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HAND IMPAIRMENT OF

MARJORIE A. AUER · 2025 · Case ID: A25105138

MIXED

Summary

The Veteran, who served from December 1961 to December 1964 and again from March 1965 to May 1968, appeals the denial of service connection for bilateral hand and lower extremity conditions, an increased rating for PTSD, and entitlement to Special Monthly Compensation (SMC) for aid and attendance. The Board granted service connection for bilateral hand and lower extremity conditions on a secondary basis to his service-connected hypertension, finding that the Veteran's hypertension contributed to his stroke, which caused his physical disabilities. The Board also granted SMC for aid and attendance, noting that the Veteran's service-connected bilateral hand tremors and lower extremity weakness render him in need of regular aid and attendance for activities like feeding himself and dressing. Furthermore, the Board granted an increased rating for PTSD to 70 percent, effective January 23, 2023, finding that while some symptoms approximated a 100 percent rating, the overall impairment level more closely aligned with a 70 percent rating. The case was remanded for further development on the claims for urinary tract infections and TDIU. The urinary tract infection claim was remanded due to inadequate VA nexus opinions that failed to address all conceded exposures or specific service treatment record findings. The TDIU claim was remanded due to a pre-decisional duty to assist error, as the AOJ did not adequately develop the claim despite the issue being raised.

Rationale

Hypertension is service-connected.; Veteran has bilateral hand tremors.; Examiner opined hypertension contributed to stroke causing physical disabilities.

Special Benefit
SMC - AID & ATTENDANCE; TDIU
Docket No.
241021-483562

Full Decision Text

Citation Nr: A25105138
Decision Date: 12/05/25	Archive Date: 12/05/25

DOCKET NO. 241021-483562
DATE: December 5, 2025

ORDER

Entitlement to service connection for a left hand condition is granted.

Entitlement to service connection for a right hand condition is granted.

Entitlement to service connection for a left lower extremity condition is granted.

Entitlement to service connection for a right lower extremity condition is granted.

Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is granted.

Entitlement to an increased rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD), from January 23, 2023, is granted.

REMANDED

Entitlement to service connection for urinary tract infections is remanded.

Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded.

FINDINGS OF FACT

1. The Veteran's bilateral hand and bilateral lower extremity conditions are due to his service-connected hypertension. 

2. The Veteran's service-connected disabilities leave him in need of regular aid and attendance of another person. 

3. The severity, frequency, and duration of the Veteran's PTSD symptoms more closely approximate occupational and social impairment, with deficiencies in most areas. 

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hand and bilateral lower extremity conditions, as secondary to service-connected hypertension, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to SMC based on the need for regular aid and attendance have been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352.

3. The criteria for an increased rating of 70 percent, but no higher, for PTSD, from January 23, 2023, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1961 to December 1964 and from March 1965 to May 1968.

This matter comes before the Board of Veterans' Appeals (Board) from November 2023 and February 2024 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the two October 21, 2024, VA Forms 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned Veterans Law Judge on July 23, 2025.

Therefore, the Board may only consider the evidence of record at the time of the November 2023 and February 2024 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding some of the claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Although the Board regrets the additional delay, a remand is necessary on some of the issues to ensure that due process is followed and there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. See 38
. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding some of the claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Although the Board regrets the additional delay, a remand is necessary on some of the issues to ensure that due process is followed and there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c).

1. Entitlement to service connection for a left hand condition 

2. Entitlement to service connection for a right hand condition 

3. Entitlement to service connection for a left lower extremity condition 

4. Entitlement to service connection for a right lower extremity condition

The Veteran contends that he is entitled to service connection for a bilateral hand condition and a bilateral knee condition. See October 2024 VA Form 10182.

As will be discussed below, the Board finds that there is sufficient evidence to grant these claims on a secondary basis.

Service connection on a secondary basis requires (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability either (a) caused, or (b) aggravated, the nonservice-connected disability. 38 C.F.R. § 3.310; Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

A review of the record shows that the Veteran has bilateral lower extremity weakness with limited range of motion. See January 2023 SMC examination. Therefore, the Board has broadened its consideration of the knee claims to include entitlement to service connection for a left lower extremity condition and entitlement to service connection for a right lower extremity condition in accordance with Clemons v. Shinseki, 23 Vet. App. 1 (2009).

In the November 2023 rating decision, the AOJ denied these four claims based upon a finding of no current disability. However, March 2022 and January 2023 SMC examinations noted that the Veteran has bilateral hand tremors and bilateral lower extremity weakness with limited range of motion. 

Thus, the Board finds that the Veteran has a bilateral hand diagnosis. Further, the Veteran's bilateral lower extremity weakness and limited range of motion, which affect his ability to walk, qualify as disabilities under Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The record also shows that the Veteran is service connected for hypertension. Therefore, the only question that remains is a nexus.

Along with the January 2023 SMC examination, the examiner submitted an opinion (uploaded as "Buddy/Lay Statement"). In that opinion, the examiner said that the Veteran's hypertension directly contributed to his stroke, which resulted in his physical disabilities, requiring complete assistance with his activities of daily living.

The Board finds the examiner's opinion to be adequate in that the examiner relied upon the examiner's own expertise, knowledge, and training. Further, the examiner considered lay evidence and the medical history of the Veteran.

Therefore, after resolving any reasonable doubt in favor of the Veteran, the Board finds that service connection for bilateral hand and bilateral lower extremity conditions, as secondary to service-connected hypertension, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to SMC based on the need for aid and attendance 

A claim for increased disability compensation may include the "inferred issue" of entitlement to SMC even where the veteran has not expressly placed entitlement to SMC at issue. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991).

There is an increased rating claim for PTSD before the Board, which thus allows the Board to consider SMC. The Board notes that the January 2023 SMC examination report indicates that the Veteran needs aid and attendance based on his now-service-connected physical disabilities.

SMC based on aid and attendance is available when, as the result of service-connected disabilities, a veteran experiences additional hardship above and beyond those contemplated by VA's schedule for rating disabilities. See 38 U.S.C. § 1114(l); 38 C.F.R
 entitlement to SMC even where the veteran has not expressly placed entitlement to SMC at issue. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991).

There is an increased rating claim for PTSD before the Board, which thus allows the Board to consider SMC. The Board notes that the January 2023 SMC examination report indicates that the Veteran needs aid and attendance based on his now-service-connected physical disabilities.

SMC based on aid and attendance is available when, as the result of service-connected disabilities, a veteran experiences additional hardship above and beyond those contemplated by VA's schedule for rating disabilities. See 38 U.S.C. § 1114(l); 38 C.F.R. §§ 3.350, 3.352. SMC can be paid pursuant to 38 U.S.C. § 1114(l) if, as a result of service-connected disability or disabilities, a veteran is permanently bedridden or with such significant disabilities as to be in need of regular aid and attendance. 38 C.F.R. § 3.350(b).

The criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance are contained in 38 C.F.R. § 3.352(a). Under that regulation, the following factors will be accorded consideration in determining whether a veteran is in need of regular aid and attendance of another person: (1) inability of the veteran to dress or undress himself, or to keep himself ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; (3) inability of the veteran to feed himself because of the loss of coordination of upper extremities or because of extreme weakness; (4) inability to attend to the wants of nature; or (5) physical or mental incapacity which requires care or assistance on a regular basis to protect the veteran from the hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352(a).

It is not required that all of the disabling conditions above be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that the Veteran is so helpless as to need regular aid and attendance, not that there is a constant need for aid and attendance. 38 C.F.R. § 3.352(a).

After careful and thorough consideration of the evidence of record, the Board finds that the Veteran's service-connected disabilities leave him in need of regular aid and attendance of another person.

In this regard, the January 2023 SMC examination shows that the Veteran's now service-connected bilateral hands specifically leave him in the need of regular aid and attendance of another person. The Veteran experiences hand tremors and is unable to grasp for an extended period of time, is unable to feed himself without assistance, and cannot button clothes or put on shoes.

The key question in this appeal is not whether the Veteran requires aid and attendance with all or a majority of his activities of daily living, but, rather, whether he requires regular aid and attendance to complete any of the activities set forth in the rating schedule. Based on a review of the evidence discussed above, the Board finds that the Veteran's service-connected disabilities leave him in need of regular aid and attendance of another person.

Therefore, as reasonable doubt must be resolved in favor of the Veteran, entitlement to SMC based on the need for regular aid and attendance is granted. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102.

6. Entitlement to an increased rating of 70 percent, but no higher, for PTSD, from January 23, 2023, is granted.

The Veteran contends that he is entitled an increased rating for his service-connected PTSD. See October 2024 VA Form 10182.

The Veteran's mental health disability is evaluated under DC 9411. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir.
 (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). 

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating higher than 50 percent.

The Board concludes that the Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. 

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

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

The Veteran first filed a claim for an increased rating on July 14, 2023, which begins the period of appellate review before the Board, plus the consideration of the one-year look back period from July 14, 2022. 

In the August 2023 VA examination report, the examiner noted occupational and social impairment with reduced reliability and productivity. The Veteran lives with his daughter and reports overall adequate familial relationships, but PTSD interferes to some degree. He reports spending his time mostly in the home, and at times goes out to take walks. His daughter indicated that Veteran is isolative, is easily triggered, is often "spaced out," and "doesn't want to be bothered." The Veteran was last seen by psychiatry in May 2022 and declined follow up with treatment at the time.

The Veteran's symptoms include depressed mood, anxiety, mild memory loss, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Id. 

VA treatment records show the following mental health visits. September 2022 and January 2023 treatment notes indicate no depression or anxiety; that the Veteran was awake, alert, and oriented; and that he had an appropriate affect. A March 2023 note says that the Veteran was alert and attentive; oriented, cooperative and reasonable; had normal speech and intact language; had a normal thought process and no unusual thought content; and had no suicidal/violent ideation.

August 2023 treatment notes indicate no depression or anxiety; the Veteran was awake, alert, and oriented; he had an appropriate affect; he was well-groomed, neat, and clean; and he was not in any distress. 

At the July 2025 Board hearing, the Veteran and his daughter reported the following about the Veteran's mental health. The Veteran sometimes calls a therapy hotline. Sometimes the Veteran gets "spaced out," "out of it," and quiet. When he falls into a depression, he does not talk to people. Sometimes the Veteran might not talk to people for two or three days. Sometimes the Veteran cannot sleep, he cries a lot, and has memory issues. The Veteran does not have anger management problems. Sometimes he gets anxiety leaving the house. 

At the July 2025 Board hearing, the Veteran implied that he had at least some suicidal ideation when asked about it. He replied, "I don't feel that way, you know, but in some cases, you can feel that direction."  The Veteran also said regarding the hotline calls, "sometimes they help me with on that, and sometimes they can't help me on that." 

VA treatment records, the August 2023 VA examination, and the hearing testimony show that the
 people. Sometimes the Veteran might not talk to people for two or three days. Sometimes the Veteran cannot sleep, he cries a lot, and has memory issues. The Veteran does not have anger management problems. Sometimes he gets anxiety leaving the house. 

At the July 2025 Board hearing, the Veteran implied that he had at least some suicidal ideation when asked about it. He replied, "I don't feel that way, you know, but in some cases, you can feel that direction."  The Veteran also said regarding the hotline calls, "sometimes they help me with on that, and sometimes they can't help me on that." 

VA treatment records, the August 2023 VA examination, and the hearing testimony show that the Veteran's PTSD was manifested by symptoms associated with a 70 percent rating (to include suicidal ideation) and symptoms associated with a 100 percent rating such as intermittent inability to perform activities of daily living. The Veteran also had symptoms that are not listed with a specific rating, such as being "spaced out" and then getting quiet.

The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. The Veteran reported that these symptoms were not present daily, but would happen about once a month. Further, being "spaced out" and quiet is similar to depression affecting the ability to function appropriately and effectively, which is contemplated by the assigned 70 percent rating.

Regarding an inability to perform activities of daily living as contemplated in the 100 percent rating, the Board notes that, in the January 2023 SMC examination report, the Veteran's major impairments were noted as related primarily to his physical issues. 

The Board acknowledges that the Veteran's mental health sometimes leads to depression where he refuses to eat. See SMC examiner's January 2023 SMC opinion (uploaded as "Buddy/Lay Statement"). Further, at the July 2025 Board hearing, the Veteran's daughter said he was forgetful, which impacts his ability to cook. 

There was also a January 2023 Board hearing regarding aid and attendance where the Veteran's daughter talked about the Veteran's memory issues affecting his ability to cook. She also stated that the Veteran cannot dress himself, clean himself, wash his face, wash his clothes, or grocery shop for himself due to his mental impairment. 

However, while the Veteran did experience symptoms contemplated by a 100 percent rating such as issues with activities of daily living, the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. First, the majority of his issues with activities of daily living appear to be linked primarily to physical issues, with his mental health being a lesser or secondary factor. His physical issues are discussed in more detail in the section above about SMC. 

Further, the evidence does not show symptoms of gross impairment in thought processes or communication or persistent delusions or hallucinations. There is no evidence of symptoms reflecting grossly inappropriate behavior or persistent danger of hurting self or others. There was no evidence of symptoms like or similar to disorientation to time or place or memory loss of names of close relatives, own occupation, or own name.

The Board notes that the Veteran expressed suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017).  However, the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran denied thoughts, intent, or a plan involving self-harm in existing treatment records, and the August 2023 VA examination does not note suicide. Further, the references to suicide at the July 23, 2025, Board hearing were more fleeting. 

Based on the above, the Board finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 70 percent rating. The Veteran experienced occupational and social impairment, with deficiencies in most areas. 

In regard to the effective date of the increased 70 percent rating, the Veteran first filed a claim for increase on July 14, 2023, which begins the period of appellate review before the Board (plus the consideration of the one-year look back period from July 14, 2022). An earlier effective date may be granted prior to the date of the filing of the claim for an increase if it is factually ascertainable that an increase in disability had occurred within the one-year period prior to the filing of the claim. See 38 U.S.C. § 5110; 38
 closely approximates the level associated with a 70 percent rating. The Veteran experienced occupational and social impairment, with deficiencies in most areas. 

In regard to the effective date of the increased 70 percent rating, the Veteran first filed a claim for increase on July 14, 2023, which begins the period of appellate review before the Board (plus the consideration of the one-year look back period from July 14, 2022). An earlier effective date may be granted prior to the date of the filing of the claim for an increase if it is factually ascertainable that an increase in disability had occurred within the one-year period prior to the filing of the claim. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o)(2). However, if the factually ascertainable increase occurred prior to the year preceding the claim, the effective date is the date of the claim. See Gaston v. Shinseki, 605 F. 3d 979 (2010)

Along with the January 2023 SMC examination, the examiner authored a January 23, 2023, opinion (uploaded as "Buddy/Lay Statement") and noted that when the Veteran becomes depressed, he refuses to eat. This indicates a worsening of the Veteran's symptoms from January 23, 2023. Therefore, entitlement to an increased rating of 70 percent, but no higher, for PTSD is warranted from January 23, 2023.

REASONS FOR REMAND

1. Entitlement to service connection for urinary tract infections is remanded.

The Veteran contends that he is entitled to service connection for urinary tract infections. See October 2024 VA Form 10182.

The February 2024 rating decision made findings of a disability and that participation in a toxic exposure risk activity is conceded. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

The AOJ obtained two negative nexus opinions. The July 2023 opinion is inadequate because it only addresses herbicide agents and not the other exposures conceded in the July 2023 TERA memo. The November 2023 addendum opinion is inadequate because, while it said that exposure to TERAs is not a risk factor for the development of urinary tract infections fifty years after service, it did not address the relevance, if any, of an August 1966 service treatment record (STR) urinalysis that noted crystals in the Veteran's urine. 

It was a pre-decisional duty to assist error for the AOJ to rely on inadequate opinions. Therefore, remand is required. 

The Board has reviewed the September 2025 email correspondence where the Veteran's attorney argues for service connection secondary to PTSD based on the fact that that PTSD memory loss leads to missed pad changes and subsequent urinary tract infections. Included is also a statement from the Veteran's daughter that says that due to PTSD, the Veteran has memory issues and forgets to change his pads. As a result, there have been multiple instances where the Veteran developed urinary tract infections because he wears unchanged pads for extended periods of time.

Unfortunately, while the Veteran's daughter can report observations about failure to change pads, as a lay person, she cannot make a medical determination that that is due to his PTSD or that unchanged pads are what cause the Veteran's urinary tract infections. Therefore, the Board is unable to grant this claim based on this statement. 

2. Entitlement to a TDIU is remanded.

The Veteran is retired. See August 2023 VA PTSD examination. At that examination, the examiner noted occupational and social impairment with reduced reliability and productivity. Thus, the Board finds that TDIU has been raised. Rice v. Shinseki, 22 Vet. App. 447 (2009).

However, before the Board can address the merits of the TDIU claim, additional development of the evidence is required to cure a pre-decisional duty to assist error. In this regard, despite the fact that the issue of a TDIU was raised by the record before the November 2023 rating decision, the AOJ did not assist the Veteran in the development of his claim. Therefore, the TDIU claim must be remanded.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for urinary tract infections. The need for an additional examination is left to the discretion of the clinician, however the Board notes that the Veteran is ill and likely unable to travel.

The record, including a copy of this remand, must be made available to the clinician.

The clinician is asked to respond to the following:

Is it at least as likely as not (likelihood is approximately balanced or nearly equal, if not higher) that the Veteran's urinary tract infections disability had its
 did not assist the Veteran in the development of his claim. Therefore, the TDIU claim must be remanded.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for urinary tract infections. The need for an additional examination is left to the discretion of the clinician, however the Board notes that the Veteran is ill and likely unable to travel.

The record, including a copy of this remand, must be made available to the clinician.

The clinician is asked to respond to the following:

Is it at least as likely as not (likelihood is approximately balanced or nearly equal, if not higher) that the Veteran's urinary tract infections disability had its onset during the Veteran's active service or is otherwise related to his active service, to include his TERA exposure?

When providing this opinion, the examiner must consider:

(a)	the total potential exposure through all applicable deployments; and

(b)	the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

When providing this opinion, the examiner must address the August 1966 STR urinalysis that notes crystals in the Veteran's urine and the July 2023 TERA memo.

As noted above, the examiner must review the claims file (including this remand) and note that such review was conducted. The examiner should review all medical evidence and all lay evidence.

A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record. The VA clinician is advised that medical opinions must contain not only clear conclusions with supporting data but also a reasoned medical explanation connecting the two.

If an opinion cannot be expressed without resort to speculation, the VA clinician must so indicate and discuss why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

2. Provide the Veteran with appropriate notice regarding the TDIU claim and request that he complete a VA Form 21-8940. Explain what is needed to establish entitlement to a TDIU. Ask the Veteran to submit any additional evidence in support of a TDIU claim, to specifically include information on his work history, salary, and educational history. Complete any development and adjudication warranted by the Veteran's response.

 

 

MARJORIE A. AUER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Veljic, Erica A.

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. 

Hand impairment, Mixed, 2025: BVA Decision A25105138 | CaseScribe AI