Case A26037625

S. B. MAYS · 2026 · Case ID: A26037625

MIXED

Summary

The Veteran, who served in the Navy from October 1968 to August 1972, appeals the denial of service connection for traumatic brain injury (TBI), left retinal tear, bilateral open angle glaucoma, loss of vision in right eye/retinal detachment, hearing loss, and obstructive sleep apnea (OSA). The Veteran also sought an increased rating for bilateral nuclear cataracts. The Board denied service connection for TBI, finding no current diagnosis or residuals of TBI, and that the Veteran's lay statements regarding in-service head injuries were not credible given the lack of corroboration in service treatment records and the Veteran's denial of head injuries during service. The Board also denied service connection for a left retinal tear, finding the evidence weighed against a service connection and that the Veteran's lay assertions regarding the etiology of the tear were not persuasive compared to unfavorable VA medical opinions. The Board granted a 30 percent rating for the left eye nuclear cataract, noting it was the minimum rating for aphakia, but denied a higher rating or any rating for the right eye pseudophakia, finding no visual impairment or incapacitating episodes attributable to it. The Board remanded claims for hearing loss (as secondary to tinnitus and mixed anxiety/depressed mood), bilateral open angle glaucoma, loss of vision in right eye/retinal detachment, and OSA. The remands were due to inadequate VA medical opinions that failed to address the Veteran's lay statements, consider relevant medical literature, or properly assess potential intermediate links like obesity for OSA. The Board noted that the Veteran's service treatment records were negative for hearing loss complaints, but the VA examiner's opinion relied on the absence of a threshold shift, which is not fatal to a claim. For OSA, the remand also requires consideration of toxic exposures and obesity as intermediate steps.

Rationale

No current diagnosis of TBI; Service treatment records negative for head injury; Lay statements regarding in-service head injuries not credible

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251120-618734

Full Decision Text

Citation Nr: A26037625
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 251120-618734
DATE: April 22, 2026

ORDER

Entitlement to service connection for traumatic brain injury (TBI) is denied.

Entitlement to service connection for left retinal tear, to include as secondary to service-connected right eye pseudophakia post nuclear cataract removal and left eye nuclear cataract, is denied.

Entitlement to an initial compensable rating for right eye pseudophakia post nuclear cataract removal is denied.

Entitlement to an initial disability rating of 30 percent, but no higher, for left eye nuclear cataract is granted, subject to the applicable regulations concerning the payment of monetary benefits.

REMANDED

Entitlement to service connection for hearing loss, to include as secondary to service-connected mixed anxiety and depressed mood and/or tinnitus, is remanded.

Entitlement to service connection for bilateral open angle glaucoma is remanded.

Entitlement to service connection for loss of vision in right eye, retinal detachment is remanded.

Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected tinnitus, is remanded.

FINDINGS OF FACT

1. The Veteran is not shown to have a TBI or residuals thereof resulting in functional impairment of earning capacity during the period on appeal.

2. The evidence of record persuasively weighs against finding that the Veteran's left retinal tear began during service or is otherwise related to an in-service injury, event, or disease, or is secondary to his service-connected right eye pseudophakia post nuclear cataract removal or left nuclear cataract.

3. For the entire period on appeal, the Veteran's right eye pseudophakia post nuclear cataract removal did not result in decrease in visual acuity or other visual impairment, or any incapacitating episodes.

4. For the entire period on appeal, the Veteran's left eye nuclear cataract resulted in aphakia but did not result in decrease in visual acuity or other visual impairment, or any incapacitating episodes.

CONCLUSIONS OF LAW

1. The criteria for service connection for TBI are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for left retinal tear, to include as secondary to service-connected bilateral nuclear cataracts, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for an initial compensable rating for right eye nuclear cataract have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.79, Diagnostic Code (DCs) 6027.

4. The criteria for an initial 30 percent rating, but no higher, for left eye nuclear cataract have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.79, DC 6029.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1968 to August 1972 with subsequent Navy Reserve service.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from March 2025, April 2025, May 2025 and August 2025 rating decisions from a Department of Veterans Affairs regional office, the agency of original jurisdiction (AOJ). The March 2025 decision, as relevant here, denied service connection for OSA and service connection for left retinal tear. The April 2025 decision denied service connection for hearing loss as secondary to tinnitus. The May 2025 decision denied service connection for loss of vision in right eye, retinal detachment, and bilateral open angle glaucoma. The August 2025 decision denied service connection for a TBI and an initial compensable rating for bilateral eye nuclear cataracts.

On November 20, 2025, the Veteran initiated this appeal to the Board with the filing of two Decision Review Request: Notice of Disagreements (VA Form 10182), requesting direct review. The VA Form 10182s constitute a timely appeal of claims adjudicated in the March 2025, April 2025, May 2025 and August 2025 decisions. Although the VA Form 10182s filed by the Veteran do not identify the issue
denied service connection for loss of vision in right eye, retinal detachment, and bilateral open angle glaucoma. The August 2025 decision denied service connection for a TBI and an initial compensable rating for bilateral eye nuclear cataracts.

On November 20, 2025, the Veteran initiated this appeal to the Board with the filing of two Decision Review Request: Notice of Disagreements (VA Form 10182), requesting direct review. The VA Form 10182s constitute a timely appeal of claims adjudicated in the March 2025, April 2025, May 2025 and August 2025 decisions. Although the VA Form 10182s filed by the Veteran do not identify the issue of entitlement to service connection for a TBI, which was denied in the August 2025 rating decision, in February 2026 correspondence, the Veteran notified the Board that while he had listed the issue of loss of vision in right eye twice, he clarified that he intended to also appeal the issue of service connection for TBI. Accordingly, the Board construes the November 2025 VA Form 10182s to include the issue of entitlement to service connection for a TBI.

Therefore, the Board may only consider the evidence of record at the time of the respective rating decisions on appeal, specifically, March 5, 2025, April 28, 2025, May 20, 2025, and August 21, 2025. 38 C.F.R. § 20.301. Any evidence submitted after the respective AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 the hearing loss, loss of vision in right eye, bilateral open angle glaucoma, and OSA 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).

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). Here, in a November 2025 appeal brief, the Veteran specifically waived his right to select a different Board review option and asked that the Board review his appeal as soon as possible. Because the Veteran explicitly waived his right to change Board dockets under Williams, which would otherwise require the Board to hold the appeal in abeyance until one year following the respective decisions in this case, the Board finds that it may proceed with review of this appeal without prejudice to the Veteran.

As reflected in the title section above, the issue of an increased rating for bilateral nuclear cataracts has been bifurcated into two separate issues, specifically, entitlement to an initial compensable rating for right eye pseudophakia post nuclear cataract removal, and entitlement to an initial compensable rating for left eye nuclear cataract to better reflect the evidence of record, namely evidence reflecting the surgical removal of the Veteran's right eye cataract prior to the claim period at issue in this appeal. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a claim is determined by the claimant's description of the claim, the symptoms described, and the information submitted or developed in support of the claim); Tyrues v. Shinseki, 23 Vet. App. 166, 178-79 (2009), aff'd, 631 F.3d 1380 (Fed. Cir. 2011) (holding that it is permissible to bifurcate a claim and to adjudicate the distinct theories of entitlement separately). Additionally, given that the Veteran has been diagnosed with bilateral hearing loss for VA purposes, as reflected in the October 2021 and May 2023 VA examinations, the issue of service connection for
5 (2009) (holding that the scope of a claim is determined by the claimant's description of the claim, the symptoms described, and the information submitted or developed in support of the claim); Tyrues v. Shinseki, 23 Vet. App. 166, 178-79 (2009), aff'd, 631 F.3d 1380 (Fed. Cir. 2011) (holding that it is permissible to bifurcate a claim and to adjudicate the distinct theories of entitlement separately). Additionally, given that the Veteran has been diagnosed with bilateral hearing loss for VA purposes, as reflected in the October 2021 and May 2023 VA examinations, the issue of service connection for "hearing loss" has been recharacterized as "bilateral hearing loss." Clemons, supra.

Preliminary Matters

Previously, pursuant to the Board's August 2024 remand, the AOJ obtained the Veteran's consent to request treatment records from private provider Optum on his behalf, and in November 2024, those records were associated with the electronic claims file. Pursuant to the Board's February 2025 remand, the AOJ contacted the Veteran requesting consent to obtain treatment records from private provider Doctor L.K., O.D. on his behalf. However, the Veteran replied in March 2025 that his eye care was predominantly provided by Doctor C.S., whose treatment records have already been associated with his claims file.

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016).

Service Connection - Applicable Laws and Regulations

Service connection may be granted for disability resulting from disease or injury incurred in, or aggravated by, active service. 38 U.S.C. § 1110.

The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2L.004).

Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a).

To prevail on the issue of entitlement to secondary service connection, there must be evidence of (1) a current disability; (2) a service-connected disability; and (3) a nexus establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Thus, a disability which is the result of a service-connected disease or injury, or a disability which would have been less severe but-for a service-connected disabilities, shall be service-connected. See 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023). Further, the cause or aggravation of one disability by a service-connected condition need not be the only factor contributing to the disability, but rather there can be multi-causal links affecting the disability. See Spicer, 61 F.4th at 1364.

The requirement for a current disability is satisfied if the disability is present at any point proximate to the claim, during the claim, or the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Additionally, there must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998).

A disability under 38 U.S.C. § 1110 refers to functional impairment of earning capacity. Saunders v. Wilkie, 886 F.
319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Additionally, there must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998).

A disability under 38 U.S.C. § 1110 refers to functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (2018) (holding that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity.").

A subsequent decision by the U.S. Court of Appeals for Veterans Claims (Court) in Wait v. Wilkie, 33 Vet. App. 8 (2020) provided further guidance on the Saunders test for establishing pain as a disability. Under Wait, the Court found that a disability under Saunders requires competent evidence demonstrating that the symptoms result in functional impairment that in fact affects the veteran's earning capacity. In determining whether a veteran's impairment rises to a level affecting earning capacity, VA can consider manifestations of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. The rating schedule may serve as a guide to determine whether certain symptoms may impair earning capacity; however, it is not dispositive. Id. at 17.

A claimant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events, or the presence of disability, or symptoms of disability subject to lay observation. 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although lay persons are considered competent to provide opinions on some medical issues, some medical issues fall outside of the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

The claimant bears the burden of presenting and supporting a claim for benefits. 38 U.S.C. § 5107(a). See Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

Traumatic Brain Injury

The Veteran asserts that service connection for a TBI is warranted. He contends that he suffered two TBIs during service, the first injury having occurred during the last days of boot camp when the Veteran was knocked unconscious by a blow to his head during an Athletic Field Day baton fight with a taller, bigger, and heavier soldier, and the second injury having occurred on January 3, 1969, when the Veteran struck his head on a pipe onboard the U.S.S. VALLEY FORGE (LPH-8) and was knocked unconscious. See October 2020 Correspondence. The Veteran's spouse contends that she and the Veteran were married in 1971. She states that the Veteran reported these two in-service head injuries to her; however, she does not state when the Veteran informed her of them. See the Veteran's spouse's February 28, 2020 statement, received in October 2020.

Initially, the Board notes that the August 2025 rating decision reflects favorable findings that the January 1971 service treatment records reflect
the second injury having occurred on January 3, 1969, when the Veteran struck his head on a pipe onboard the U.S.S. VALLEY FORGE (LPH-8) and was knocked unconscious. See October 2020 Correspondence. The Veteran's spouse contends that she and the Veteran were married in 1971. She states that the Veteran reported these two in-service head injuries to her; however, she does not state when the Veteran informed her of them. See the Veteran's spouse's February 28, 2020 statement, received in October 2020.

Initially, the Board notes that the August 2025 rating decision reflects favorable findings that the January 1971 service treatment records reflect headaches, October 1986 Reserve records note a scar on the left side of the Veteran's head, and that the Veteran participated in a TERA. However, as the record does not include evidence of a TBI or residuals thereof during or after service and the Veteran's TERA is not relevant to the TBI claim, these favorable findings are rebutted. Id.

The Board has reviewed the record and finds that the threshold element of the claim for service connection, i.e., a current disability, is not met. The evidence persuasively weighs against finding that the Veteran currently has a TBI diagnosis from the date of this claim and during the pendency of the appeal.

The Veteran's service treatment records are negative for complaints, findings, symptoms or diagnoses related to a head injury. He complained of headaches and fatigue for the prior week in January 1971, however, he did not report a head injury at that time, and his headaches and fatigue were thought to be flu symptoms. See January 1971 Sick Call Treatment Record. Notably, the remainder of the service treatment records reflect that the Veteran repeatedly denied a head injury.

Post-service VA and private treatment records fail to show TBI complaints, treatment, or diagnoses from the date of this claim and during the pendency of the appeal.

A December 2024 VA medical opinion obtained for a claim for service connection for vertigo states that the Veteran's vertigo was at least as likely as not secondary to the Veteran's service-connected [sic] TBI. As a rationale, the examiner recited the Veteran's October 2020 statement describing an in-service head injury and noted that vertigo is a common symptom of TBI and up to 50 percent of people with TBI experience vestibular impairments. However, this opinion appears to be based entirely on the Veteran's subjective report of having suffered a head injury during service and his report of a current TBI diagnosis, neither of which is reflected in the record. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based upon an inaccurate factual premise has no probative value). Accordingly, the Board assigns this opinion low probative weight.

During a December 2024 VA TBI examination, the Veteran reported having two head traumas during military service, one when knocked unconscious by a blow to his head with a baton, and the other aboard U.S.S. Valley Forge when he struck his head on a pipe, although he denied losing consciousness from the injury aboard the Valley Forge. He endorsed current symptoms of poor balance, confusion, poor sleep, tinnitus, vision issues, dizziness, anger and mood issues, and headaches. The VA examiner noted that the Veteran denied seeking medical attention for these injuries during service, explaining, "we just didn't do that," and when asked when he first sought treatment for a TBI, the Veteran stated, "it was awhile ... I don't know why ... it was some years ... until I got help ... I don't know why, that's what was done." The examiner concluded that "there are no findings, signs and or symptoms" and "no pathology to warrant a diagnosis." The VA examiner issued an unfavorable medical opinion, explaining in part, that medical examinations "through his active duty and Reserve career ... are silent for any reported head traumas or residuals of TBIs dating into the mid 1990s" and "not only did the claimant not seek treatment for his claimed injuries, but he also failed to mention them during an entire career's worth of routine screenings. He also cannot say when he first sought treatment for his claimed symptoms [and] [a]fter he left the military, he did not seek treatment for any of his claimed symptoms for 'years' and could not explain this." The VA examiner emphasized that the Veteran "had excellent functioning when he left the military: he earned a bachelor's degree in business and had a successful career at the Social Security Administration for about 30 years, becoming an assistant branch manager." The examiner concluded that did not suffer
or residuals of TBIs dating into the mid 1990s" and "not only did the claimant not seek treatment for his claimed injuries, but he also failed to mention them during an entire career's worth of routine screenings. He also cannot say when he first sought treatment for his claimed symptoms [and] [a]fter he left the military, he did not seek treatment for any of his claimed symptoms for 'years' and could not explain this." The VA examiner emphasized that the Veteran "had excellent functioning when he left the military: he earned a bachelor's degree in business and had a successful career at the Social Security Administration for about 30 years, becoming an assistant branch manager." The examiner concluded that did not suffer "a TBI during his time on active duty and as such is not experiencing any residuals from such an injury."

The December 2024 TBI opinion is competent, credible and probative: It was authored by a licensed clinician who reviewed the Veteran's claims file and was therefore familiar with the Veteran's symptoms, diagnoses, and treatment of his various documented in-service and post-service ailments; the opinion was based on a review of the evidence of record as well as lay statements of the Veteran; and the opinion contains clear conclusions connected by a reasoned medical explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-02 (2008). Accordingly, the Board finds the December 2024 VA medical opinion probative, competent and persuasive medical evidence in this case.

In a February 2025 addendum to resolve the inconsistencies between the first December 2024 medical opinion and the second December 2024 examination report and medical opinion, the first VA examiner again recited the Veteran's October 2020 statement and concluded that the Veteran's diagnosis of TBI is warranted. However, as noted above, the initial December 2024 VA opinion is based upon an inaccurate factual premise. Reonal, supra. As such, the February 2025 addendum, which merely restates the earlier opinion, is assigned no probative weight.

A May 2025 VA TBI examination report reflects the Veteran's reported history of two in-service blows to the head that produced subjective alteration in mental state and neurological changes. The VA examiner concluded that the Veteran does not now have, and had never had, a TBI or any residuals of a TBI, explaining that "neither of these events nor any potentially-related neurological signs or symptoms are corroborated in his service treatment records. There are also no in-service diagnoses of TBI or a related condition. Neither reported event occurred as a result of combat. As a result, the Veteran does not meet criteria for having suffered a TBI event related to service per VA established standards." The examiner opined that the Veteran "has been diagnosed with several other medical conditions that confound his current complaints of headaches and dizziness and may instead explain them, including having had a history of a retinal detachment, glaucoma, obstructive sleep apnea, hypertension, hyperglycemia, and peripheral vestibular disorder." The examiner emphasized that the Veteran does not meet the criteria for diagnosis of a TBI.

The May 2025 VA opinion is competent, credible and probative: It was authored by a licensed clinician who reviewed the Veteran's claims file and was therefore familiar with the Veteran's symptoms, diagnoses, and treatment of his various documented in-service and post-service ailments; the opinion was based on a review of the evidence of record as well as lay statements of the Veteran; and the opinion contains clear conclusions connected by a reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 301-02. Accordingly, the Board finds the May 2025 VA medical opinion probative, competent and persuasive medical evidence in this case.

In an August 2025 addendum medical opinion, another VA examiner concluded that, based on a review of the record, there is no in-service or post-service evidence that demonstrates a diagnosis of TBI.

The Board concludes that the foregoing evidence persuasively weighs against finding that the Veteran currently has a TBI diagnosis from the date of this claim and during the pendency of the appeal, including persistent or recurrent TBI symptoms, or any related symptoms resulting in functional impairment of earning capacity. In so finding, the Board assigns greater probative weight to the December 2024, May 2025, and August 2025 VA opinions that the Veteran does not have a TBI and did not incur one during service outweigh the December 2024 positive vertigo opinion. As discussed above, the unfavorable VA opinions provide detailed rationales that are consistent with the record while the favorable December 2024 opinion ignores the service treatment records, does not address the specific facts
the foregoing evidence persuasively weighs against finding that the Veteran currently has a TBI diagnosis from the date of this claim and during the pendency of the appeal, including persistent or recurrent TBI symptoms, or any related symptoms resulting in functional impairment of earning capacity. In so finding, the Board assigns greater probative weight to the December 2024, May 2025, and August 2025 VA opinions that the Veteran does not have a TBI and did not incur one during service outweigh the December 2024 positive vertigo opinion. As discussed above, the unfavorable VA opinions provide detailed rationales that are consistent with the record while the favorable December 2024 opinion ignores the service treatment records, does not address the specific facts of the Veteran's claim, and appears to be based entirely on the Veteran's subjective report of having suffered a head injury during service and his report of a current TBI diagnosis, which, as shown above, is not supported by the record. Furthermore, the VA examinations consistently show that the Veteran has not met the criteria for diagnosis of a TBI based on objective diagnostic criteria and each examiner's own subject-matter medical knowledge and expertise. Nieves-Rodriguez, 22 Vet. App. at 304.

The Board recognizes that the Veteran is competent to report events and symptoms that are directly observable to him, such as being struck in the head and having headaches during service. See Jandreau, supra. However, regarding his assertion that his claimed in-service head injuries are not documented in his service treatment records because "we just didn't do that," suggesting that seeking treatment for such injuries was not acceptable, the Veteran's assertions in this regard are not credible given that his service records show that he sought treatment for less severe medical issues, including nasal congestion, coughing, and a heel spur. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (The credibility and weight to be attached to evidence are within the Board's province as finder of fact). Furthermore, the Board assigns greater probative value to the VA medical opinions regarding whether the Veteran has a currently diagnosed TBI disability.

The Board can identify no duty to assist error in the AOJ's August 2025 adjudication of this claim as the evidence of record at the time of the August 2025 rating decision does not demonstrate a current diagnosis of a TBI or symptoms resulting in functional impairment of earning capacity that are not already accounted for by one or more service-connected disabilities, including the service-connected migraine headaches.

As there is no competent evidence that the Veteran has been diagnosed with the claimed TBI disability, further analysis of the remaining elements of the service connection claim is unnecessary. The evidence is persuasively against the claim for service connection for TBI on any basis, and the benefit-of-the-doubt rule does not apply. The appeal is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303.

Left Retinal Tear

The Veteran contends that his currently diagnosed left retinal tear is the result of his service-connected bilateral nuclear cataracts or due to a head injury during active duty service. See November 2025 Appeal Brief.

The Veteran's service treatment records are negative for complaints, findings, symptoms or diagnoses related to a left retinal tear. Furthermore, as discussed above, the service records are negative for complaints, findings, symptoms or diagnoses of a head injury. Although the Veteran complained of headaches and fatigue in January 1971, these symptoms were attributed to his having the flu. He did not report any head injury at that time and the remainder of the service treatment records show that the Veteran repeatedly denied a head injury. The Veteran has asserted that his claimed in-service head injuries are not documented in his service treatment records because "we just didn't do that," indicating that he did not seek treatment for the injuries. However, as discussed above, the Veteran's assertions in this regard are not credible given that his service records show that he sought treatment for less severe medical issues, including nasal congestion, coughing, and heel spur. See Guerrieri, supra.

Post-service private treatment records reflect diagnosis of left retinal tear. See, e.g., June 2018 Medical Treatment Record (M.C., M.D.). Thereafter, the left retinal tear was characterized as well treated without additional breaks. See June 2018 Medical Treatment Record (M.C., M.D.). However, the post-service records do not address the etiology of the retinal tear.

VA medical opinions obtained prior to the Board's August 2024 remand were previously determined by the Board to be inadequate and need not be discussed further.

An unfavorable August 2024
for less severe medical issues, including nasal congestion, coughing, and heel spur. See Guerrieri, supra.

VA medical opinions obtained prior to the Board's August 2024 remand were previously determined by the Board to be inadequate and need not be discussed further.

An unfavorable August 2024 VA medical opinion and addendum address whether the Veteran's left retinal tear is related to the TERA of herbicide agent and asbestos exposures. The examiner noted, "In March 2016, [the] Veteran experienced a retinal detachment with an associated vitreous hemorrhage. The retinal detachment resulted in a decrease in visual acuity." The examiner added that "medical literature and reference material" show that "[t]here is a lack of medical or scientific evidence indicating any relationship between the TERA and the retinal detachment[.]" On this basis, the examiner opined that it is less likely than not that the Veteran's left retinal tear is related to the Veteran's in-service TERAs. The Board finds this opinion competent, credible and probative as it was authored by a medical clinician who reviewed the Veteran's claims file and was therefore familiar with the symptoms, diagnosis, and treatment of his left retinal tear; it is based on a review of the evidence of record as well as the Veteran's lay statements of record; and it contains a clear conclusion connected by a reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 301-02. Accordingly, the Board finds the August 2024 VA TERA opinion probative, competent and persuasive medical evidence in this case.

A December 2024 VA medical opinion addresses direct and secondary service connection. First, the examiner concludes that the Veteran's left retinal tear was neither caused nor aggravated by his service-connected bilateral cataracts. The examiner explained that "a retinal tear is the result of vitreous traction on the retina" associated with factors such as "abnormally thin retina, retinal tears, peripheral retinal degenerations, contre coup trauma to the head." The examiner emphasized that "[c]ataract formation is not a known cause or aggravation of retinal tear." Second, regarding the Veteran's assertion that his left retinal tear is related to blunt trauma during service, the December 2024 VA examiner acknowledged reviewing the claims file, which includes the Veteran's lay statements asserting head injuries during service. However, given that the service treatment records are negative for such injuries, the examiner appears to have assigned low probative weight to the Veteran's statements in this regard, concluding that it was unlikely that the Veteran's left retinal tear is related to service. The Board finds this opinion competent, credible and probative as it was authored by a medical clinician who reviewed the Veteran's claims file and was therefore familiar with the symptoms, diagnosis, and treatment of his left retinal tear; it is based on a review of the evidence of record as well as the Veteran's lay statements of record; and it contains a clear conclusion connected by a reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 301-02. Accordingly, the Board finds the December 2024 VA medical opinion probative, competent and persuasive medical evidence in this case.

In January 2025, a VA examiner opined that the Veteran's left retinal tear is less likely than not related to the service-connected cataracts, explaining that "[c]ataract formation is not a known cause or aggravation of retinal tear." The examiner explained that "a retinal tear is the result of vitreous traction on the retina" typically caused by "abnormally thin retina, retinal tears, peripheral retinal degenerations, [and] contre coup trauma to the head." He added, "As we get older, the vitreous in our eyes starts to shrink and get thinner. Usually, the vitreous moves around on the retina without causing problems. But the vitreous may stick to the retina and pull hard enough to tear it. When that happens, fluid can pass through the tear and lift (detach) the retina[.]" The Board finds this opinion competent, credible and probative as it was authored by a medical clinician who reviewed the Veteran's claims file and was therefore familiar with the symptoms, diagnosis, and
" typically caused by "abnormally thin retina, retinal tears, peripheral retinal degenerations, [and] contre coup trauma to the head." He added, "As we get older, the vitreous in our eyes starts to shrink and get thinner. Usually, the vitreous moves around on the retina without causing problems. But the vitreous may stick to the retina and pull hard enough to tear it. When that happens, fluid can pass through the tear and lift (detach) the retina[.]" The Board finds this opinion competent, credible and probative as it was authored by a medical clinician who reviewed the Veteran's claims file and was therefore familiar with the symptoms, diagnosis, and treatment of his left retinal tear; it is based on a review of the evidence of record as well as the Veteran's lay statements of record; and it contains a clear conclusion connected by a reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 301-02. Accordingly, the Board finds the January 2025 VA medical opinion probative, competent and persuasive medical evidence in this case.

The January 2025 VA examiner also opined that the Veteran's left retinal tear is less likely than not related to his TERA of herbicide agents and asbestos exposures. See July 2024 TERA Memorandum; August 2024 Examination Addendum (AOJ notes Veteran was also exposed to asbestos). The VA examiner explained that exposure was to herbicide agents is not a known cause of a retinal tear and that based on a review of medical literature there is insufficient evidence to determine whether there is an association between such exposure and eye conditions. The examiner stated that risk factors for retinal tear include abnormally thin retina, retinal tears, peripheral retinal degenerations, and contre coup trauma to the head, and that the more likely cause of the Veteran's left retinal tear was "vitreous traction on the retina." The examiner stressed that exposure to an herbicide agent and asbestos exposure is not a known cause of retinal tear.

The Board finds this opinion competent, credible and probative as it was authored by a medical clinician who reviewed the Veteran's claims file and was therefore familiar with the symptoms, diagnosis, and treatment of his left retinal tear; it is based on a review of the evidence of record as well as the Veteran's lay statements of record; and it contains a clear conclusion connected by a reasoned medical explanation. See Nieves-Rodriguez, 22 Vet. App. at 301-02. Accordingly, the Board finds the January 2025 VA TERA opinion probative, competent and persuasive medical evidence in this case.

The Board recognizes that the Veteran is competent to report events and symptoms that are directly observable to him, such as head trauma and eye symptoms. However, regarding his assertion that his currently diagnosed left retinal tear is secondary to his bilateral nuclear cataracts or due to the claimed in-service head injury, the Veteran has not been shown to be competent to opine as to the etiology of an eye disorder, which is a medical question. See Jandreau, supra. Consequently, the Board assigns greater probative value to the aforementioned VA medical opinion regarding the etiology of the Veteran's left retinal tear.

The Board can identify no duty to assist error in the AOJ's March 2025 adjudication of this claim as the evidence of record at the time of the March 2025 rating decision does not demonstrate that the Veteran's currently diagnosed left retinal tear is etiologically related to his service-connected bilateral nuclear cataracts or to service.

As there is no competent evidence that the Veteran's left retinal tear is etiologically related to his service-connected bilateral nuclear cataracts or to service, including his TERAs, the evidence is persuasively against the claim for service connection for left retinal tear, and the benefit-of-the-doubt rule does not apply. The appeal is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

Increased Ratings - Applicable Laws and Regulations

In general, ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4.

Increased Ratings - Applicable Laws and Regulations

When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. An exception to this rule applies when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, and 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018).

After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. With a claim for an increased initial rating, separate staged ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The benefit of the doubt applies when the evidence for and against is in "approximate balance" or "nearly equal," but does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Right and Left Eye Disabilities

Rating Criteria

The Veteran is currently in receipt of a single initial noncompensable disability rating for bilateral eye nuclear cataracts under Diagnostic Code (DC) 6027, effective August 10, 2022, based on no incapacitating episodes. See October 2023 Rating Decision at 5; 38 C.F.R. § 4.79, DC 6027. The Veteran seeks an initial 20 percent disability rating. See November 2025 Appeal Brief.

As noted above, the Board has recharacterized these issues as entitlement to an initial compensable rating for right eye pseudophakia post nuclear cataract removal, and entitlement to an initial compensable rating for left eye nuclear cataract. See Clemons, supra.

DC 6027 provides that preoperative cataracts are to be evaluated under the General Rating Formula for Diseases of the Eye. For postoperative cataracts, if a replacement lens is present (pseudophakia), the condition is to be evaluated under the General Rating Formula for Diseases of the Eye. If there is no replacement lens, the condition is to be evaluated based on aphakia under DC 6029 for aphakia or dislocation of crystalline lens: Under DC 6029, evaluation is based on visual impairment and elevating the resulting level of visual impairment one step. The minimum (unilateral or bilateral) rating is 30 percent. 38 C.F.R. § 4.79, DCs 6027 and 6029.

The General Rating Formal for Diseases of the Eye provides for evaluation based on either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapac
or dislocation of crystalline lens: Under DC 6029, evaluation is based on visual impairment and elevating the resulting level of visual impairment one step. The minimum (unilateral or bilateral) rating is 30 percent. 38 C.F.R. § 4.79, DCs 6027 and 6029.

The General Rating Formal for Diseases of the Eye provides for evaluation based on either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Id.

Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates 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. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, DCs 6061- 6091. Id.

The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a).

Evaluation of visual acuity is based on corrected distance vision with central fixation, and the visual acuity measurements for each eye are applied to the table for Impairment of Central Visual Acuity. 38 C.F.R. § 4.76(b)(1). Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c).

Evaluation of visual field is based on the remaining field of vision in each eye. With respect to field of vision impairment, 38 C.F.R. § 4.76a, Table III, reflects that the normal visual field extent at the 8 principal meridians totals 500 degrees. Normal findings for the 8 principal meridians are as follows: 85 degrees temporally; 85 degrees down temporally; 65 degrees down; 50 degrees down nasally; 60 degrees nasally; 55 degrees up nasally; 45 degrees up; and 55 degrees up temporally. The extent of visual field contraction in each eye is determined by recording the extent of the remaining visual field in each of the eight 45-degree principal meridians. To calculate average concentric contraction, the rater should add the remaining visual field (in degrees) at each of eight principal meridians 45 degrees apart and divide the sum by eight. 38 C.F.R. § 4.77(b).

To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, VA is to separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity) and combine them under the provisions of 38 C.F.R. § 4.25. 38 C.F.R. § 4.77(c).

Rating Analysis

In his November 2025 appeal brief the Veteran contends that the AOJ erred when it concluded that visual activity and visual fields, bilaterally, are normal. He asserts that his right and left nuclear cataracts "require" ongoing medical treatment to prevent "total loss" of the right eye and loss of vision in the left eye. He reiterates that the condition causes eye pain, hazy vision, contract, colored lines, floaters, dry eyes, excess liquid, sensitivity to light, difficulty driving
as a level of visual acuity) and combine them under the provisions of 38 C.F.R. § 4.25. 38 C.F.R. § 4.77(c).

Rating Analysis

In his November 2025 appeal brief the Veteran contends that the AOJ erred when it concluded that visual activity and visual fields, bilaterally, are normal. He asserts that his right and left nuclear cataracts "require" ongoing medical treatment to prevent "total loss" of the right eye and loss of vision in the left eye. He reiterates that the condition causes eye pain, hazy vision, contract, colored lines, floaters, dry eyes, excess liquid, sensitivity to light, difficulty driving at night, difficulty driving in the rain and difficulty changing lanes.

Turning to the evidence, the record contains VA and private treatment records, which the Board has carefully reviewed. The Board notes that private treatment records show that the Veteran's right eye cataract was surgically removed in 2016. The medical records from Doctor C. S. at Fort Carson Army Hospital to 2021, and medical records from Doctor J. B. of Colorado from 2021 to the present confirm that the Veteran has seen an ophthalmologist for over 30 years with three to seven visits each year for treatment purposes, including treatment for glaucoma and right eye surgery for vitreous hemorrhage and retinal tear in 2016. However, while the VA and private treatment records during the period on appeal consistently reference the Veteran's right eye pseudophakia and left eye nuclear cataract, they do not reflect any specific treatment for either disability.

The record contains VA examination reports dated May 2023, March 2024, December 2024 and July 2025, as well as a March 2024 VA examination completed by private ophthalmologist J.B., M.D. Each of these reports reflect that the Veteran has right eye pseudophakia postoperative cataract removal and left eye nuclear cataract; the Veteran's decrease in visual acuity or other visual impairment is not attributable to his right eye pseudophakia and left eye nuclear cataract; and during the past 12 months, the Veteran had not had any incapacitating episodes attributable to an eye condition. The May 2023 VA examination report notes that the Veteran's left eye nuclear cataract previously affected his vision but observes that there was "no vision issue from it currently." The report specifically states that it was the Veteran's glaucoma that was causing his decrease in visual field and visual acuity, bilaterally. See May 2023 VA Eye Conditions Disability Benefits Questionnaire at 10-11.

The Board recognizes that the December 2024 and July 2025 VA reports do not explicitly address the May 2023 notation that the Veteran's nuclear cataract was affecting his vision, as requested by the Board's August 2024 remand. Nevertheless, the December 2024 and July 2025 reports implicitly address the May 2023 notation in stating that the Veteran's decrease in visual acuity or other visual impairment was not attributable to his right eye pseudophakia and left eye nuclear cataract. In addition, the May 2023 notation itself states that there were currently no vision issues from the Veteran's left eye nuclear cataract and it was his glaucoma that was causing his decrease in visual field and visual acuity, bilaterally, which is consistent with his private treatment records.

On review and resolving any reasonable doubt in favor of the Veteran, the Board finds that the foregoing evidence supports an initial 30 percent disability rating for the Veteran's left eye nuclear cataract for the entire appeal period under DC 6029, as this is the minimum rating for aphakia or dislocation of crystalline lens. 38 C.F.R. § 4.79, DC 6029. However, an initial rating higher than 30 percent for left eye nuclear cataract is not warranted as the evidence does not reflect incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition over a 12 month period. Id. Indeed, the Veteran consistently denied such episodes as reflected in the May 2023, March 2024, December 2024 and July 2025 VA examination reports, as well as the March 2024 VA examination completed by private ophthalmologist J.B., M.D., as, as discussed above, incapacitating episodes are not reflected in the VA or private treatment records during the period on appeal.

Additionally, the evidence persuasively weighs against finding that the Veteran's right eye pseudophakia warrants a compensable initial rating at any point during the appeal period. Specifically, the VA and private examination
requiring at least 5 but less than 7 treatment visits for an eye condition over a 12 month period. Id. Indeed, the Veteran consistently denied such episodes as reflected in the May 2023, March 2024, December 2024 and July 2025 VA examination reports, as well as the March 2024 VA examination completed by private ophthalmologist J.B., M.D., as, as discussed above, incapacitating episodes are not reflected in the VA or private treatment records during the period on appeal.

Additionally, the evidence persuasively weighs against finding that the Veteran's right eye pseudophakia warrants a compensable initial rating at any point during the appeal period. Specifically, the VA and private examination reports state that the Veteran's decrease in visual acuity or other visual impairment is not attributable to his right eye pseudophakia and had not had any incapacitating episodes attributable to either eye. Thus, an initial compensable rating for right eye pseudophakia post nuclear cataract is not warranted under DCs 6027 and 6029, respectively. 38 C.F.R. § 4.79, DCs 6027, 6029.

The Board acknowledges the Veteran's assertions that his service-connected right and left eye disabilities warrant a 20 percent rating. He has described eye pain, hazy vision, contract, colored lines, floaters, dry eyes, excess liquid, sensitivity to light, difficulty driving at night, difficulty driving in the rain and difficulty changing lanes as symptoms of his service-connected eye disabilities. While the Veteran is competent to report observable symptoms, Jandreau, supra, he has not been shown to have such specialized medical training or knowledge to identify a specific level of a vision disability according to the applicable DCs. Competent objective evidence concerning the nature and extent of his eye disabilities is provided by the VA and private examination reports, which reflect medical findings that address the criteria under which his disabilities are evaluated. Therefore, the Veteran's description of his service-connected disabilities must be considered in conjunction with the clinical evidence of record as well as the pertinent rating criteria. Here, the Board assigns greater probative weight to the clinical findings than to the Veteran's lay statements regarding the severity of his service-connected eye disabilities.

Regarding the Veteran's service-connected right eye pseudophakia post nuclear cataract removal, the Board can identify no duty to assist error in the AOJ's March 2025 adjudication of this claim as the evidence of record at the time of the March 2025 rating decision does not demonstrate that the Veteran's service-connected right eye disability results in visual impairment. Thus, an initial compensable rating for right eye pseudophakia post nuclear cataract removal is not warranted under DCs 6027 and 6029, respectively. 38 C.F.R. § 4.79, DCs 6027, 6029.

In sum, with application of the benefit of the doubt rule, an initial 30 percent disability rating, but not higher, for the service-connected left nuclear cataract is warranted, and to this extent the appeal is granted. However, the evidence is persuasively against a finding that an initial compensable disability rating for the service-connected right eye pseudophakia post nuclear cataract removal is warranted; therefore, the benefit of the doubt rule is not for application and an initial compensable rating therefor must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7, 4.79, DCs 6027, 6029.

REASONS FOR REMAND

Remand by the Board in the AMA is proper for correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors) and (2)?AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38?C.F.R. §?20.802(a).

When VA undertakes to provide an examination or obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Furthermore, a VA examiner must address the veteran's lay statements to provide the Board with an adequate medical opinion. Miller v. Wilkie, 32 Vet. App. 249, 260 (2020).

Bilateral Open Angle Glaucoma; Loss of Vision Right Eye/Retinal Detachment

Although the Board's February 2025 remand requested a VA medical opinion as to whether the Veteran's bilateral open angle glaucoma and/or right
.R. §?20.802(a).

Bilateral Open Angle Glaucoma; Loss of Vision Right Eye/Retinal Detachment

Although the Board's February 2025 remand requested a VA medical opinion as to whether the Veteran's bilateral open angle glaucoma and/or right eye vision loss with retinal detachment are related to his military service, to include consideration of the Veteran's statements that vision loss in his right eye is secondary to his service-connected glaucoma, and that his vision problems were evident during his 1969 to 1972 period of active duty, as well as his 1978 to 2000 Navy Reserve duty, the unfavorable April 2025 VA opinions fail to address these statements. Miller, 32 Vet. App. at 260.

Failing to obtain an adequate examination or opinion and relying on an inadequate examination or opinion is a pre-decisional duty to assist error, which must be corrected on remand. 38 C.F.R. § 20.802(a); Barr, 21 Vet. App. at.

Bilateral Hearing Loss

The Board's February 2025 remand requested a VA medical opinion as to whether the Veteran's currently diagnosed bilateral hearing loss is related to service, to include the Veteran's reports of being on the flight deck during service. In doing so, the Board emphasized that the VA examiner: "CANNOT rely on the fact that the Veteran did not experience a threshold shift in his hearing loss during service. The absence of documented hearing loss while in service is NOT fatal to a claim for service connection. Additionally, a threshold shift in hearing is NOT necessary for entitlement to service connection for hearing loss." However, the unfavorable February 2025 VA opinion obtained by the AOJ notes, in part, that the Veteran's July 1972 separation examination reflects normal hearing results at all frequencies with no decrease in high-frequency thresholds compared to earlier examinations, which relies on the absence of a threshold shift in hearing during service. See Reonal, 5 Vet. App. at 461 (a medical opinion based upon an inaccurate factual premise has no probative value). Furthermore, the secondary service connection opinions merely state that the Veteran's lay statements were reviewed and "there is no medical evidence to support hearing loss" was caused or aggravated "due to mixed anxiety and depressed mood and tinnitus." These opinions state the obvious and provide no meaningful rationale. See Nieves-Rodriguez, 22 Vet. App. at 302-04 (a central issue in determining the probative value of a medical opinion is whether the examiner provides the required explanation for conclusions).

Obstructive Sleep Apnea

An unfavorable December 2024 VA medical opinion as to direct service connection does not address the Veteran's October 2020 statement that he was told by Navy colleagues that he stopped breathing, gasped for air, and snored throughout the night while on board the U.S.S. Valley Forge in 1969, or statements reflected in the May 2023 VA sleep apnea examination that his bunk mates told him he snored and would stop breathing in his sleep and that he has experienced fatigue since in-service head injuries. Miller, supra. Additionally, the December 2024 TERA opinion references an Internet site as a basis for concluding that the Veteran's sleep apnea is not related to his in-service risk exposures with no explanation. See Nieves-Rodriguez, 22 Vet. App. at 302-04 (noting that a central issue in determining the probative value of a medical opinion is whether the examiner provides the required explanation for conclusions). Furthermore, while the December 2024 addendum opinion that concludes that the Veteran's sleep apnea is less likely than not secondary to his service-connected tinnitus appears to be adequate, this opinion, as well as the May 2023 VA opinion, together with evidence of record indicating the Veteran's limited mobility due to service-connected disabilities raises the question of obesity as an intermediate step. VA's Office of General Counsel issued an opinion which, in part, states that obesity may serve as an "intermediate step" between
-Rodriguez, 22 Vet. App. at 302-04 (noting that a central issue in determining the probative value of a medical opinion is whether the examiner provides the required explanation for conclusions). Furthermore, while the December 2024 addendum opinion that concludes that the Veteran's sleep apnea is less likely than not secondary to his service-connected tinnitus appears to be adequate, this opinion, as well as the May 2023 VA opinion, together with evidence of record indicating the Veteran's limited mobility due to service-connected disabilities raises the question of obesity as an intermediate step. VA's Office of General Counsel issued an opinion which, in part, states that obesity may serve as an "intermediate step" between a service-connected disability and a current disability, see VAOPGCPREC 1-2017.

The AOJ's failure to obtain a VA opinion addressing obesity as an intermediate step regarding sleep apnea is a pre-decisional duty to assist error. 38 C.F.R. § 20.802. Accordingly, remand is required for appropriate corrective action.

The matters are REMANDED for the following action:

1. Obtain addendum opinions to help determine the likely etiology of the currently diagnosed bilateral open angle glaucoma and loss of vision in right eye, retinal detachment. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials.

After complete review of the evidence, the examiner is asked to respond to the following:

(a) Provide opinions as to whether the Veteran's bilateral open angle glaucoma and right eye vision loss with retinal detachment had their onset during service, onset within one year following separation from service, or are otherwise etiologically related to service.

" In forming the opinions, the examiner must address the Veteran's lay statements that his vision problems were evident during his 1969 to 1972 period of active duty, as well as his 1978 to 2000 Navy Reserve duty.

The standard of review to be applied is "as likely as not" (meaning that the likelihood is at least approximately balanced or nearly equal, if not higher).

A full and thorough rationale must be provided for all opinions, referencing relevant medical and lay evidence where appropriate.

2. Obtain an addendum opinion to help determine the likely etiology of the currently diagnosed bilateral hearing loss. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials.

After review of the evidence, the examiner is asked to respond to the following:

(a) Provide an opinion as to whether the Veteran's current bilateral hearing loss had its onset during service, onset within one year following separation from service, or is otherwise etiologically related to service, to include the Veteran's reports of being on the flight deck.

" In forming the opinion, the examiner CANNOT rely on the fact that the Veteran did not experience a threshold shift in his hearing loss during service, the absence of documented hearing loss while in service is NOT fatal to a claim for service connection, and a threshold shift in hearing is NOT necessary for entitlement to service connection for hearing loss.

(b) Provide opinions as to:

(i) whether the Veteran's bilateral hearing loss was as likely as not caused by his service-connected adjustment disorder with mixed anxiety and depressed mood and/or his service-connected tinnitus; and

(ii) whether the Veteran's bilateral hearing loss is as likely as not aggravated (any incremental increase in disability regardless of permanence) by his service-connected adjustment disorder with mixed anxiety and depressed mood and/or his service-connected tinnitus.

*The examiner must consider any causal link between the Veteran's bilateral hearing loss and his service-connected adjustment disorder with mixed anxiety and depressed mood and/or his service-connected tinnitus.

The standard of review to be applied is "as likely as not" (meaning that the likelihood is at least approximately balanced or nearly equal, if not higher).

A full and thorough rationale must be provided for all opinions, referencing relevant medical and lay evidence where appropriate.

3. Obtain an addendum opinion to help determine the likely etiology of the currently diagnosed obstructive sleep apnea. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials.

After review of the evidence, the examiner is asked to respond to the following:

(a) Provide an opinion as to whether the Veteran's obstructive sleep apnea had its onset during service or is otherwise etiologically related to service.

In forming the opinion, the examiner must address the Veteran's October 2020 statement that he experienced grasping for air, stopped breathing and snoring while on board the U.S.S. VALLEY FORGE (LPH8) in 1969, and the May 2023 VA examination report
etiology of the currently diagnosed obstructive sleep apnea. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials.

After review of the evidence, the examiner is asked to respond to the following:

(a) Provide an opinion as to whether the Veteran's obstructive sleep apnea had its onset during service or is otherwise etiologically related to service.

In forming the opinion, the examiner must address the Veteran's October 2020 statement that he experienced grasping for air, stopped breathing and snoring while on board the U.S.S. VALLEY FORGE (LPH8) in 1969, and the May 2023 VA examination report reflecting that he states that he had two head injuries during service and has been fatigued throughout the days for many years since then, and states that his bunk mates have told him that he snored and would stop breathing in his sleep when he was on the ships during service.

In forming the opinion, the examiner must consider the Veteran's toxic exposure risk activity(s) (TERA):

" Total potential exposure through all applicable military deployments; and,

" Synergistic, combined effect of all toxic exposure risk activities.

The standard of review to be applied is "as likely as not" (meaning that the likelihood is at least approximately balanced or nearly equal, if not higher).

(b) Obesity as Intermediate Step - PTSD

(i) Determine whether the Veteran's obstructive sleep apnea was caused or aggravated by a service-connected disability(s) and/or medications taken for treatment of a service-connected disability(s).

(ii) If yes, was obesity a substantial factor in causing the Veteran's obstructive sleep apnea?

(iii) Would the obstructive sleep apnea not have occurred but for obesity caused or aggravated by a service-connected disability(s) and/or medications taken for treatment of service-connected disability(s); and

(iv) Does the obesity aggravate (i.e., make worse to any degree without consideration of what might be the natural progress of the disease) the Veteran's obstructive sleep apnea?

The examiner must consider any causal link between the Veteran's obstructive sleep apnea and the service-connected disability(s), to include via obesity.

The standard of review to be applied is "as likely as not" (meaning that the likelihood is at least approximately balanced or nearly equal, if not higher).

A full and thorough rationale must be provided for all opinions, referencing relevant medical and lay evidence where appropriate.

S. B. MAYS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. Farrell, Counsel

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

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