Case A26001250

A. J. SPECTOR · 2026 · Case ID: A26001250

MIXED

Summary

The veteran, who served from November 1968 to June 1970 and August 1976 to September 1984, including combat service in Vietnam, appeals the denial of an earlier effective date for his right foot disability, an increased rating for his right foot disability, TDIU, DEA benefits, and the restoration of prior ratings for ocular hypertension, right foot scar, and hypertension. The Board granted an earlier effective date of July 27, 2023, for service connection of his right foot disability, finding that the veteran continuously pursued entitlement and that his disability manifested prior to the claim date. The Board also granted a 30 percent rating for the right foot disability, finding it approximated the criteria for severe impairment, and granted TDIU from July 27, 2023, due to the combined effect of his service-connected disabilities preventing substantially gainful employment. The Board restored prior 10 percent ratings for ocular hypertension and hypertension, and a 20 percent rating for his right foot scar, finding the reductions improper as there was no evidence of actual improvement. The issue of special monthly compensation (SMC) based on aid and attendance was remanded for a VA examination to determine the veteran's need for regular aid and attendance due to his service-connected disabilities.

Rationale

Service connection granted with earlier effective date due to continuous pursuit of claim.; Increased rating to 30 percent based on severe functional impairment, approximating criteria for severe foot disability.; No higher rating warranted for loss of use of foot due to lack of objective findings for foot drop or muscle impairment.

Special Benefit

SMC - AID & ATTENDANCE; TDIU; EARLIER EFFECTIVE DATE

Docket No.

251009-591077

Full Decision Text

Citation Nr: A26001250
Decision Date: 01/07/26 Archive Date: 01/07/26

DOCKET NO. 251009-591077
DATE: January 7, 2026

ORDER

Entitlement to an earlier effective date of July 27, 2023, for the grant of service connection for right foot dermatofibrosarcoma protuberans, dorsolateral aspect, claimed as loss of use of feet (right foot disability), is granted.

Entitlement to an increased initial evaluation of 30 percent, but no higher, for a right foot disability from July 27, 2023, is granted.

Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities from July 27, 2023, is granted.

Entitlement to eligibility for Dependents' Educational Assistance under 38 U.S.C. Chapter 35 (DEA) from July 27, 2023, is granted.

Entitlement to restoration of a 10 percent evaluation for ocular hypertension with pseudophakia of right eye and cataract of left eye, and heterochromia (ocular hypertension) from April 9, 2025, is granted.

Entitlement to restoration of a 20 percent evaluation for a right foot scar from April 10, 2025, is granted.

Entitlement to restoration of a 10 percent evaluation for hypertension from May 21, 2025, is granted.

REMANDED

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

FINDINGS OF FACT

1. The Veteran did not file a notice of disagreement or submit any new and material evidence within one year of the November 2006 rating decision (December 1, 2006, notification) that denied service connection for a right foot disability (dermatofibrosarcoma protuberans), or the October 2014 rating decision (October 24, 2014, notification) that denied an increased evaluation for right foot scars; these rating decisions became final.

2. The Veteran's supplemental claim for a right foot disability was received on July 27, 2023; there was no communication indicating an intent to file a claim within the one-year period prior to receipt of the July 27, 2023, supplemental claim.

3. The evidence demonstrates that throughout the review period, the Veteran's right foot disability manifested with symptoms and impairment reflecting a severe foot injury.

4. The Veteran was unemployed throughout the review period; resolving reasonable doubt in the Veteran's favor, his service-connected disabilities prevented him from securing or following a substantially gainful occupation.

5. The Veteran has had a permanent and total service-connected disability since July 27, 2023.

6. The evidence shows that as of the June 2025 rating decision, the Veteran's ocular hypertension symptoms manifested by visual field defects including a scotoma affecting at least one-quarter of his visual field and remaining visual field of less than 60 degrees.

7. The evidence shows that as of the June 2025 rating decision, the Veteran's right foot scar was painful and unstable.

8. The evidence shows that as of the June 2025 rating decision, the evidence did not show actual improvement in the Veteran's hypertension symptoms.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an earlier effective date of July 27, 2023, for the grant of service connection for a right foot disability have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.160, 3.400, 3.2501.

2. The criteria for an increased initial evaluation of 30 percent, but no higher, for the service-connected right foot disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5284.

3. The criteria for entitlement to a TDIU due to service-connected disabilities have been met from July 27, 2023. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16.

4. As of July 27, 2023, the criteria for basic eligibility to DEA benefits have been met. 38 U.S.C. §§ 5110, 3500; 38 C.F.R. §§ 3.310, 3.155, 3.400, 3.807, 21.3020, 21.3021.

5. The reduction
entitlement to a TDIU due to service-connected disabilities have been met from July 27, 2023. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16.

4. As of July 27, 2023, the criteria for basic eligibility to DEA benefits have been met. 38 U.S.C. §§ 5110, 3500; 38 C.F.R. §§ 3.310, 3.155, 3.400, 3.807, 21.3020, 21.3021.

5. The reduction of the evaluation of the Veteran's ocular hypertension, from 10 percent to noncompensable, effective April 9, 2025, was not proper, and the 10 percent evaluation is restored, effective from April 9, 2025. 38 U.S.C. §§ 1155, 5107, 5112(6); 38 C.F.R. §§ 4.75, 4.76, 4.77, 4.79, Diagnostic Codes 6027, 6066, 6080, 6081.

6. The reduction of the evaluation of the Veteran's painful and unstable right foot scar, from 20 percent to noncompensable, effective April 10, 2025, was not proper, and the 20 percent evaluation is restored, effective from April 10, 2025. 38 U.S.C. §§ 1155, 5107, 5112(6); 38 C.F.R. § 4.118, Diagnostic Code 7804.

7. The reduction of the evaluation of the Veteran's hypertension, from 10 percent to noncompensable, effective May 21, 2025, was not proper, and the 10 percent evaluation is restored, effective from May 21, 2025. 38 U.S.C. §§ 1155, 5107, 5112(6); 38 C.F.R. § 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1968 to June 1970, and August 1976 to September 1984, with service in the Reserves, and combat service in Vietnam. He was awarded the Vietnam Cross of Gallantry, five Air Medals, and the Distinguished Flying Cross.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2025 higher-level review rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In June 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2025 rating decision. In September 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior June 2025 rating decision.

In the October 2025 VA Form 10182 Decision Review Request: Board Appeal, under the Appeals Modernization and Improvement Act (AMA), the Veteran elected Direct Review. Therefore, the Board may only consider evidence of record as of the June 2025 rating decision, which was subsequently subject to HLR. 38 C.F.R. § 20.301.

If evidence was associated with the claims file during a period when additional evidence was not allowed, the Board has not considered it in this decision. 38 C.F.R. § 20.300. Regarding the issues the Board is deciding, if the Veteran would like VA to consider any evidence that was added to the claims file 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

Regarding the issue the Board is remanding, any evidence the Board could not consider will be considered by the AOJ in adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

The Board finds that entitlement to a TDIU was raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009); October 2024 VA Form 21-526
§ 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

Regarding the issue the Board is remanding, any evidence the Board could not consider will be considered by the AOJ in adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

The Board finds that entitlement to a TDIU was raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009); October 2024 VA Form 21-526EZ; February 2025 VA Form 21-8940. The Board also finds that entitlement to SMC, specifically SMC based on the need for aid and attendance, has been raised by the record. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); October 2024 VA Form 21-526EZ; October 2024 VA Form 21-4138.

The Board appreciates that the Veteran has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); see Williams v. McDonough, 37 Vet. App. 305 (2024). Although the period to change dockets has not elapsed, the Veteran, through his authorized representative, explicitly waived his right to select a different Board review option and requested that a decision be issued as soon as possible. See October 9, 2025, Motion to Waive Right to Switch Appeal Lanes. Therefore, there is no prejudice to the Veteran in proceeding to adjudicate the appeal.

This appeal has been advanced on the docket pursuant to 38 U.S.C. § 7107(b); 38 C.F.R. § 20.902(c).

EARLIER EFFECTIVE DATE

1. Entitlement to an effective date earlier than October 8, 2024, for the grant of service connection for a right foot disability.

The Veteran contends that he is entitled to an effective date of July 27, 2023, the date he filed a supplemental claim for the award of service connection for a right foot disability, because he continually pursued entitlement to a separate disability evaluation for functional impairment of his right foot in addition to his right foot scar evaluation. See October 2025 VA Form 10182; October 2025 Appellate Brief.

The Veteran's current effective date of service connection for his right foot disability is October 8, 2024, the date he filed an intent to file followed by a supplemental claim for loss of use of both feet. See October 2024 VA Form 21-0966; October 2024 VA Form 20-0995.

Generally, the effective date for an award of service connection is the day following separation from active service or the date entitlement arose, if the claim is received within one year after separation from service; otherwise, the effective date is the later of the date of receipt of the claim or the date entitlement to service connection arose. 38 C.F.R. § 3.400(b)(2). The date of receipt shall be the date on which a claim, information or evidence was received by VA. 38 C.F.R. § 3.1(r).

As previously outlined, the November 2006 rating decision that denied service connection for right foot dermatofibrosarcoma protuberans, and the October 2014 rating decision that denied an increased evaluation for a service-connected right foot scar from an in-service excision of dermatofibrosarcoma and skin graft, became final, as the Veteran did not submit notice of disagreements or new and material evidence within a year of the rating decisions. On July 27, 2023, the Veteran filed a supplemental claim for service connection for dermatofibrosarcoma from the November 2006 rating decision. See July 2023 VA Form 20-0995. On the same day, he also filed a claim for an increased rating for his service-connected foot scar for "right foot pain from cancer". See July 2023 VA Form 21-526EZ. In a December 2023 rating decision, the Veteran was denied entitlement to an initial compensable evaluation for a right foot scar "also claimed as right foot pain from cancer". On September 23, 2024, the
and material evidence within a year of the rating decisions. On July 27, 2023, the Veteran filed a supplemental claim for service connection for dermatofibrosarcoma from the November 2006 rating decision. See July 2023 VA Form 20-0995. On the same day, he also filed a claim for an increased rating for his service-connected foot scar for "right foot pain from cancer". See July 2023 VA Form 21-526EZ. In a December 2023 rating decision, the Veteran was denied entitlement to an initial compensable evaluation for a right foot scar "also claimed as right foot pain from cancer". On September 23, 2024, the Veteran filed a supplemental claim for his right foot "in addition to right foot scar", and a separate statement that he was "entitled to a separate rating for impairment of function of his right foot" due to the removal of nerves from his right foot that resulted less feeling in that foot that had worsened over time, affected his balance, prevented him from being able to walk in a straight line, and to have "full" use of his right foot. See September 2024 VA Form 20-0995; September 2024 Statement. In October 2024, the Veteran filed a claim for loss of use of both feet, and in November 2024, he filed a supplemental claim for a right foot disability in addition to his right foot scar. See October 2024 VA Form 21-526EZ; November 2024 VA Form 20-0995. In a March 2025 rating decision, the Veteran was granted an increased evaluation of 20 percent for his right foot scar, and in April 2025 he was notified that his right foot nerve damage claim was rejected for improper form. See April 14, 2025, Letter. In May 2025, the Veteran filed a request for HLR of the March and April 2025 rating decisions, requesting "a separate rating for nerve damage and neuropathy of his right foot caused by his service-connected excision of dermatofibrosarcoma". See May 2025 VA Form 20-0996; May 2025 VA Form 20-0996 Continuation Sheet. In June 2025, the Veteran filed a request for HLR of a June 2025 rating decision that denied service connection for loss of use of feet and requested a separate evaluation for "nerve damage and loss of use" of his right foot. See June 2025 VA Form 20-0996. The Veteran filed this appeal seeking an earlier effective date within a year of the September 2025 rating decision that granted service connection for his right foot disability, effective October 8, 2024.

Under the AMA, if a claimant continues to request an available review option within one year of each prior decision on an issue, they can preserve the effective date associated with the initial claim. 38 C.F.R. § 3.2500(c), (h).

The Board finds that the Veteran continuously pursued entitlement for service connection for a right foot disability from his July 27, 2023, supplemental claim.

Therefore, the Board finds that the earliest possible date the Veteran is entitled to service connection for his right foot disability is from the date of his supplemental claim; specifically, July 27, 2023. See 38 U.S.C. § 5110; 38 C.F.R. §§ 3.1, 3.155, 3.400(q)(1).

However, the effective date of service connection for a disability is either the date of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2); see also McGrath v. Gober, 14 Vet. App. 28, 25 (2000).

Here, the Board finds the evidence persuasively shows that the Veteran's right foot disability manifested prior to the July 27, 2023, supplemental claim. The Veteran was diagnosed with right foot pain caused by removal of a dermatofibroma on the dorsum of his right foot during a July 1985 VA examination; he has consistently reported progressively increased pain and stiffness in his right foot that made it difficult to stand, walk, or raise from sitting; and in a September 2023 VA opinion, the examiner who examined the Veteran's right foot opined that his right foot pain was the result of the excision of a "big chunk" of his right foot along with underlying tissue, when his dermatofibroma was removed in service. See July 1985 VA Foot Examination; April 201
disability manifested prior to the July 27, 2023, supplemental claim. The Veteran was diagnosed with right foot pain caused by removal of a dermatofibroma on the dorsum of his right foot during a July 1985 VA examination; he has consistently reported progressively increased pain and stiffness in his right foot that made it difficult to stand, walk, or raise from sitting; and in a September 2023 VA opinion, the examiner who examined the Veteran's right foot opined that his right foot pain was the result of the excision of a "big chunk" of his right foot along with underlying tissue, when his dermatofibroma was removed in service. See July 1985 VA Foot Examination; April 2013, November 2024, May 2025 Statements; September 2023 VA Foot Conditions Examination; September 2023 VA Right Foot Opinion.

Therefore, because the Veteran's right foot disability manifested prior to July 2023, the date of claim for the grant of service connection is later than the date of entitlement. Accordingly, the Veteran is entitled to an effective date of July 27, 2023, but no earlier, for the grant of service connection for a right foot disability. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i).

The Board has considered whether an effective date earlier than July 27, 2023, is warranted in this case. However, the Veteran's July 2023 supplemental claim was submitted more than a year after the November 2006 rating decision that denied service connection for dermatofibrosarcomas protuberans and the October 2014 rating decision that denied an increased evaluation for his service-connected right foot scar. A review of the claims file does not show that an intent to file or a formal or informal claim for service connection for a right foot disability was received after these decisions became final, prior to July 27, 2023. Therefore, the earliest effective date possible for the Veteran's claim is July 27, 2023, the date of his VA Forms 20-0995 and 21-526EZ. 38 U.S.C. § 5101(a); 38 C.F.R. §§ 3.1(p), 3.151(a), 3.155.

The Board is sympathetic to the fact that the Veteran has been suffering from symptoms of a right foot disability prior to the currently assigned effective date. However, the Board is obligated to apply the law as Congress has created it. 38 U.S.C. § 7104(c); 38 C.F.R. § 20.105. Accordingly, as the criteria for an effective date of July 72, 2023, but no earlier, are met, the claim for an earlier effective date for the award of service connection for a right foot disability is granted.

INCREASED RATINGS

1. Entitlement to an evaluation greater than 10 percent for a right foot disability.

The Veteran contends that his right foot disability is "far more severe" than his current evaluation. See October 2025 VA Form 10182; October 2025 Appellate Brief. He specifically contends that he is entitled to an evaluation of at least 30 percent from July 27, 2023, due to the severe functional impairment caused by his chronic right foot pain and loss of feeling in his right foot that has prevented him from having "full use of that foot", caused his balance to be "off", resulted in a slow antalgic gait, prevented him from being able to walk in a straight line, and required him to stop working because he could "hardly move around". See September 2024 VA Forms 21-10210, 20-0995; February 2025 VA Form 21-8940; October 2025 Appellate Brief.

The Veteran was granted service connection and an initial 10 percent evaluation for his right foot disability in the September 2025 HLR rating decision on appeal. The Board has herein granted an earlier effective date of July 27, 2023, for the Veteran's entitlement to service connection for a right foot disability. Therefore, the review period for the Veteran's appeal for an initial increased rating begins on July 27, 2023, the date of service connection for his right foot disability.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

With the initial rating assigned upon a grant of service connection,
decision on appeal. The Board has herein granted an earlier effective date of July 27, 2023, for the Veteran's entitlement to service connection for a right foot disability. Therefore, the review period for the Veteran's appeal for an initial increased rating begins on July 27, 2023, the date of service connection for his right foot disability.

With the initial rating assigned upon a grant of service connection, separate (staged) ratings may be assigned for separate periods of time, based on the facts found. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

The Veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; see also Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.

The Veteran's right foot disability is currently assigned a 10 percent initial rating, under 38 C.F.R. § 4.71a, Diagnostic Code 5284.

Under this rating criteria, "other foot injuries" are rated as 10 percent disabling when moderate, 20 percent disabling when moderately severe, and 30 percent disabling when severe; a 40 percent rating is assigned for actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284, Note.

The words "mild," "moderate," and "severe" as used in the various diagnostic codes are not defined in the Rating Schedule. See Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018). In the absence of an express definition, words are given their ordinary meaning. See Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citing Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003)).

According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "mild" means gentle in nature or temperate, "moderate" means limited in scope or effect, and "severe" means very painful or harmful or of a great degree.

After careful review, the Board finds that an increased initial rating of 30 percent is warranted for the Veteran's right foot disability for the entire review period.

During a September 2023 VA foot examination, the Veteran reported that he limped every week due to pain and stiffness in his right foot, and that he had difficulty getting up from sitting to standing, walking long distances, and standing for long periods of time. See September 2023 VA Foot Conditions Examination. Based on his reports, the examiner opined that the Veteran's right foot pain and nerve damage symptoms resulted in the loss of two to four weeks of work in a twelve-month period and noted that his right foot pain caused difficulty with his gait and his balance. Id. In a separate etiology opinion, the same examiner opined that the Veteran's right foot pain, stiffness, and limping caused difficulty with ambulation and back pain. See September 2023 VA Right Foot Pain Opinion.

In October 2023, the Veteran reported to his VA primary care provider that he spent most of his day sitting due to back and right foot pain, and in March 2024, his primary care provider observed that he could stand up and walk, but "with obvious pain". See October 2023, March 2024 VA Primary Care Notes. During a February 2025
-month period and noted that his right foot pain caused difficulty with his gait and his balance. Id. In a separate etiology opinion, the same examiner opined that the Veteran's right foot pain, stiffness, and limping caused difficulty with ambulation and back pain. See September 2023 VA Right Foot Pain Opinion.

In October 2023, the Veteran reported to his VA primary care provider that he spent most of his day sitting due to back and right foot pain, and in March 2024, his primary care provider observed that he could stand up and walk, but "with obvious pain". See October 2023, March 2024 VA Primary Care Notes. During a February 2025 VA podiatry consult, the Veteran's right foot neurological testing showed limited range of motion in his right foot, with intact monofilament neurological testing except at his skin graft site, which was insensate to light touch, and also noted that his graft site and first metatarsophalangeal joint were tender to palpitation. See February 2025 VA Podiatry Consult. The VA podiatrist noted that imaging showed no degenerative arthritis, fracture or dislocation, and diagnosed his right foot pain as secondary to his in-service full thickness skin graft. Id.

During an April 2025 VA foot examination, the Veteran reported that he did not have full use of his right foot because of the pain, numbness, and loss of feeling in his foot. See April 2025 VA Foot Conditions Examination. He reported swelling, limited mobility, and difficulty walking or standing for prolonged periods due to pain. Id. He reported daily flareups of sharp pain at a level of severity of 8/10 in his right foot that lasted from two to four hours, were precipitated by movement, and alleviated with rest and massage. Id. The examiner noted that the Veteran's daily right foot pain compromised his weight bearing, and concluded that his resulting pain, weakness, and lack of endurance resulted in functional loss of moderate severity. Id. The examiner opined that there was no diagnosis for loss of use of his feet based on a lack of objective findings on examination. Id.

The Veteran's right foot disability symptoms were also noted during VA scars examinations throughout the review period; the examiners specifically annotated that his right foot pain and stiffness affected his balance, caused him to limp, prevented him from walking or standing for long periods, and made it difficult for him to get up from sitting to standing. See September 2023 VA Scars Examination; November 2024 VA Scars Examination. During an April 2025 VA scars examination, the Veteran stated that he did not have full use of his right foot. See April 2025 VA Scars Examination.

After resolving any reasonable doubt in the Veteran's favor, the Board finds that from July 27, 2023, the Veteran's right foot disability more closely approximates the 30 percent rating, but no higher, for a severe foot disability. He reported daily right foot pain at a level of 8/10, with flareups that required him to rest for several hours; prevented him from being able to work; and examiners noted that he walked with an antalgic gait, moved with "obvious" pain, and that his pain and reduced sensation at his skin graft site resulted in a limited range of motion, a loss of balance, and prevented him from being able to stand or walk for long periods of time.

The Board does not find that a higher disability evaluation is warranted for loss of use of his right foot. At no point has medical evidence been provided that characterizes the Veteran's right foot disability as a loss of use of his right foot, foot drop, or a muscle condition with functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. Notably, while he reported it was difficult to walk in a straight line, balance, stand or walk for long periods, or rise from sitting to standing, he also reported that he did not have foot drop and he needed no assistive devices as a normal or occasional mode of locomotion or to stand or rise from sitting to standing. See September 2023 A Foot Conditions Examination; December 2023 VA Addendum; Therefore, a higher initial 40 percent disability evaluation is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5284; 38 C.F.R. §§ 4.63, 4.68.

The Board has also considered whether a rating is warranted under various other diagnostic codes. See Schafrath, supra. However, the evidence does not support assigning a rating under Diagnostic Code 527
sitting to standing, he also reported that he did not have foot drop and he needed no assistive devices as a normal or occasional mode of locomotion or to stand or rise from sitting to standing. See September 2023 A Foot Conditions Examination; December 2023 VA Addendum; Therefore, a higher initial 40 percent disability evaluation is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5284; 38 C.F.R. §§ 4.63, 4.68.

The Board has also considered whether a rating is warranted under various other diagnostic codes. See Schafrath, supra. However, the evidence does not support assigning a rating under Diagnostic Code 5276 (acquired flat foot or pes planus), Diagnostic Code 5277 (weak foot), Diagnostic Code 5278 (claw foot), Diagnostic Code 5279 (anterior metatarsalgia), Diagnostic Code 5280, (hallux valgus), or Diagnostic Code 5282 (hammer toe). Rather, the Board finds that Diagnostic Code 5284 is the most appropriate to evaluate the Veteran's right foot disability. See Butts v. Brown, 5 Vet. App. 532, 539 (1993) (holding that the Board's choice of Diagnostic Code should be upheld if supported by explanation and evidence); Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992) (indicating that any change in Diagnostic Code must be specifically explained). Furthermore, Diagnostic Code 5284 does not apply to the eight specific foot conditions enumerated under § 4.71a because applying it to those listed conditions "would essentially render the diagnostic codes of the enumerated conditions redundant." See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015), (quoting Prokarym v. McDonald, 27 Vet. App. 307, 311 (2015)).

Based on the foregoing and after resolving all reasonable doubt in the Veteran's favor, the Board finds that the functional impairment caused by his right foot disability is most closely reflected by a 30 percent rating for the entire review period. Accordingly, a 30 percent initial rating, but no higher, is warranted for the Veteran's service-connected right foot disability. 38 C.F.R. § 4.3, Lynch, supra.

2. Entitlement to a TDIU.

The Veteran contends he is unable to work because of his service-connected disabilities, including his foot conditions and the loss of use of his feet. See October 2024 VA Form 21-526EZ; February 2025 VA Form 21-8940. He specifically contends he is entitled to a TDIU because he was forced to retire when he "could hardly move around" due to his back and foot pain. See February 2025 VA Form 21-8940; March 2025 VA Form 21-4192 E.R.R. Group, C.L.

The Veteran was last employed in October 2014. See April 2025 VA Form 21-4192, E.R.R. Group, C.L.

A TDIU claim, either expressly raised by a Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. See Rice, supra.

As previously discussed, the Board finds that the review period for determining the Veteran's entitlement to an increased evaluation for his right foot disability is from July 27, 2023. As the issue of entitlement to a TDIU is part and parcel of the Veteran's underlying claim for an increased rating for his right foot disability, the review period for his entitlement to a TDIU is also from July 27, 2023. See 38 C.F.R. §§ 3.2400, 3.2500(h); see also Rice, supra.

VA will grant a TDIU when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing or following "substantially gainful employment" consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. A TDIU may be assigned where the schedular rating is less than total. 38 C.F.R. § 4.16(a).

Based on a review of the record and resolving reasonable doubt in his favor, the Board concludes that the combined effect of the Veteran's service-connected disabilities rendered him unable to secure and maintain substantially gainful employment from July 27, 2023.

A TDIU may be assigned when a Veteran is unable
Veteran is precluded, by reason of his service-connected disabilities, from securing or following "substantially gainful employment" consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. A TDIU may be assigned where the schedular rating is less than total. 38 C.F.R. § 4.16(a).

A TDIU may be assigned when a Veteran is unable to secure or follow a substantially gainful occupation because of service-connected disabilities. 38 C.F.R. § 4.16. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income, while the noneconomic component requires determination as to a Veteran's ability to secure and follow such employment. Id. Attention should be given to the Veteran's history, education, skills, and training; whether the Veteran has the physical ability to perform the types of activities required by the occupation at issue; and whether the Veteran has the mental ability to perform the activities required by the occupation at issue. Id.

An award of TDIU is an individualized determination, specific to a Veteran's particular circumstances, for example, their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. See Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they can perform the physical and mental acts required by employment, not whether they can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Medical evaluations are probative evidence to understanding the level of functional impairment; however, the ultimate determination of unemployability is a legal question, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013).

The Veteran has a high school education with some college; his military occupational specialties included helicopter mechanic, crew chief, and helicopter pilot; and after service he worked in construction and then as a field superintendent for an engineering and remediation group for over sixteen years until he had to reduce his hours to part-time and eventually retire due to "limitations related to chronic back and foot issues" in October 2014. See June 1970 and September 1984 DD Forms 214; March 1978 Warrant Officer Application Recommendation; April 1984 Office Record Brief; November 1990 Patient History, Dr. T.S.; February 2025 VA Form 21-8940; March 2025 VA Form 21-4192.

The Veteran is service-connected for sinusitis, an acquired psychiatric disorder, tinnitus, hearing loss, eye disabilities, headaches, hypertension, and musculoskeletal disabilities of his knees, lumbar spine, and right foot.

As previously outlined, the Veteran's treatment records, statements, and examination reports show that his right foot disability caused chronic right foot pain, reduced sensation over his graft site, limited range of motion, an antalgic gait with loss of balance, and prevented him from being able to stand or walk for long periods of time. VA examinations throughout the review period showed flare ups of his lumbar spine arthritis and bilateral knee pain that prevented him from being able to sit, stand or drive for long periods, and the examiners noted that the pain, limited range of motion, and the interference with sitting, standing, walking, and getting up from sitting to standing caused by his lumbar spine and bilateral knee disabilities, "significantly limit[ed] his functional ability"; blurry vision, which was attribute to his glaucoma and cataract; hearing difficulty that makes communication difficult when the speaker is not facing him or with background noise; tinnitus that is constant, "very distracting", and aggravating; throbbing headaches two to three times a week; and monthly sinus pressure with headaches, pain, and tenderness. See September 2023 and November 2024 VA Back Conditions and Knee and Lower Leg Examinations; August 2023 VA Eye Conditions Examination; August 2023 and July 202
and the interference with sitting, standing, walking, and getting up from sitting to standing caused by his lumbar spine and bilateral knee disabilities, "significantly limit[ed] his functional ability"; blurry vision, which was attribute to his glaucoma and cataract; hearing difficulty that makes communication difficult when the speaker is not facing him or with background noise; tinnitus that is constant, "very distracting", and aggravating; throbbing headaches two to three times a week; and monthly sinus pressure with headaches, pain, and tenderness. See September 2023 and November 2024 VA Back Conditions and Knee and Lower Leg Examinations; August 2023 VA Eye Conditions Examination; August 2023 and July 2025 VA Hearing Loss and Tinnitus Examinations; April 2025 VA Headaches Examination; July 2025 VA Sinusitis Examination. His emphysema caused shortness of breath after climbing a flight of stairs, walking more than ten minutes, or lifting more than twenty pounds, and any physical activity required him to stop and catch his breath for "some time", up to fifteen minutes; his heart condition interview based metabolic equivalent of task (METs) levels showed breathlessness on eating, dressing, taking a shower or slow walking for one to two blocks, with sharp uncomfortable intermittent chest pain, and breathlessness with fatigue; and he reported multiple conflicts with his coworkers and management and a ninety-day suspension prior to his retirement, and that he had recently been charged with assault with a weapon after he almost hit someone with his vehicle and then verbally assaulted them. See April 2024, November 2024 and February 2025 VA Respiratory Conditions and Heart Conditions Examinations; April 2025 VA Heart Conditions and PTSD Examinations. His examining VA psychologist opined that his avoidance, irritable behavior, angry outbursts, hypervigilance, exaggerated startle, sleep disturbance, depression, anxiety, and suspiciousness resulted in "clinically significant distress or impairment in social, occupational, or other important areas of functioning". See April 2025 VA PTSD Examination.

Considering the Veteran's background and experience, the Board cannot determine the kind of work for which he would have been most suited. His military training and experience in helicopter maintenance and piloting, and his civilian careers in construction and environmental cleanup involved high degrees of physical exertion, dexterity, visual and audio acuity, personal interaction, and significant cognitive abilities, including an ability to concentrate, focus, and communicate effectively.

The Veteran's statements, VA treatment records, and examination reports show that the combined effect of his service-connected disabilities limited his ability to work in any capacity throughout the review period. His prior employer noted that he was reduced to part time, and his hours were cut to 20 hours a week due to his "chronic back and foot issues"; he was "unable to handle his prior full-time workload due to his disabilities"; and he eventually had to retire due to "limitations related to his chronic back and foot issues". See March 2025 VA Form 21-4192 E.R.R.G., C.L.; May 2025 VA Form 21-10210, C.L. His VA treatment records and examinations show additional functional impairment related to his service-connected hearing loss, tinnitus, headaches, sinusitis, emphysema, heart conditions, eye disabilities, lumbar spine and knee disabilities, and that the symptoms of his acquired psychiatric disorder negatively impacted his productivity, reliability, and ability to effectively communicate and interact in any employment setting.

After careful review of the record and consideration of the Veteran's education, training, and employment history, the Board finds that the evidence is at least in approximate balance as to whether he could secure or follow substantially gainful employment due to his service-connected disability symptoms from July 27, 2023. After resolving reasonable doubt in the Veteran's favor, the Board finds that his service-connected disabilities prevented him from securing or following a substantially gainful occupation from July 27, 2023. 38 U.S.C. § 5110(b)(3). Therefore, a TDIU from July 27, 2023, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.16; Lynch, 21 F.4th at 776.

3. Eligibility to DEA benefits prior to October 8, 2024.

Survivors' and Dependents' Educational Assistance under Chapter 35, Title 38, of the United States Code, is a program of education or special restorative training that may be authorized for an eligible person, such as a surviving spouse, if the applicable criteria are met. See 38 U.S.C. §§ 3500,
3). Therefore, a TDIU from July 27, 2023, is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.16; Lynch, 21 F.4th at 776.

3. Eligibility to DEA benefits prior to October 8, 2024.

In the case of a Veteran who is alive, the conditions for basic eligibility for DEA include: (1) the Veteran's discharge from service under conditions other than dishonorable; and (2) the Veteran has a permanent total service-connected disability. 38 C.F.R. § 3.807(a).

The Veteran was awarded eligibility to DEA effective October 8, 2024, based upon the finding that the evidence showed permanent and total disability. Because the Veteran is now granted an earlier effective date of July 27, 2023, for a TDIU, a "permanent and total disability", the earliest date at which the Veteran could establish eligibility for Chapter 35 benefits is July 27, 2023. Accordingly, entitlement to an earlier effective date for DEA eligibility is granted from July 27, 2023.

RATING REDUCTIONS

The Veteran contends that the discontinuance of his compensable evaluations for a right foot scar, ocular hypertension, and hypertension, were unlawful and must be reversed. See June 2025 VA Form 20-0996; October 2025 VA Form 10182; June 2025 and October 2025 Appellate Briefs. The Veteran specifically contends that his right foot scar remains painful and unstable; his blood pressure readings continue to be predominantly greater than 160 despite the use of medication; and the reduction of his ocular hypertension was not based on sustained or actual improvement. Id.

Where a reduction in an evaluation of a service-connected disability is considered warranted, and the lower evaluation would result in a reduction or termination of compensation payments currently being made, a rating proposing the reduction will be prepared setting forth all material facts and reasons, with notification of the right to request a predetermination hearing or present additional evidence showing that compensation should be continued at the present level. 38 C.F.R. § 3.105(e), (i). This regulation also governs effective dates for any reduction or discontinuance; however, if there is no reduction in the amount of compensation payable to a beneficiary, 38 C.F.R. § 3.105 (e) does not apply.

In the June 2025 rating decision on appeal, the ratings for the Veteran's right foot scar, ocular hypertension, and hypertension were reduced to noncompensable evaluations, from April 9, 2025 (ocular hypertension), April 10, 2025 (right foot scar), and May 21, 2025 (hypertension), with no reduction in the Veteran's overall disability evaluation of 80 percent. See June 18, 2025, Rating Decision; June 2025 Codesheet. The effectuation of these reductions did not result in a reduction in his overall compensation; therefore, the procedural safeguards of 38 C.F.R. § 3.105 do not apply here. See Stelzel v. Mansfield, 508 F.3d 1345, 1349 (Fed. Cir. 2007); Tatum v. Shinseki, 24 Vet. App. 139, 143 (2010); VAOPGCPREC 71-91.

The provisions of 38 C.F.R. § 3.344(a) and (b) prescribe additional requirements for rating reductions but only apply to ratings that have continued for long periods at the same level (five years or more). These provisions do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating. 38 C.F.R. § 3.344(c).

The Veteran was granted service connection for a right foot scar with an initial noncompensable rating from October 1, 1984, and an increased evaluation of 20 percent from July 27, 2023; hypertension with an initial 10 percent evaluation from August 10, 202
3.344(a) and (b) prescribe additional requirements for rating reductions but only apply to ratings that have continued for long periods at the same level (five years or more). These provisions do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating. 38 C.F.R. § 3.344(c).

The Veteran was granted service connection for a right foot scar with an initial noncompensable rating from October 1, 1984, and an increased evaluation of 20 percent from July 27, 2023; hypertension with an initial 10 percent evaluation from August 10, 2022; and ocular hypertension with initial 10 percent evaluation from July 27, 2023. As none of the evaluations were continued at the same level for five years or more, the provisions of 38 C.F.R. 3.44(a) and (b) do not apply.

However, there are general VA regulations that apply to all rating reductions regardless of whether the rating has been in effect for five years or more. See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; Brown v. Brown, 5 Vet. App. 413, 420-421 (1993).

Pursuant to 38 C.F.R. § 4.1, it is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. See Brown, supra at 420. Similarly, 38 C.F.R. § 4.2 establishes that "[i]t is the responsibility of the rating specialist to interpret reports of examination in light of the whole record history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present." Id. The provisions "impose a clear requirement" that rating reductions be based on the entire history of the Veteran's disability. Id.

Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms. Additionally, any rating-reduction requires not only determination that an improvement in a disability has occurred, but also that improvement reflects an improvement in a Veteran's ability to function under ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 349 (2000); 38 C.F.R. §§ 4.2, 4.10.

In considering the propriety of a reduction, the Board must focus on the evidence of record available at the time the reduction was effectuated, although post-reduction medical evidence may be considered for the limited purpose of determining whether the condition had demonstrated actual improvement. See Dofflemyer v. Derwinski, 2 Vet. App. 277, 279-80 (1992). The question of whether a disability has improved involves consideration of the applicable rating criteria; when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; see also Lynch, supra.

1. Propriety of the reduction of the evaluation for a right foot scar from 20 percent to noncompensable, from April 10, 2025.

The Veteran's right foot scar is evaluated at 20 percent disabling from July 27, 2023, and noncompensable from April 10, 2025, pursuant to Diagnostic Code 7804.

Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful; a 10 percent rating is warranted for one or two scars that are unstable or painful; a 20 percent rating is warranted for three or four scars that are unstable or painful; a 30 percent rating is warranted for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7804. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Id. Note (3) states that scars evaluated
one or two scars that are unstable or painful; a 20 percent rating is warranted for three or four scars that are unstable or painful; a 30 percent rating is warranted for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7804. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Id. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this Diagnostic Code, when applicable. Id.

The Board finds that the decrease in evaluation from 20 percent to noncompensable, effective April 10, 2025, was not proper as the medical and lay evidence of record prior to the June 2025 rating decision showed that the Veteran had painful and unstable scars on his right foot.

The Veteran was provided with VA scars examinations in September 2023, October 2023, May 2024, November 2024, and April 2025. His initial VA examiner concluded that the Veteran's right foot scars were stable and not painful; however, during a subsequent VA examination, the examiner noted that while "currently intact", his right foot scar was dry and scaly, subject to skin breakdown with bleeding, required the use of topical care to prevent further breakdown, and concluded that his right foot scar was unstable and would result in lost work during a period when it "breaks down". See September 2023 and October 2023 VA Scar Examinations. During the November 2024 VA examination, the examiner noted that the Veteran's right foot scar from the excision of a dermatofibroma on his right foot was both painful and unstable; a painful and unstable scar on his left forearm with underlying tissue damage and an open sore; a scar on his right thigh; and that he was missing part of his left eyelid. See November 2024 VA Scars Examination; November 2024 VA Skin Diseases Examination.

The Veteran reported that the skin at the donor site on his thigh "burns like fire"; he experienced recurrent breakdowns of the skin of his right foot scar with bleeding that required the application of ointment and prevented him from wearing shoes or going outside as it healed; and he requested shoes that would not press on the skin graft site. See September 2024 VA Form 21-10210; October 2023 VA Scars Examination; February 2025 VA Podiatry Consult. His tenderness and discomfort on palpitation of the graft site on his right foot were noted by his VA primary care provider and a VA podiatrist. See October 2023 VA Primary Care Note; February 2025 VA Podiatry Consult.

The Veteran's 20 percent evaluation for his right foot scar was based on the presence of one or more scars that is both unstable and painful. See March 2025 Rating Decision.

The April 2025 VA examiner concluded that the Veteran's right foot scar was stable and not painful; that he had no scars on his left upper extremity or his left lower extremity; and that the scar on his right lower extremity was stable and not tender. See April 2025 VA Scars Examination. However, the Board finds that the conclusions reached in the April 2025 VA examination are inconsistent with the other evidence of record and the examiner failed to reconcile the new findings with the other VA examination reports, the Veteran's lay statements, or his VA treatment records. Therefore, the Board does not find that the April 2025 VA examination accurately reflects the elements of the disability present or shows actual improvement in his service-connected right foot scar.

Based on the foregoing, after resolving reasonable doubt in the Veteran's favor, the Board finds that the reduction was improper as the medical evidence prior to the June 2025 rating decision established that the Veteran had painful and unstable scars on his right foot, and there was no evidence of improvement. Therefore, the Veteran's 20 percent evaluation for a right foot scar is restored, from April 10, 2025.

2. Propriety of the reduction of the evaluation for ocular hypertension, from 10 percent to noncompensable, from April 9, 2025.

The Veteran's ocular hypertension is evaluated at 10 percent disabling from July 27, 2023, and noncompensable from April 9, 2025, pursuant to Diagnostic Codes
Veteran's favor, the Board finds that the reduction was improper as the medical evidence prior to the June 2025 rating decision established that the Veteran had painful and unstable scars on his right foot, and there was no evidence of improvement. Therefore, the Veteran's 20 percent evaluation for a right foot scar is restored, from April 10, 2025.

2. Propriety of the reduction of the evaluation for ocular hypertension, from 10 percent to noncompensable, from April 9, 2025.

The Veteran's ocular hypertension is evaluated at 10 percent disabling from July 27, 2023, and noncompensable from April 9, 2025, pursuant to Diagnostic Codes 6027-6066.

Evaluations of visual impairment range from noncompensable to 100 percent based on organic impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. §§ 4.76(a), 4.79. The examination for visual impairment must be conducted by a licensed optometrist or by a licensed ophthalmologist and the examiner must identify the disease, injury, or any other pathologic found. 38 C.F.R. § 4.76(b). Examination of visual fields or muscle function will be conducted only when there is a medical indication of disease or injury that may be associated with visual field defect or impaired muscle function. Id. Unless medically contraindicated, the fundus must be examined with the Veteran's pupils dilated. Id.

Unless otherwise directed, diseases of the eye are evaluated under the General Rating Formula for Diseases of the Eye. 38 C.F.R. § 4.79, Diagnostic Codes 6000 through 6009. Impairment of Visual Acuity is rated under Diagnostic Codes 6061 through 6066. Impairment of Visual Fields is rated under Diagnostic Codes 6080 and 6081. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. 38 C.F.R. § 4.27.

Diagnostic Code 6027 concerns cataracts of any type and provides that preoperative cataracts should be evaluated under the General Rating Formula for Diseases of the Eye. See 38 C.F.R. § 4.79. For postoperative cataracts, Diagnostic Code 6027 provides that if a replacement lens is present (right eye pseudophakia), or the cataract is preoperative (left eye), the condition should be evaluated under the General Rating Formula for Diseases of the Eye. Id.

The General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. See 38 C.F.R. § 4.79. Note (1) identifies an incapacitating episode as an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Id. Note (2) specifies that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Id. Note (3) references 38 C.F.R. § 4.75-4.78 and § 4.79, Diagnostic Codes 6061-6091for the evaluation of visual impairment due to a particular condition. Id.

The Veteran was provided with VA eye conditions examinations in August 2023, October 2023, October 2024, and April 2025. However, only the October 2023 VA examination report contained the results of Goldmann's equivalent III/4e target visual field testing; diagnosed a scotoma affecting at least one quarter of his visual field on his left eye; and impairment of the visual field with a remaining field of less than 60 degrees in both eyes due to his ocular hypertension in both eyes with a preoperative cataract in the left eye and pseudophakia in the right eye. See October 2024 VA Eye Conditions Examination.

The Veteran's service-connected right eye pseudophakia (postoperative cataract) was initially rated based on an average contraction to 55.75 degrees and his left eye (preoperative) cataract was initially rated based on an average contraction to 55.25 degrees, which equates to visual acuity of 20/50 for each eye, pursuant to 38 C.F.R. §§ 4.76, 4.77, Diagnostic Codes 6027
field of less than 60 degrees in both eyes due to his ocular hypertension in both eyes with a preoperative cataract in the left eye and pseudophakia in the right eye. See October 2024 VA Eye Conditions Examination.

The Veteran's service-connected right eye pseudophakia (postoperative cataract) was initially rated based on an average contraction to 55.75 degrees and his left eye (preoperative) cataract was initially rated based on an average contraction to 55.25 degrees, which equates to visual acuity of 20/50 for each eye, pursuant to 38 C.F.R. §§ 4.76, 4.77, Diagnostic Codes 6027, 6066, and 6080. See January 2024 Rating Decision, Codesheet.

The Board finds that the decrease in evaluation from 10 percent to noncompensable, effective April 9, 2025, was not proper. There was no evidence prior to the June 2025 rating decision that the Veteran's impaired visual field due to a left eye scotoma and remaining bilateral visual fields of less than 60 degrees, had improved.

The only visual field testing evidence of record prior to the June 2025 rating decision showed that he had a unilateral scotoma that affected at least one quarter of his visual field, warranting a 10 percent evaluation pursuant to 38 C.F.R. § 4.79, Diagnostic Code 6081; as well as remaining visual field of less than 60 degrees bilaterally, warranting a 10 percent evaluation pursuant to 38 C.F.R. § 4.79, Diagnostic Code 6080. See October 2023 VA Eye Conditions Examination. Diagnostic Code 6080 instructs that for the Veteran's level of impaired visual fields, a 10 percent evaluation may be assigned for a unilateral or a bilateral impaired visual field, or each affected eye may be evaluated as 20/50 visual acuity. 38 C.F.R. § 4.79, Diagnostic Code 6080. Visual acuity in either eye of 20/50 warrants a 10 percent evaluation. 38 C.F.R. § 4.79, Diagnostic Code 6066. There is no medical evidence showing improvement of the Veteran's documented visual field defect. See Faust, supra; 38 C.F.R. §§ 4.2, 4.10. Rather, the Board finds that the reduction was improperly effectuated based on a less thorough examination instead of an actual change in the severity of the Veteran's disability. See 38 C.F.R. § 4.13.

Based on the foregoing, the Board finds that the reduction was improper as the medical evidence prior to the June 2025 rating decision established that the Veteran had documented visual field impairments shown during the October 2023 VA eye examination by appropriate testing, and there is no evidence of improvement. Therefore, the Veteran's 10 percent evaluation for ocular hypertension, is restored, from April 9, 2025.

3. Propriety of the reduction of the evaluation for hypertension, from 10 percent to noncompensable, from May 21, 2025.

The Veteran's hypertension is evaluated at 10 percent disabling from August 10, 2022, and noncompensable from May 21, 2025, pursuant to Diagnostic Code 7101.

Under Diagnostic Code 7101, the following ratings apply to hypertensive vascular disease: a 10 percent rating is warranted when diastolic pressure is predominantly 100 or more or when systolic pressure is predominantly 160 or more, or for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control; a 20 percent rating is warranted when diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more; a 40 percent rating is warranted when diastolic pressure is predominantly 120 or more; and a 60 percent rating is warranted when diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

The Veteran's 10 percent hypertension evaluation was based on his history of systolic pressure predominantly 160 or more. See December 2023 Rating Decision.

The Veteran was afforded VA hypertension examinations in November 2023 and May
rating is warranted when diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101.

The Veteran's 10 percent hypertension evaluation was based on his history of systolic pressure predominantly 160 or more. See December 2023 Rating Decision.

The Veteran was afforded VA hypertension examinations in November 2023 and May 2025. The November 2023 VA examiner noted the Veteran required two medications, Amlodipine and Metoprolol, and based his hypertension diagnosis on blood pressure readings from November 17, 2023, of 162/79 and 180/80; November 18, 2023, of 168/80 and 145/77; and November 19, 2023, of 160/76 and 156/78. See November 2023 VA Hypertension Examination. The Veteran's current blood pressure readings on the day of examination of 162/76, 185/90, and 163/82 showed systolic blood pressure readings predominantly 160mm or greater, with diastolic blood pressure less than 90mm. Id.

The May 2025 VA examiner noted that the Veteran continued to require two blood pressure medications; recorded his blood pressure readings on the day of examination as 142/72, 153/74, and 144/63; and concluded that he continued to have a moderate level of hypertension as his blood pressure readings during the examination were "still elevated" despite his ongoing treatment with Amlodipine and Metoprolol. See May 2025 VA Hypertension Examination. Notably, the Veteran's VA treatment records since the November 2023 VA examination also show elevated blood pressure readings, including 173/77 during a March 2024 primary care visit, and readings of 145/99 and 149/66 during April 2024 and April 2025 VA heart conditions examinations. The Veteran reported in May 2024 that his home blood pressure readings were between 125 and 140 systolic over less than 80 diastolic. See May 2024 VA Primary Care Note; February 2025 VA Podiatry Consult.

The Board does not find competent medical evidence showing actual improvement of the Veteran's hypertension. See Faust, supra; 38 C.F.R. §§ 4.2, 4.10. Rather, the Board finds that the reduction was improperly effectuated as it disregarded the Veteran's continued "elevated" blood pressure readings to include those that were specifically identified by the May 2025 VA examiner. The May 2025 VA examiner concluded that the presence of continued elevated blood pressure readings despite the Veteran's continued use of two prescription medications designed to lower his blood pressure signified a continued moderate level of disability. Therefore, the Board finds the medical evidence did not show actual improvement in the severity of the Veteran's hypertension disability. See 38 C.F.R. § 4.13.

Based on the foregoing, the Board finds that the reduction was improper as the medical evidence prior to the June 2025 rating decision established that the Veteran continued to have elevated blood pressure despite his continued treatment with two blood pressure medications; there was no evidence of actual improvement in his hypertension. Therefore, the Veteran's 10 percent evaluation for hypertension, is restored, from May 21, 2025.

REASONS FOR REMAND

Entitlement to SMC based on the need for regular aid and attendance is remanded.

The Board finds that the issue of SMC based on the need for regular aid and attendance was raised by the record during the increased rating period on appeal for the Veteran's right foot disability. The Veteran contends he requires regular aid and attendance due in part to his right foot disability. See October 2024 VA Form 21-526EZ; VA Form 2-4138. The Board must consider SMC when it is raised by the Veteran or the record and pertains to the period on appeal for the associated increased rating claim. See Perciaville v. Wilkie, 32 Vet. App. 117 (2019), Wilson v. McDonough, 35 Vet. App. 103 (2022); see also 38 C.F.R. § 3.155(d)(2); Akles, supra.

SMC at the aid and attendance rate is warranted if
disability. The Veteran contends he requires regular aid and attendance due in part to his right foot disability. See October 2024 VA Form 21-526EZ; VA Form 2-4138. The Board must consider SMC when it is raised by the Veteran or the record and pertains to the period on appeal for the associated increased rating claim. See Perciaville v. Wilkie, 32 Vet. App. 117 (2019), Wilson v. McDonough, 35 Vet. App. 103 (2022); see also 38 C.F.R. § 3.155(d)(2); Akles, supra.

SMC at the aid and attendance rate is warranted if the Veteran, because of a service-connected disability, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to need regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. §§ 3.350(b)(3), 3.352(a). The criteria include an inability to dress or undress, keep ordinarily clean and presentable, attend to the wants of nature, feed oneself, or physical or mental incapacity that requires care or assistance on a regular basis to protect from hazards or dangers incident to the daily environment. 38 C.F.R. § 3.352(a). Determinations regarding the need for aid and attendance must be based on actual requirements of personal assistance from others as outlined in the criteria set forth in 38 C.F.R. § 3.352(a).

Under the AMA framework, the Board may remand where there has been a duty to assist error prior to issuance of a rating decision. While the Board regrets the additional delay, the Veteran's claims must be remanded to correct duty to assist errors which occurred prior to the June 2025 rating decision. See 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

As outlined, the Veteran specifically claimed entitlement to SMC based on aid and attendance prior to the June 2025 rating decision on appeal. However, the necessary development was not completed prior to the June 2025 rating decision. Therefore, remand is required for an examination to determine whether the Veteran required regular aid and attendance due to his service-connected disabilities.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination (in person or via telehealth) with an appropriate clinician, regarding whether the Veteran's service-connected disabilities result in the need for aid and attendance. Any indicated evaluations or studies should be conducted.

The examiner must address if the Veteran, because of his service-connected disabilities, has suffered the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to need regular aid and attendance.

"Bedridden" will be that condition which, through its essential character, actually requires that the Veteran remain in bed. The fact that the Veteran has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice.

The examiner is asked to provide an opinion as to the impact the Veteran's service-connected disabilities have on his activities of daily living and whether he can leave his home, including whether his disabilities cause him to be unable to dress, undress, keep ordinarily clean and presentable, feed himself, attend to the wants of nature, or protect himself against the hazards or dangers incident to his daily environment. Please identify the specific disabilities that result in the need for aid and attendance.

In providing the requested information, the examiner must consider and discuss all pertinent medical and lay evidence. The examiner is advised that the Veteran is competent to report symptoms and treatment and that his reports, including his reports as to the onset and nature of his symptoms, must be considered in formulating the requested opinions. If the clinician finds any medical reason to reject the lay reports, then they must provide an explanation for such rejection.

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A complete rationale must be provided for all opinions expressed. If an opinion cannot be provided without resorting to speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that the limits of current medical knowledge in providing an answer to that particular question have been exhausted.

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the

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