of the record during the time when VA received the Veteran's claim to the present shows that his claimed disorder is less likely than not related to his active service.

The Board notes the general arguments of the Veteran that his psychiatric disorder is etiologically related to his active service. The Board notes that lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to" and a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010).

While the Veteran may believe his psychiatric symptoms had their onset in service or is the result of service, he is not competent to provide a diagnosis or nexus opinion regarding this issue. The issues are medically complex, as it requires knowledge of anatomical and psychiatric functions and limits. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. See Jandreau v. Nicholson, supra; see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Therefore, the Veteran
v. Shinseki, 601 F.3d 1274, 1278 (2010).

Accordingly, service connection for an acquired psychiatric disorder, to include PTSD, adjustment disorder, anxiety and major depressive disorder, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

2. Entitlement to service connection for a seizure disorder, to include as secondary to service-connected concussions with headaches, is denied.

The Veteran contends that he has a seizure disorder which is either due to an in-service head injury or, alternatively, is caused or aggravated by his service-connected concussion with headaches.

Initially, the record shows that the Veteran has a current seizure disorder. Significantly, a February 2016 treatment note reflects a diagnosis of seizure disorder. In addition, following a VA examination in July 2016, the examiner reported a diagnosis of tonic-clonic seizures or grant mal (generalized convulsive seizures). Another VA examination in October 2016 reported a diagnosis of tonic-clonic seizures or grand mal. VA examinations in June 2020 and February 2021 also reflect a diagnosis of tonic-clonic seizures or grand mal. As such, the first requirement for establishing a claim of service connection is met.

As for presumptive service connection and service connection based on continuity of symptomatology, while epilepsies or a seizure disorder is a chronic disease subject to such forms of service connection under 38 C.F.R. §§ 3.303, 3.307, 3.309, there is no evidence that the Veteran's seizures manifested to a compensable degree with the one-year period following his discharge from service. Therefore, presumptive service connection or service connection based on continuity of symptomatology is not warranted.

As for direct service connection, the Board notes that, while the service treatment records show that the Veteran suffered a head injury and was treated for headaches, there is no evidence of treatment for any seizures or seizure disorder during service. The service treatment records are completely silent with respect to any complaints or treatment related to a disability manifested by seizures. The Board therefore concludes that the in-service element is not met in this case.

In fact, the earliest evidence of any diagnosis of a seizure disorder is contained in VA treatment records dated beginning in February 2016, which is approximately 26 years after Veteran's separation from service. The Court has determined that a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim. See generally Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000).

Moreover, there is no competent evidence of record that would etiologically link the present diagnosed condition to his active service. Rather, following a July 2016 VA neurological examination, the examiner noted that the Veteran had generalized epilepsy, with onset date in February 2016. The examiner indicated that there was no evidence of seizures in service. The examiner stated that the traumatic brain injury (concussion) during service that reportedly caused the Veteran's headaches was many years prior to his onset of seizures, making this event an unlikely cause of the Veteran's current seizures. The examiner further stated that the Veteran's headaches were not medically recognized as a cause of generalized epilepsy.

With respect to the Veteran's contentions that his seizure disorder was caused by or aggravated by his service-connected concussion with headaches, an October 2016 VA examiner concluded that the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner noted that the Veteran had a history of traumatic brain injury, mild after closed head injury in 1977; however, he did not have seizures until 2016. The examiner also noted that the Veteran suffered a stroke in 2002; he had all the symptoms, including a syncopal episode with jerking movements, after 2001 and the ischemic stroke. The examiner further noted that the Veteran had a fall with head injury three months prior to the first seizures in 2016. The examiner explained that seizures can have a large list of causes, with the etiology comprising of closed head injury, traumatic brain injury and stroke. The examiner state that, considering the timeline and the fact that even the syncope with jerking movements which was not considered seizures occurred after his stroke with multiple ischemic brain changes on magnetic resonance imaging (MRI) scan, it was his opinion that the claimed condition was less likely than not due to the service-connected condition.

In the January 2020 decision, the Court found the Board provided inadequate reasons and bases in denying service connection for a seizure disorder. Specifically, the Court found that the Board failed to consider whether the Veteran's seizure disorder may be entitled to service connection pursuant to 38 C.F.R. § 3.310(d). The Court explained that the Veteran should have analyzed evidence concerning reported in-service head injuries in light of 3.310(d). The Court noted that the Veteran has been diagnosed with a traumatic brain injury, and there was evidence suggesting that the traumatic brain injury was related to military service.

Accordingly, in its May 2020 remand, the Board requested an opinion an opinion as to whether the Veteran's seizure disorder is etiologically related to military service, to include his in-service head trauma and concussion. The Board requested that the examiner specifically opined whether the Veteran's seizures are unprovoked as well as whether his concussion may be classified as moderate or severe.

Pursuant to the Board remand, the Veteran underwent a VA examination in June 2020 to evaluate his condition and determine the etiology of his seizure disorder. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that while the Veteran is service connected for his traumatic brain injury and headaches, this was diagnosed many decades ago and he did not have any seizure activity associated with his traumatic brain injury. The examiner also stated that, while traumatic brain injuries and head trauma can result with residual seizures, the Veteran did not have any noted seizures in the immediate time after the head trauma; he further noted that the seizures were diagnosed many decades later and are unrelated to the traumatic brain injury and/or migraine headaches. The examiner indicated that the seizures are unprovoked, that he has been on medication to help control them, but he still has them and he described the severity of the resultant concussion as mild. Therefore, the examiner concluded that it is less likely than not that the claimed seizures are related to the Veteran's military service, to include his in-service head traumas.

In another medical opinion, dated in December 2020, a VA examiner noted that the Veteran is service connected for residuals of traumatic brain injury that consist of post-traumatic headaches. The examiner also noted that the Veteran's syncopal episodes appear to have begun in 2004 and recurred infrequently over many years. The examiner related that the Veteran presented in February for status epilepticus, and history indicates a fall with head injury three months prior. The examiner indicated that the Veteran clearly had seizures in 2016, so it is possible that the prior infrequent events may have been partial seizures. The examiner further opined that, in any event, they were not incurred in service and noted that post-traumatic epilepsy typically begins after six months and within several years of the inciting trauma. The examiner stated that a 14-year interval between service and onset of possible seizures in 2004, or 17 years to a definite seizure make it unlikely that the two are related.

Subsequently, another opinion was obtained in February 2021. Following a review of the claims file, the examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran did have a concussion on two occasions while in service, but he had no seizure activity while in service. The examiner stated that it is less than likely that the in-service concussions are the cause of veteran new onset seizure. The examiner noted that, according to Up to Date, post traumatic epilepsy, mild traumatic brain injury is associated with twofold in risk of epilepsy for the first five years after injury; she noted that the time since the Veteran's concussions until seizure activity is approximately 38 years. The examiner explained that unprovoked seizures occur in the absence of provocative causes or more than seven days after an acute injury or insult such as stroke or brain hemorrhage and that recurrent unprovoked seizures define epilepsy. The examiner stated that the Veteran's seizures would fall into the category of provoked due to the fall with head injury three months prior to the onset of seizure activity. The examiner also explained that a moderate type of concussion involves a brief loss of consciousness lasting less than a minute but less than five minutes and noted that the medical records indicate the Veteran's loss consciousness was two minutes, constituting a moderate concussion. The examiner further noted that there was no seizure activity while in service.

The examiner also opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner noted that most seizures happen in the first several days or weeks after a brain injury and explained that a seizure more than seven days after a brain injury is called a late post-traumatic seizure. The examiner noted that about 80 percent of people who have a late post-traumatic seizure will have another seizure (epilepsy) and that 65 percent of people with brain injuries caused by bullet wounds have seizures, bleeding between the brain and the skull, which is called a subdural hematoma, also may cause a seizure. The examiner noted that, according to Up-To-Date, stroke is a common cause of seizures and epilepsy in population studies of adults over the age of 35 and that the risk of late-onset seizures may increase over time. The examiner noted that, for primary intracerebral hemorrhage, subcortical hematoma location may actually pose higher risk for late-onset seizures than cortical location. The examiner reasoned that the underlying permanent lesion that leads to persistent changes in neuronal excitability appears to be responsible for late-onset seizures after stroke and other brain injuries and probably accounts for the fact that the risk of chronic epilepsy is higher in patients with late rather than early occurrence of seizures. The examiner concluded that the Veteran's in-service concussion with subsequent headaches is not the cause of the new onset of seizures in 2016; she stated that it is more than likely that his previous cerebrovascular accident and the fall with head injury three months prior to his new onset seizures is the cause of his seizures and that therefore there is no aggravation. The Board finds the VA examiner's opinion is probative because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, supra.

In June 2021, the claims folder was referred to a neurologist for another opinion on the etiology of the Veteran's seizure disorder. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that the Veteran's seizure disorder is less likely than not related to the traumatic brain injury history, including the head traumas and concussions that are clearly documented in the service treatment records. The examiner stated that the seizures in this Veteran are unprovoked; however, it does not mean that they are related to another disease.

The examiner explained that any person that has recurrent seizures when there is no physiological cause or external factor involved at the moment the seizures happen, is said to have "unprovoked seizures." The examiner noted that, to diagnose epilepsy, a recurrent seizure disorder and to give meds (as in this case) the doctors must conclude that the patient "out of the blue" had a seizure and will have more "out of the blue" seizures in the future, more unprovoked seizures. The examiner noted that take any person, not this case, with lung issues of any sort and that if the lung issue causes low oxygen that person will have a 'provoked' seizure due to low oxygen. The examiner noted that treatment is for the lung problem, not seizure medications and that that is not epilepsy. The examiner noted that in this Veteran's case, he goes on to have witnessed and recurrent seizures that are unprovoked by any outside or abnormal physiological condition or event. The examiner noted that this epilepsy and the Veteran has epilepsy with unprovoked "grand mal" seizures. The examiner explained that the cause of the Veteran's epilepsy/seizure disorder is the fall with brain trauma in late 2015 leading to epilepsy/seizure onset in February 2016. The examiner noted that the Veteran had a moderate traumatic brain injury in February 1978. The examiner indicated that while this has been stated to be 'mild' on other reports, it is clearly seen in the original emergency room and hospital documents that the Veteran had persistent altered level of consciousness for over one hour which resolved over the ensuing 24 hours; this is the criteria for a 'moderate.' The examiner noted while the Veteran reported a history of a moderate traumatic brain injury at Ft. Benning in 1986, but he saw no evidence of that to establish a diagnosis. The examiner stated that, one or two moderate traumatic brain injuries in service does not make a difference in regard to the issues addressed.

The June 2021 examiner noted that the Veteran developed epilepsy after a head injury in late 2015; this event was very bad and very significant. The examiner stated that it is unclear whether the Veteran had some other issue and then a fall with another traumatic brain injury but at his age it was bad as he fell out of bed in a hospital and loss of consciousness was witnessed. The examiner observed that a three-month delay in developing post-traumatic seizure disorders is classic and is a well-established fact in neurology and noted in any textbook or reference on head trauma and epilepsy/seizures (Roper, 2019). The examiner noted that, in one major study which reflects the ongoing statistics the risk of seizures was 0.7 percent at one year and 1.6 percent at five years (Ropper, 2019). The examiner noted that about 90 percent of that 1.6 percent start having seizures in the first year. The examiner stated that he clearly would be willing to state any soldier (or maybe a civilian) that had even one concussion while on active duty and developed seizures within three to five years has service-connected post-traumatic seizures. The examiner noted that, if there are multiple traumatic brain injuries, depending on the situation extending out to seven to 10 years could be conceivable but even that is a stretch based on literature. The examiner explained, after about five years, the risks of seizures revert to those of the general population not having a concussion. The examiner noted that here we have seizure onset 25 years later and that the present seizure disorder has nothing to do with the concussion history in the United States Army, cause, or effect or any other pre-existing (service-connected or not) medical conditions. The examiner noted that this has been stated by others as noted. The examiner reasoned that, not only do we have that 25-year timeline, but we also have the timeline of the seizures three months after the 2015 traumatic brain injury and that his clearly is the most likely time frame for developing post-traumatic seizures.

The June 2021 VA examiner further noted that people who develop seizures after a head injury show evidence of brain damage from that injury in most cases and that we have that here in this case. The examiner noted that MRI scan in 2016 at the time of seizure onset shows NEW scarring/bruising in the temporal lobes, an area of the brain highly prone to seizures and that we cannot state for sure if the seizures are coming from the left temporal lobe (EEGs are negative) but the history would support such. The examiner noted that the neurology evaluation at the VA Medical Center after the February 2016 hospitalization notes that the Veteran had a transient RIGHT hemiparesis from the seizure activity and that this shows onset in the left brain, most likely the left temporal scar. The examiner explains that the scarring in the cerebellum also is noted in 2016 but is not seizure prone area and that this scarring from a brain bruise, the "hemosiderin," is not seen on MRI scan in 2007. The examiner stated, even assuming a great difference in MRI technology from 2007-2016, the hemosiderin would have been seen in 2007 if not also on the computed tomography (CT) and that these scars occurred after 2007 and fit with the post-traumatic epilepsy in 2016. The neurologist stated that, another way to say this, it would be almost inconceivable for the Veteran to have had a traumatic brain injury decade earlier, that such a traumatic brain injury caused a brain bruise and that this bruise was in the temporal lobe but then had his first seizure from that decades earlier traumatic brain injury. The examiner found that that would be almost impossible and that this Veteran had only one moderate traumatic brain injury in 1978 and had post-traumatic headaches ONLY as a residual of that (even if there was a second traumatic brain injury the only issue from both is headache as a residual). The examiner noted that this too has been stated many times by others. The examiner further reasoned there are no neuro-cognitive nor neuro-behavioral issues after recovery assuming 1986 as the last and that this is clearly shown by the Veteran's TIS and progression in rank, his acquisition of a college degree, his stable psycho-social history during and after separation (even with the early history of depression and self-medication with alcohol under stress). The examiner noted that further concerns for brain function are not found in the service treatment records or prior to the development of the next significant brain issue-the cerebrovascular accident in March 2001, that the Veteran has headaches that have both tension type and migraine-like features and that it would be best to call these chronic post-traumatic headaches as labelled by others. The examiner noted that the question is: could post-traumatic headaches cause a stroke in this Veteran, and could it cause epilepsy? The examiner noted that the Veteran has migraine issues and there is a clear relationship between migraine and epilepsy and stroke that is complex (Anderman, 1987 for the most classic of texts, but there are many others).

The June 2021 VA examiner further reasoned that, as opined in the past by neurology/others, the headache issue has no bearing on the strokes or the seizure disorder. In summary, the examiner noted that migraines do not cause epilepsy for the most part, and clearly not in this case. First, the examiner reasoned that a migraine must cause brain damage like a large embolic or thrombotic stroke that then would secondarily cause a seizure focus, that is the only way to link migraine to a seizure issue, that we do not have that here as we have only lacunar strokes that are very small and not a result of the headache and that lacunar strokes do not cause seizures (see Ropper and references). The examiner noted that ongoing headaches, migraines or post-traumatic, do not lead to epilepsy unless something unusual happens from a migraine attack. The examiner reasoned that such patients have "complex migraines" as called in the past, that this does not apply to this veteran whatsoever and that there is a headache noted with the stroke and during his seizure onset which is to be expected. The examiner noted that he has a "routine headache" issue (caused by a traumatic brain injury perhaps it is accepted) and routine headache issues do not cause epilepsy (Anderman, 1987). The examiner indicated that the Veteran is focused on having had a headache at the time of his stroke; however, such an acute headache is the result of the stroke, not the cause of the stroke which was a lacunar stroke
lead to epilepsy unless something unusual happens from a migraine attack. The examiner reasoned that such patients have "complex migraines" as called in the past, that this does not apply to this veteran whatsoever and that there is a headache noted with the stroke and during his seizure onset which is to be expected. The examiner noted that he has a "routine headache" issue (caused by a traumatic brain injury perhaps it is accepted) and routine headache issues do not cause epilepsy (Anderman, 1987). The examiner indicated that the Veteran is focused on having had a headache at the time of his stroke; however, such an acute headache is the result of the stroke, not the cause of the stroke which was a lacunar stroke. The examiner further noted that the Veteran had no military medical condition that caused the epilepsy/seizure as hypertension can cause a provoked seizure if a patient is in a "hypertensive crises." The examiner further explained that hypertension can cause epilepsy in a proximate fashion if it secondarily from such a crisis leads to brain damage that is significant, usually a large or life-threatening stroke; however, he noted that this has no relevance to this Veteran. The examiner reasoned that here we have the trauma as the cause as stated and the focal hemosiderin seen is more consistent with the recent (three month) trauma than any type of hypertension brain damage and that lacunar strokes do not cause seizures (see references).

The June 2021 VA examiner also opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner stated that the conditions of seizure disorder and traumatic brain injury with post-traumatic headache (as well as hypertension) are not medically related. The examiner explained that the seizure disorder is a separate entity entirely from the traumatic brain injury with post-traumatic headache (as well as hypertension) and unrelated to it. The examiner opined that a thorough review of medical literature failed to demonstrate a causal relationship, that a nexus has not been established and a nexus for the etiology has been established. The examiner reasoned that it is established that the condition is from some type of brain injury that caused a scar in the left temporal lobe, that this is undeniable, that this scar is seen in 2016 and is consistent with a contusion in that area, an area of the brain that is prone to seizures when there is hemosiderin (a "bloodscar") present and he noted that this was not seen prior.

The June 2021 VA examiner concluded that the seizure disorder which developed in 2016 is now independent of any pre-existing medical condition that started while on active duty. The examiner stated that the only clear relationship that could exist from a pre-existing service-connected condition, modified now by seizures is the headache pain. The examiner explained that ongoing seizures can make pre-existing headache issues worse; however, while the Veteran was having increasing headaches as he states throughout the evaluation his VA treatment records do not clearly state headaches have worsened since seizure onset. The examiner stated that, given the overall data and the progressive multi-system disease in this Veteran his headache disorder is progressing in a fashion independent of his seizures more likely than not. The examiner noted that the Veteran's sleep apnea and depression from the cerebrovascular accident are noteworthy as headache exacerbators. Additionally, the examiner noted that the Veteran's seizure issue is progressing/not progressing independent of service-connected medical conditions. The examiner stated that the old cliché "anything is possible in medicine" is true; however, there is no coherent medical argument to link the Veteran's service-connected medical conditions to his seizure disorder given the facts of the seizure development. The examiner further noted that there is no coherent medical argument to link his present seizure disorder as to affecting his prior service-connected conditions currently, and then maybe only headache at some time in the future, if documentation of such develops.

The Board accords the findings of the June 2021 VA neurologist significant probative weight, as the examiner demonstrated a detailed understanding of the Veteran's medical history and medical records and is supported by an explanation. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). The examiner provided a detailed analysis of the Veteran's medical records and cited numerous medical studies in arriving at their opinion. Notably, there are no medical
explanation. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). The examiner provided a detailed analysis of the Veteran's medical records and cited numerous medical studies in arriving at their opinion. Notably, there are no medical opinions or other competent medical evidence of record that weighs against the VA examiner's opinion. Accordingly, the Board finds the June 2021 medical opinion regarding the Veteran's seizure disorder highly probative, competent, and persuasive medical evidence in this case.

After a review of the entire evidentiary record, the Board finds that service connection for a seizure disorder is not warranted. Although the Veteran has been diagnosed post-service with a seizure disorder (possibly grand mal), the evidence fails to show that it is related to his military service. Significantly, the Board finds that the most reliable and credible evidence of record demonstrates the onset of seizures was more than one year after Veteran's discharge from service in approximately 2016, more than 26 years following discharge from service. In addition, the most probative evidence in this case demonstrates that the Veteran's seizures began many years after discharge from service and were found by the VA examiners to most likely be the result of a serious head injury in late 2015. Moreover, the Board finds that the evidence is against a finding that the Veteran's current seizure disorder was proximately caused by, or aggravated by, service-connected concussion with headaches.

Additionally, due to the Veteran's service-connected traumatic brain injury (concussion with headaches) and his diagnosis of seizures, the Board has specifically considered the presumptive provisions under 38 C.F.R. § 3.310(d). Under 38 C.F.R. § 3.310(d), a veteran who has a service-connected traumatic brain injury, the following shall be held to be the proximate result of the service-connected traumatic brain injury, in the absence of clear evidence to the contrary: (i) Parkinsonism, including Parkinson's disease, following moderate or severe traumatic brain injury; (ii) Unprovoked seizures following moderate or severe traumatic brain injury; (iii) Dementias of the following types: presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, if manifest within 15 years following moderate or severe traumatic brain injury; (iv) Depression if manifest within three years of moderate or severe traumatic brain injury, or within 12 months of mild traumatic brain injury; or (v) Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifest within 12 months of moderate or severe traumatic brain injury. Thus, 38 C.F.R. § 3.310(d)(1) entails presumptive service connection for the above disabilities.

However, in the present case, there is no evidence of record showing that the Veteran's seizures, while described as unprovoked, was manifested within three years of a moderate or severe traumatic brain injury or within 12 months of a mild traumatic brain injury. 38 C.F.R. § 3.310(d)(1)(iv). The earliest medical evidence showing that the Veteran suffered from seizures was in 2016. Moreover, in the June 2021 etiology opinion, the VA neurologist noted that the Veteran experienced traumatic brain injury in service; however, he stated that one or two moderate traumatic brain injuries in service does not make a difference in regard to the issues addressed. The examiner explained that the Veteran had only one moderate traumatic brain injury in 1978 and had post-traumatic headaches only as a residual of that (even if there was a second 1986 traumatic brain injury 1986 the only issue from both is headache as a residual). The examiner further noted that, in this situation, we have seizure onset 25 years later. The examiner explained that the cause of the Veteran's epilepsy/seizure disorder is the fall with brain trauma in late 2015 leading to epilepsy/seizure onset in February 2016. Consequently, the present seizure disorder has nothing to do with the concussion history in service, cause, or effect or any other pre-existing (service-connected or not) medical conditions in the examiner's opinion.

The Board acknowledges the Veteran's statements that his seizure disorder is related to his service and/or the service-connected concussion with headaches. In this regard, a lay
brain injury 1986 the only issue from both is headache as a residual). The examiner further noted that, in this situation, we have seizure onset 25 years later. The examiner explained that the cause of the Veteran's epilepsy/seizure disorder is the fall with brain trauma in late 2015 leading to epilepsy/seizure onset in February 2016. Consequently, the present seizure disorder has nothing to do with the concussion history in service, cause, or effect or any other pre-existing (service-connected or not) medical conditions in the examiner's opinion.

The Board acknowledges the Veteran's statements that his seizure disorder is related to his service and/or the service-connected concussion with headaches. In this regard, a layperson is competent to report on that of which he or she has personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as a fall leading to a broken leg. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the question of causation or aggravation of a seizure disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, such an opinion requires specialized knowledge of the neurological system. There is no indication that the Veteran possesses such specialized knowledge. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion regarding the etiology of her seizure disorder is non-probative evidence. See Jandreau v. Nicholson, supra; Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

The Board notes that the Veteran has submitted an article about the epilepsy and traumatic brain injuries. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. See 38 C.F.R. § 3.159(a)(1) (competent medical evidence may include statements contained in authoritative writings such as medical and scientific articles and research reports and analyses). However, treatise evidence must "not simply provide speculative generic statements not relevant to the [claimant]'s claim." Wallin v. West, 11 Vet. App. 509, 514 (1998). Instead, the treatise evidence, "standing alone," must discuss "generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion." Id. (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)); see also Libertine v. Brown, 9 Vet. App. 521, 523 (1996) (medical treatise evidence must demonstrate connection between service incurrence and present injury or condition); Beausoleil v. Brown, 8 Vet. App. 459, 463(1996) (generic statement about the possibility of a link between chest trauma and restrictive lung disease is too general and inconclusive); Mattern v. West, 12 Vet. App. 222, 227 (1999) (generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive (quoting Sacks v. West, supra)).

In this case, the article submitted by the Veteran provided only general information as to the incurrence of epilepsy and traumatic brain injuries. It is not accompanied by any corresponding clinical evidence specific to the Veteran and does not suggest a generic relationship between the Veteran's epilepsy and service and/or concussion with headaches with a degree of certainty such that, under the facts of this specific case, reflects plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. As such, the Board finds this information to not be relevant as to the matter for consideration and, therefore, is not probative to this case. Wallin v. West, supra; Sacks v. West, supra.

Moreover, the Veteran has offered only conclusory statements regarding the relationship between his seizure disorder and his service. In contrast, the VA examiners took into consideration all the relevant facts in providing their opinions. Therefore, the Board gives more probative weight to the competent medical evidence of the February 2021 and June 2021 VA examinations and opinions because, contrary to the Veteran's contentions, they were based on a review of the claims file, detailed clinical interview, and thorough examination; and because the examiners provided clear rationale for their opinions that the claimed seizure
to the matter for consideration and, therefore, is not probative to this case. Wallin v. West, supra; Sacks v. West, supra.

Moreover, the Veteran has offered only conclusory statements regarding the relationship between his seizure disorder and his service. In contrast, the VA examiners took into consideration all the relevant facts in providing their opinions. Therefore, the Board gives more probative weight to the competent medical evidence of the February 2021 and June 2021 VA examinations and opinions because, contrary to the Veteran's contentions, they were based on a review of the claims file, detailed clinical interview, and thorough examination; and because the examiners provided clear rationale for their opinions that the claimed seizure disorder was not caused or aggravated by the Veteran's service-connected concussion with headaches.

In the October 2023 Joint Motion for Remand, the parties agreed that the Board failed to adequately address the Veteran's statements of seizures in service because it did not provide an adequate statement of reasons or bases. The parties agreed that the Board did not adequately address the Veteran's statements, to include the August 2022 hearing testimony wherein the Veteran testified that he experienced petit mal seizures during service.

In addition, in adjudicating claims, the Board must assess not only competency of the Veteran's statements, but also their credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The former, the Court has held, is a legal concept, which is useful in determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Credibility can be generally evaluated by considering interest, bias, or inconsistent statements, the demeanor of the witness, facial plausibility of the testimony, and the consistency of the witness testimony. Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Caluza, 7 Vet. App. at 506 (citing State v. Asbury, 415 S.E.2d 891, 895 (W.Va. 1992)).

In the present case, the Veteran has generally suggested that he has continued to have seizure symptoms since the in-service head injury and concussion. At his August 2022 Board hearing, the Veteran testified that he experienced symptoms of petit mal seizures during service, including chronic headaches. The Veteran indicated that he had the symptoms that are now being called petit mal seizures during service and they have continued from that time until today. However, in an October 2016 VA examination, the Veteran reported that he was diagnosed with seizures in February 2016 and that his first seizure activity occurred in February 2016. A February 2016 VA treatment note indicates that the Veteran had been discharged from a private hospital with new onset of seizures a few days ago, that his wife reported that he had three seizures on that day and that his wife reported that the Veteran had fallen three months ago with a head injury. The Veteran's statements in this February 2016 VA treatment note regarding the onset of his right seizure symptoms are considered to be exceptionally trustworthy as they were made for the purpose of medical diagnosis and treatment. See White v. Illinois, 502 U.S. 346, 356 (1992). The Veteran specifically denied that he experienced seizures in an April 2009 VA Traumatic Brain Injury examination report. A May 2012 VA Traumatic Brain Injury Disability Benefits Questionnaire (DBQ) report reflected a detailed discussion of the Veteran's past medical history, to include his past head injuries and functional impairments, and does not indicate that the Veteran had any subjective symptoms of a seizure or seizures as a mental, physical or neurological conditions or residuals attributable to a traumatic brain injury. Therefore, the Veteran's current statements, made in connection with his pending claim for VA benefits that his seizures had their onset in service and/or have been continuous since service, are inconsistent with the contemporaneous evidence and, therefore, are not credible. Consequently, the Board assigns no probative weight to such statements.

In the October 2023 Joint Motion for Remand, the parties determined that the Board should consider the adequacy of the "May 2022" VA medical
discussion of the Veteran's past medical history, to include his past head injuries and functional impairments, and does not indicate that the Veteran had any subjective symptoms of a seizure or seizures as a mental, physical or neurological conditions or residuals attributable to a traumatic brain injury. Therefore, the Veteran's current statements, made in connection with his pending claim for VA benefits that his seizures had their onset in service and/or have been continuous since service, are inconsistent with the contemporaneous evidence and, therefore, are not credible. Consequently, the Board assigns no probative weight to such statements.

In the October 2023 Joint Motion for Remand, the parties determined that the Board should consider the adequacy of the "May 2022" VA medical opinion in light of its consideration of Veteran's assertions. However, the Board is unable to address the specific concerns of the Joint Motion for Remand as the record does not include report of a May 2022 VA medical opinion.

As noted above, the Board has found that the December 2020, February 2021, and June 2021 opinions are of greater probative value, as the opinions are consistent with the Veteran's past medical history and reported symptoms. Significantly, the Board has found that the Veteran's August 2022 Board hearing testimony suggesting the in-service onset of his seizures and/or a continuity of symptoms regarding his seizures to not be credible. As such, additional VA opinion to discuss the impact of the Veteran's August 2022 Board testimony is not warranted.

In the most recent March 2025 Joint Motion for Remand, the parties determined that the Board should consider whether service connection for seizures was presumptively warranted under the provisions of 38 C.F.R. 3.310(d)(1)(ii). Accordingly, the AOJ attempted to schedule the Veteran for a VA examinations following the most recent June 2025 Board remand; however, in September 2025, the Veteran canceled the scheduled VA examination. As noted above, he has not provided good cause for his failure to appear for the scheduled examination and has not requested that the examination be rescheduled. Evidence, which may have been favorable, that could have been obtained from the scheduled examination cannot be considered.

With regard to the issue of whether service connection is warranted presumptively under 38 C.F.R. 3.310(d)(1)(ii), the Board has found that the June 2021 to be of great probative value. Significantly, the examiner determined that the conditions of seizure disorder and traumatic brain injury with post-traumatic headache (as well as hypertension) are not medically related. The examiner explained that the seizure disorder is a separate entity entirely from the traumatic brain injury with post-traumatic headache (as well as hypertension) and unrelated to it. Moreover, the evidence of record reflects that, in the present case, there is no evidence of record showing that the Veteran's seizures, while described as unprovoked, was manifested within three years of a moderate or severe traumatic brain injury or within 12 months of a mild traumatic brain injury. 38 C.F.R. § 3.310(d)(1)(iv). The earliest medical evidence showing that the Veteran suffered from seizures was in 2016. Moreover, in the June 2021 etiology opinion, the VA neurologist noted that the Veteran experienced traumatic brain injury in service; however, he stated that one or two moderate traumatic brain injury in service does not make a difference in regard to the issues addressed. The examiner explained that the Veteran had only one moderate traumatic brain injury in 1978 and had post-traumatic headaches only as a residual of that (even if there was a second 1986 traumatic brain injury the only issue from both is headache as a residual). The examiner further noted that, in this situation, we have seizure onset 25 years later. The examiner explained that the cause of the Veteran's epilepsy/seizure disorder is the fall with brain trauma in late 2015 leading to epilepsy/seizure onset in February 2016. Consequently, the present seizure disorder is not related to the concussion history in service, cause, or effect or any other pre-existing (service-connected or not) medical conditions in the examiner's opinion.

Accordingly, the Board finds that service connection for a seizures disorder, to include as secondary to service-connected concussion with headaches, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

Special Monthly Compensation Criteria

Special monthly compensation for aid and attendance is payable under several circumstances, including if, as the result of the veteran's service-connected disability or disabilities, the veteran; has an anatomical loss or loss of use of both feet, or of one hand and one foot; is so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; is a patient in a nursing home because of a mental or physical incapacity; is permanently bedridden; or, is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. § 1114; 38 C.F.R. § 3.350.

Determinations as to the need for aid and attendance are based on the actual requirements of personal assistance from others. In determining the need for regular aid and attendance, consideration will be given to the inability of the veteran to dress himself, or to keep himself clean; frequent need of adjustment of any prosthetic which by reason of the disability cannot be done without aid; inability of the veteran to feed himself; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect himself from the hazards or dangers of his daily environment. Bedridden will be that condition which, through its essential character, actually requires the veteran to remain in bed. 38 C.F.R. § 3.352. It is mandatory for VA to consider the enumerated factors within the regulation; at least one of the enumerated factors must be present. Turco v. Brown, 9 Vet. App. 222 (1996).

There need not be a constant need but, rather, only a regular need for aid and attendance. Id. It is not required that all of the disabling conditions are present or are due to a service-connected condition to warrant special monthly compensation. Id.; see also Turco v. Brown, 9 Vet. App. 222, 224 (1996).

Special monthly compensation is also warranted when a veteran has a single service-connected disability rated as 100 percent disabling and is permanently housebound by reason of his service-connected disability or disabilities. This requirement is met when a veteran is substantially confined as a direct result of service-connected disabilities to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 C.F.R. § 3.350.

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

3. Entitlement to special monthly compensation based on the need for aid and attendance of another person is denied.

The Veteran contends that he is entitled to special monthly compensation based on the need for regular aid and attendance of another person. See April 2013 VA Form 21-0820, Report of General Information.

In the present case, the Veteran is service connected for concussion with headache, rated as 50 percent disabling; hearing loss, rated as 50 percent disabling; residuals of low back injury with strain, rated as 40 percent disabling; burn scar, right lower extremity, with underlying tissue damage associated with residuals of low back injury with strain, rated as 40 percent disabling; peptic ulcer disease with history of chronic gastritis and irritable bowel syndrome, rated as 30 percent disabling; tinnitus, rated as 10 percent disabling; painful burn scars, bilateral lower extremity associated with residuals of low back injury with strain, rated as 10 percent disabling; multiple scars from shell fragment wound, left arm, and surgical excision, ganglion cyst, left wrist, ganglion left wrist, erectile dysfunction associated with residuals of low back injury with strain and burn scar, left lower extremity associated with residuals of low back injury with strain, all rated as noncompensable disabling. The Veteran
extremity, with underlying tissue damage associated with residuals of low back injury with strain, rated as 40 percent disabling; peptic ulcer disease with history of chronic gastritis and irritable bowel syndrome, rated as 30 percent disabling; tinnitus, rated as 10 percent disabling; painful burn scars, bilateral lower extremity associated with residuals of low back injury with strain, rated as 10 percent disabling; multiple scars from shell fragment wound, left arm, and surgical excision, ganglion cyst, left wrist, ganglion left wrist, erectile dysfunction associated with residuals of low back injury with strain and burn scar, left lower extremity associated with residuals of low back injury with strain, all rated as noncompensable disabling. The Veteran's combined rating was 80 percent beginning April 23, 2015, 90 percent from March 27, 2019, and 100 percent beginning on December 19, 2019. He was also awarded a total disability rating based on unemployability (TDIU) based on the combined effects of his service connected disabilities beginning on April 23, 2015.

Of record is the report of an April 2013 VA examination for traumatic brain injury, at which time the examiner sated that, based on the above information, it is this examiner's opinion that the veteran does not have any cognitive impairment attributable to the traumatic brain injuries which occurred in the military. He did have residual headaches prior to the stroke but there is no record of cognitive impairment. For clarification, the veteran's cognitive impairment is most likely due to the stroke he suffered in 2001 and to a lesser degree his underlying depression. However, there is no evidence to suggest that the veteran's traumatic brain injury has any relation to his cognitive impairment.

Submitted in support of the Veteran's claim was the November 2013 report of an examination for aid and attendance or housebound status (VA Form 21-2680) which reported diagnoses of status post two cerebrovascular accidents with left sided hemiparesis, hypertension, right renal carcinoma, coronary artery disease, history of alcohol abuse, anemia, gastroesophageal reflux disease/hiatal hernia, history of peptic ulcer disease, dysphagia, depression, diabetes mellitus, hyperlipidemia, obstructive sleep apnea, elevated protein specific antigen, carpal tunnel syndrome, depression/cognitive disorder, discoid lupus, low back pain/degenerative arthritis, and history of concussion (traumatic brain injury)/headaches. It was noted that the Veteran is able to travel beyond his current domicile accompanied by a family member in a specially equipped van. It was also noted that the Veeran lives with his wife who makes all meals and helps Veteran with self-care skills as noted in this report, and she sometimes has to help the Veteran with eating. It was noted that the Veteran is able to let their three puppies in and out during the day; otherwise, the Veteran primarily sits at home during the day and watches television. It was also noted that the Veteran uses a power wheelchair, rolling walker at home and two forearm crutches. It was further noted that the Veteran is unable to dress and undress, bathe, and groom individually. The provider indicated that the Veteran's cognitive impairment is most likely due to the stroke he suffered in 2001 and to a lesser degree his underlying depression.

The provider noted that the Veteran is service connected for a traumatic brain injury, peptic ulcer disease, headache, ganglion left wrist, low back injury strain, and left arm shrapnel scar; none of these at present at present limit Veteran's ability to care for himself or walk in and out of his home; he is not bedridden. The provider further noted that the Veteran does need his wife's help doing routine daily activities and for protection from hazards in his environment; however, it is the Veteran's history of cerebral vascular accidents which is the cause for these needs. Therefore, the provider opined that solely with regard to the Veteran's service-connected disabilities, the Veteran does not need the aid and assistance of another person in attending to the routine activities of daily living. In addition, the provider noted that solely with regard to the Veteran's service connected disabilities, the Veteran does not need the attendance of another person to protect himself from the ordinary hazards of his daily environment.

Submitted in support of the Veteran's claim was the December 2013 report of a private examination for housebound stated or permanent need for regular aid and attendance. The provider indicated that the complete diagnoses were diabetes, hypertension, renal disability, coronary artery disease/myocardial infarction, chronic low back pain, sleep apnea, hyperlipidemia and depression. The provider noted that the Veteran is primarily restricted in function by his chronic low back pain. The provider indicated that the Veteran was not hospitalized; and, while he is not able to prepare his own meals, he is able to feed himself. The provider noted that the Veteran did not heed assistance in bathing or tending to other hygiene needs. The provider found that the Veteran was not legally blind and did not require nursing home care. The provider found that the Veteran did not require assistance with medication management, and he had the ability to manage his own financial affairs. The provider noted that the Veteran was sitting in a wheelchair, but was in no acute distress and that there were no restrictions involving the upper extremities. The provider indicated that the Veteran had a history of chronic low back pain; the Veteran reported chronic low back pain with a history of falls related to decreased strength. The provider noted that the Veteran requires the use of a wheelchair for locomotion.

A May 2014 private examination for aid and attendance indicated that the Veteran's complete diagnoses were diabetes, hypertension, chronic low back pain, kidney cancer, prostate cancer, coronary artery disease, cognitive and adjustment disorder. The provider indicated that the Veteran was not hospitalized; and, while he is not able to prepare his own meals, he is able to feed himself. The provider indicated that the Veteran needs his wife's assistance in bathing and tending to other hygiene needs. The provider found that the Veteran was not legally blind and did not require nursing home care. The provider indicated that the Veteran needs his wife's assistance with medication management and to manage his financial affairs. The provider noted that the Veteran was using a motorized scooter; he was in no acute distress, and he was alert and oriented. The provider noted that the Veteran was status post prostate surgery and undergoing radiation therapy. It was noted that the Veteran had restrictions caused by osteoarthritis and chronic low back pain. The provider noted that the Veteran requires the use of a motorized scooter.

During April 2015 VA examinations for headaches and wrist conditions, the Veteran was not found to have any functional impact. Similarly, an April 2015 VA examination for scars/disfigurement noted that the Veteran's disability did not cause any functional impact.

Following an April 2015 VA examination for back conditions, the examiner noted that the Veteran was in a motorized power chair due to history of having had a stroke a number of years ago. As such, the examiner indicated that they were unable to safely perform range of motion testing as required for the back examination. The examiner indicated that the Veteran had a neurological examination report indicated that the Veteran had a series of strokes which started in 2001 and the most recent was last month. It was also noted that the Veteran was able to walk 10 feet with assistance before too much pain. It was further noted that he is able to get around the house with a cane or rolling walker and he tries to stay as active as he can. The assessment of the neurologist was that he had a fairly significant left hemiparesis and hemisensory loss due to stroke. The examiner did not find any deficits which he could relate to the lumbar spine, but stated that they may be masked by the strokes. Consequently, it was noted that there doesn't appear to be anything related to the lumbar spine that would impede his activities of daily living.

In July 2015, the Veteran submitted a January 2023 VA 21-2690. The provider indicated that the complete diagnoses needed to equal the level of assistance described during the examination included diabetes mellitus, gastroesophageal reflux disease, status post cerebrovascular accident, traumatic brain injury, hypertension, chronic low back pain, and status post cerebrovascular. The provider indicated that the Veteran was not hospitalized; and, while he is not able to prepare his own meals, he is able to feed himself. The provider indicated that the Veteran has chronic low back pain and status post cerebrovascular accident that makes it very difficult for him to do things. The provider found that the Veteran was not legally blind and did not require nursing home care. The
a January 2023 VA 21-2690. The provider indicated that the complete diagnoses needed to equal the level of assistance described during the examination included diabetes mellitus, gastroesophageal reflux disease, status post cerebrovascular accident, traumatic brain injury, hypertension, chronic low back pain, and status post cerebrovascular. The provider indicated that the Veteran was not hospitalized; and, while he is not able to prepare his own meals, he is able to feed himself. The provider indicated that the Veteran has chronic low back pain and status post cerebrovascular accident that makes it very difficult for him to do things. The provider found that the Veteran was not legally blind and did not require nursing home care. The provider indicated that the Veteran should be in a nursing home due to his illness, but his family will take care of him at home for as long as they can. The provider also noted that, due to all of the Veteran's medical problems, he requires monitoring and lots of medications to keep him stable. In addition, the provider indicated that the Veteran is not able to manage his own financial affairs due to the fact that is traumatic brain injury and cerebrovascular accident has affected his memory. The provider noted that the Veteran is in a wheelchair, but he is well developed, well nourished, and well-groomed. The provider indicated that the Veteran has weakness in both upper extremities, but his fine motor is intact; he noted that the Veteran easily fatigues with prolonged tasks. It was further noted that the Veteran has chronic low back pain that limits his mobility, and he has gait disturbance that has led to multiple falls. The provider added that the Veteran has bladder dysfunction due to the cerebrovascular accident. The provider concluded that the Veteran is only able to live with assistance of family, and he only comes out for medical appointments and sometimes church.

Of record is another private examination for aid and attendance dated in November 2016. The provider indicated that the complete diagnoses were gastric ulcers, ischemic heart disease, congestive heart failure, hypertension, post stroke, seizures, diabetes mellitus, and peripheral neuropathy. The provider indicated that the Veteran was not hospitalized; and, while he is not able to prepare his own meals, he is able to feed himself. The provider indicated that the Veteran needs assistance in bathing and tending to other hygiene needs. The provider found that the Veteran was legally blind, but did not require nursing home care. The provider indicated that the Veteran needs assistance with medication management and to manage his financial affairs. The provider noted that the Veteran is wheelchair bound and he needs help when he tries to sit up. The provider also noted that the Veteran has difficulty in dressing without help; he cannot shave or get into the shower without assistance. It was further noted that he uses a urinal and wears depends. The provider indicated that the Veteran has problems sitting up without a brace, pillow or assistance. She further noted that the Veteran has lack of bowel and bladder control, impaired memory, has been declared incompetent by VA, cannot ambulate or leave home without a caretaker. He only leaves home to go to medical appointments.

In a September 2017 statement, D. T. D., a registered nurse indicated that she has been caring for the Veteran with home health for about one year. The nurse indicated that the Veteran is considered homebound due to his dyspnea, oxygen use, unsteady gait, shortness of breath with minimal exertion, unsteady cardiac system and uncontrolled capillary blood glucose. She further noted that the Veteran's mobility is impacted by pain, and he needs assistance to leave the house.

During an October 2017 VA examination for stomach and duodenal conditions, the Veteran was not found to have a functional impact.

During the October 2017 VA examination for back and wrist conditions, the Veteran was not found to have a functional impact.

During a January 2020 VA examination for back conditions, the Veteran was not found to have a functional impact.

During a January 2020 VA examination for diabetes mellitus, the Veteran was not found to have a functional impact.

During a January 2020 VA examination for knee and lower leg conditions, the Veteran was not found to have a functional impact.

During a February 2020 VA examination for scars/disfigurement, the Veteran was not found to have a functional impact.

During a July 2020 VA examination for male reproductive system conditions, the Veteran was not found to have a functional impact.

During a January 2020 VA examination for knee and lower leg conditions, the Veteran was not found to have a functional impact.

During a February 2020 VA examination for scars/disfigurement, the Veteran was not found to have a functional impact.

During a July 2020 VA examination for male reproductive system conditions, the Veteran was not found to have a functional impact.

In June 2023, the Veteran submitted yet another private examination for aid and attendance examination, indicating that the Veteran is restricted in his activities by cerebrovascular accident, unsteady gait. The provider indicated that the complete diagnoses were hypertension, cerebrovascular accident, concussion with headache, peptic ulcer disease, irritable bowel syndrome and back injury. The provider indicated that the Veteran was not hospitalized; and, while he is not able to ambulate and stand to prepare his own meals, he is able to feed himself. The examiner indicated that the Veteran needs assistance in bathing and tending to other hygiene needs. The provider found that the Veteran was not legally blind. The provider indicated that the Veteran needs assistance with medication management and to manage his financial affairs. The provider noted that the Veteran is wheelchair bound and he needs the use of a cane. The provider also noted that the Veteran has left sided weakness after cerebrovascular accident which decreases his grip and fine motor movement. It was noted that the Veteran has left sided weakness after cerebrovascular accident that causes decreased plantar flexion and dorsiflexion. The provider noted that the Veteran has limited range of motion due to arthritis. The provider also noted that the Veteran currently had problems with diarrhea, ambulation and balance issues as a result of the cerebrovascular accident. The provider indicated that the Veteran only leaves his home to attend medical appointments and errands with his wife.

Based on the foregoing, the Board finds that the Veteran's service connected disabilities alone are not so severe as to cause him to require regular aid and attendance or to be permanently bedridden at any time during the period on appeal. While the evidence indicates that the Veteran does benefit from the assistance of his wife, the functional impairments the Veteran experiences are primarily caused by his nonservice connected conditions, to include cerebrovascular accidents, ischemic heart disease, congestive heart failure, hypertension, post stroke, seizures, diabetes mellitus, and peripheral neuropathy. Additionally, at no time during the period on appeal has the Veteran been shown to have anatomical loss or loss of use of both feet, or of one hand and one foot, blindness in both eyes with visual acuity of 5/200 or less, be permanently bedridden, being so helpless as to be in need of regular aid and attendance of another person, the inability of the Veteran to dress himself, or to keep himself clean, the frequent need of adjustment of any prosthetic which by reason of the disability cannot be done without aid, the inability of the Veteran to feed himself, the inability to attend to the wants of nature or incapacity, physical or mental, which requires care or assistance on a regular basis to protect herself from the hazards or dangers of his daily environment at any time during the period on appeal.

Therefore, the Board finds that entitlement to special monthly compensation based on the need for aid and attendance is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

Specially Adapted Housing Criteria

A certificate of eligibility for specially adapted housing is available to a veteran who has a permanent and total service-connected disability due to: (1) amyotrophic lateral sclerosis rated as 100 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8017; (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; (3) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or (4) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbows. 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(b).

The certificate of eligibility is also available to a veteran with a permanent and total disability that precludes locomotion without the aids of braces, crutches, canes, or a wheelchair due to: (1) the loss, or loss of use, of both lower extremities; (2) the loss or loss of use of one lower
resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or (4) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbows. 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(b).

The certificate of eligibility is also available to a veteran with a permanent and total disability that precludes locomotion without the aids of braces, crutches, canes, or a wheelchair due to: (1) the loss, or loss of use, of both lower extremities; (2) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which so affect the functions of balance and propulsion; or, (3) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion. Id.

The phrase "preclude locomotion" is defined as the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion, although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(c). Regarding "loss of use" in the context of specially adapted housing claims, the Court had held that that terms generally means "a deprivation of the ability to avail oneself of the anatomical region in question." Jensen v. Shulkin, 29 Vet. App. 66 (2017). The Court also identified four elements that must be satisfied to establish entitlement to specially adapted housing based on loss of use of the lower extremities: "That the individual must (1) have a permanent and total service-connected disability (2) due to a disorder that (3) involves both lower extremities and (4) causes a loss of use so severe that it precludes locomotion without the regular and constant use of assistive devices. Id.

Where entitlement to specially adapted housing is not established, an applicant may nevertheless qualify for a special home adaptation grant if he or she is entitled to compensation for a service-connected disability that is due to blindness, or has a permanent or total service-connected disability that is due to the anatomical loss or loss of use of both hands; burns that have resulted in limitation of motion of one or more extremities or of at least one extremity and the trunk; or residuals of an inhalation injury. 38 U.S.C. § 2101(b); 38 C.F.R. § 3.809a(b).

4. Entitlement to a certificate of eligibility for assistance in acquiring special adapted housing is denied.

5. Entitlement to a certificate of eligibility for special home adaptation grant is denied.

The Veteran is requesting specially adapted housing or special home adaptation grant.

As noted above, the Veteran is service connected for concussion with headache, rated as 50 percent disabling; hearing loss, rated as 50 percent disabling; residuals of low back injury with strain, rated as 40 percent disabling; burn scar, right lower extremity, with underlying tissue damage associated with residuals of low back injury with strain, rated as 40 percent disabling; peptic ulcer disease with history of chronic gastritis and irritable bowel syndrome, rated as 30 percent disabling; tinnitus, rated as 10 percent disabling; painful burn scars, bilateral lower extremity associated with residuals of low back injury with strain, rated as 10 percent disabling; multiple scars from shell fragment wound, left arm, and surgical excision, ganglion cyst, left wrist, ganglion left wrist, erectile dysfunction associated with residuals of low back injury with strain and burn scar, left lower extremity associated with residuals of low back injury with strain, all rated as noncompensable disabling. The Veteran's combined rating was 80 percent beginning April 23, 2015, 90 percent from March 27, 2019, and 100 percent beginning on December 19, 2019. He was also awarded a TDIU based on the combined effects of his service connected disabilities beginning on April 23, 2015.

However, despite having a permanent and total service-connected disability, the Board finds that none of the criteria for entitlement to specially adapted housing or a special home adaptation grant are applicable in this case. Specifically, the Veteran is not service connected for amyotrophic lateral sclerosis, a disability that results in blindness in both eyes, loss of use of both upper extremities, and/or loss of use of both lower extremities. Additionally, while the record shows that the Veteran has service-connected burns on the lower extremities, he does not have full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk. The record does not show that there are contractures due to the burns. Moreover, although the evidence of record reflects that the Veteran is wheelchair bound and requires the use of a cane, the medical providers have indicated that the need for assistive devices is due to weakness in the lower extremities, as well as decreases his grip and fine motor movement and decreased plantar flexion and dorsiflexion after cerebrovascular accident. The Veteran is not service-connected for residuals of a cerebrovascular accident. Therefore, the record does not show loss, or loss of use, of both lower extremities, or the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which affect the functions of balance and propulsion, due to a service-connected disability. Therefore, the Veteran does not qualify for specially adapted housing based on loss or loss of use of the lower extremities. See 38 C.F.R. § 3.809(b)(1), (b)(4). Furthermore, the Veteran does not qualify for specially adapted housing based on loss of use of both upper extremities such as to preclude use of the arms at or above the elbow. See 38 C.F.R. § 3.809(b)(5).

Accordingly, as the Veteran's service-connected disabilities are not shown to meet any of the applicable criteria, there is no basis for awarding entitlement to specially adapted housing or to a special home adaptation grant; thus, the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Suzie Gaston, 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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