TESTICLE ATROPHY OR INJURY OF

Summary

The veteran, who served from February 2007 to June 2012, including Reserve service, appeals the denial of service connection for a left eye condition. The Board granted service connection for a testicular injury and a traumatic brain injury (TBI). Regarding the testicular injury, the Board found the prior VA examination inadequate because it failed to consider the veteran's consistent reports of an in-service injury from a 2008 bomb explosion and subsequent persistent pain, despite the examiner's opinion that it was less likely than not service-related due to a lack of in-service treatment. The Board found the veteran's statements credible and related the condition to service. For the TBI, the Board granted service connection, finding the veteran's account of losing consciousness after a 2008 bomb explosion and subsequent cognitive difficulties credible and supported by a VA examiner's opinion that it was at least as likely as not related to service. The claim for a left eye condition was remanded because the RO denied it based on astigmatism being congenital, but the Board noted that aggravation in service or superimposed injury could warrant service connection. The veteran reported vision changes after the 2008 explosion, including squinting and glare, and was told he had astigmatism. VA treatment notes showed complaints about the left eye, including microaneurysms, but no confirmed astigmatism diagnosis. The Board found the failure to provide a VA eye examination and nexus opinion for the left eye condition to be a duty-to-assist error.

Rationale

In-service injury reported from bomb explosion; Persistent pain and diagnosis of epididymal head cyst; Inadequate VA exam due to failure to consider veteran's reports

Full Decision Text

Citation Nr: A26038393
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 210910-185327
DATE: April 23, 2026

ORDER

Entitlement to service connection for a testicular injury is granted.

Entitlement to service for a traumatic brain injury is granted.

REMANDED

Entitlement to service connection for a left eye condition is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his testicular injury is at least as likely as not related to his active service.

2. Resolving reasonable doubt in the Veteran's favor, his traumatic brain injury is at least as likely as not related to his active service.

CONCLUSIONS OF LAW

1. The criteria for service connection for a testicular injury are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a traumatic brain injury are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 2007 to June 2012, with additional service in the Reserve.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 2025.

Therefore, the Board may only consider the evidence of record at the time of the May 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

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

However, because the Board is remanding the claim of entitlement to service connection for a left eye condition, 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).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  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. 2004).

VA is responsible for determining whether the evidence supports the claim, with the veteran prevailing, or whether the evidence weighs persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b).

1. Entitlement to service connection for a testicular injury is granted.

The Veteran asserts that he is entitled to service connection for a testicular injury. 

The Board notes at the outset that in the May 2021 rating decision currently on appeal, the RO
 veteran prevailing, or whether the evidence weighs persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b).

1. Entitlement to service connection for a testicular injury is granted.

The Veteran asserts that he is entitled to service connection for a testicular injury. 

The Board notes at the outset that in the May 2021 rating decision currently on appeal, the RO found that the evidence of record shows the Veteran has been diagnosed with epididymitis. The Board is bound by this favorable finding. See 38 C.F.R. § 3.104 (c).

Resolving doubt in favor of the Veteran, the Board finds that the evidence establishes that the Veteran's testicular injury is related to service.

During the June 2025 Board hearing, the Veteran explained that he believed that his testicular injury occurred in 2008 during service when he was caught in a blast wave from several bomb explosions that threw him to the ground. He stated he sustained soft tissue damage due to the explosion, noting that for years afterwards he dealt with testicular pain. The Veteran further explained that his VA physicians could not determine the cause of the pain, and he eventually agreed to have a denervation of the testicle to eliminate the pain. 

A review of VA treatment records revealed that the Veteran complained of left scrotal pain in July 2018. He returned for treatment in December 2020 due to painful ejaculation. At that time, the Veteran reported sustaining testicular trauma during an explosion in 2008 while in service. He described having testicular discomfort and occasional sharp pains. A CT scan and ultrasound revealed an epididymal head cyst. In April 2021, the Veteran was seen again due to chronic left orchalgia (chronic testicular pain) and perineal pain. In June 2021 he underwent surgery for denervation of the left testicle. 

The Veteran was afforded a VA male reproductive system conditions examination in April 2021. He reported that in 2008, he sustained a testicular injury during a bomb explosion. The Veteran also stated he was injured again in 2008 when he landed on his left groin after being knocked around in the gun turret when his vehicle struck a large hole int eh road. The VA examiner noted that the Veteran has a diagnosis of chronic epididymitis but opined that it was less likely than not that the claimed testicular injury was incurred in or caused by service. As rationale in support of the claim, the VA examiner stated that the Veteran's service treatment records did not reveal symptoms, findings, or diagnosis of a testicular injury. The VA examiner further stated that the Veteran was not diagnosed with epididymitis until about five years after military service. 

When VA undertakes to obtain an examination or opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical examination or opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Board finds the VA medical opinion is inadequate, as it improperly relies on a lack of in-service treatment and/or diagnosis, and gives no consideration to the Veteran's reports of his in-service injury and persistent pain. See Dalton v. Nicholson, 21 Vet. App. 23 (2007).

The Board finds the Veteran's statements and medical records are credible in showing that his testicular condition is related to service. The Veteran is competent to report his testicular injury and symptoms that began in service and the Board finds the Veteran's statements credible. See 38 C.F.R. § 3.159 (a)(2); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board finds that the lay evidence is competent and credible. The Veteran has consistently and repeatedly reported over many years his belief that he sustained a testicular injury due to an in-service bomb explosion. 

Thus, service connection is warranted for a testicular injury, which occurred in service, resulted in a current diagnosis of epididymitis, and has caused persistent pain since service separation. 

2. Entitlement to service for a traumatic brain injury is granted.

The Veteran asserts that he is entitled to service connection for
 the Board finds the Veteran's statements credible. See 38 C.F.R. § 3.159 (a)(2); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board finds that the lay evidence is competent and credible. The Veteran has consistently and repeatedly reported over many years his belief that he sustained a testicular injury due to an in-service bomb explosion. 

Thus, service connection is warranted for a testicular injury, which occurred in service, resulted in a current diagnosis of epididymitis, and has caused persistent pain since service separation. 

2. Entitlement to service for a traumatic brain injury is granted.

The Veteran asserts that he is entitled to service connection for residuals of a traumatic brain injury (TBI).  

The Board notes that in the May 2021 rating decision currently on appeal, the RO found that the evidence of record shows the Veteran has been diagnosed with a TBI. The Board is bound by this favorable finding. See 38 C.F.R. § 3.104 (c).

Resolving doubt in favor of the Veteran, the Board finds that the evidence establishes that the Veteran's TBI is related to service.

As noted above, the Veteran explained at the Board hearing that he believed that his TBI occurred during service when he was caught in a blast wave from several bomb explosions that threw him to the ground. He stated he did not recall exactly what happened after the explosion, as he lost consciousness. Shortly after this incident, he noticed he began to have uncharacteristic memory lapses and training mistakes, which resulted in him being reprimanded. The Veteran stated that after service separation he continued to have difficulties with his memory, processing information, and concentrating.

Service treatment records show that in May 2009, the Veteran was given a brain MRI due to complaints of headaches, neck pain, photophobia, and visual defect. The results of the MRI showed no focal abnormality identified in the brain. 

After service separation, the Veteran sought treatment at a VA medical facility in August 2018. The Veteran reported that he was knocked down during a multiple bomb explosion during service, and he recalled being slow and dazed when he was able to get up. The VA physician noted that the Veteran sustained a mild TBI while in service.

The Veteran was afforded a VA TBI examination in November 2021. He recalled being injured due to a blast wave from several detonated bombs in close proximity while deployed during service. The Veteran stated he lost consciousness and when he regained consciousness, he was informed that there were multiple casualties due to the explosion. He indicated he did not seek medical attention at the time and resumed his mission the next day. Since then, the Veteran stated he has had problems with his memory and thought processes. The VA examiner opined that it is at least as likely as not that the Veteran sustained a mild TBI during his active service. In support of the opinion, the VA examiner stated that the TBI was manifested by brief loss of consciousness due to a blast wave from bombs that detonated in close proximity to the Veteran's base. 

The Board finds the Veteran's statements and medical records are credible in showing that his TBI is related to service. The Veteran is competent to report when his TBI occurred and the symptoms that have persisted since service separation, and the Board finds the Veteran's statements credible. See 38 C.F.R. § 3.159 (a)(2); Layno, 6 Vet. App. at 470 (1994). The Board finds that the lay evidence is competent and credible. The Veteran has consistently and repeatedly reported over many years his belief that he sustained a TBI due to an in-service bomb explosion. Further, the November 2021 VA examiner opined that the Veteran's TBI is due to the in-service bomb explosion. 

Accordingly, service connection for a TBI is warranted. 

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), the Board must remand a claim to correct an error by the RO to satisfy its duty to assist the Veteran under 38 U.S.C. § 5103A if the error occurred prior to the RO decision on appeal. 38 U.S.C. § 5103A (f)(2)(A); 38 C.F.R. § 20.802 (a). The Board may also remand a claim to correct any other RO error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802 (a).

1. Entitlement to service connection for a left eye condition is remanded.

The Veteran asserts that he is entitled to service connection for a left eye condition. 

The Board notes that the issue was originally characterized as entitlement to
 § 5103A if the error occurred prior to the RO decision on appeal. 38 U.S.C. § 5103A (f)(2)(A); 38 C.F.R. § 20.802 (a). The Board may also remand a claim to correct any other RO error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802 (a).

1. Entitlement to service connection for a left eye condition is remanded.

The Veteran asserts that he is entitled to service connection for a left eye condition. 

The Board notes that the issue was originally characterized as entitlement to service connection for a left eye astigmatism, but the issue has now been broadened to include any left eye condition. See Clemons v. Shinseki, 23 Vet. App. 1, 9 (2009).

During the Board hearing, the Veteran recalled that he did not have any vision problems at service entrance, but his vision changed after the 2008 explosion. He stated he began to squint and to see a glare. The Veteran indicated that he was told he has astigmatism.

In the May 2021 rating decision on appeal, the RO denied the Veteran's claim, determining that astigmatism is considered a congenital or developmental defect, which is unrelated to military service and not subjected to service connection. See 38 C.F.R. §§ 3.303, 4.9.  However, congenital diseases may be recognized as service-connected if the evidence reveals aggravation in service within the meaning of VA regulations. 38 C.F.R. § 3.306. Moreover, although congenital or developmental defects are not service connectable, service connection may be granted for additional disability due to disease or injury superimposed upon a defect during service. VAOPGCPREC 82-90.

VA optometry treatment notes show the Veteran was seen in April 2021 with complaints regarding the left eye. During that visit, he informed the VA optometrist that he was told in service that he has astigmatism, but notably the VA optometrist did not confirm such a diagnosis. Instead, the VA optometrist assessed the Veteran as having "MA OU" - microaneurysms of both eyes - and discussed with the Veteran his new glasses prescription and that he should present to the clinic when he experiences monocular nystagmus.

To date, the Veteran has not been afforded a VA examination to identify current left eye diagnoses, nor has a medical nexus opinion been obtained to determine if any such left eye condition is related to service. In addition to the VA treatment notes showing the Veteran was seen for left eye concerns, the service treatment records detailing the Veteran's complaints that lead to him being given an MRI indicate he also complained of a visual defect. The Board finds that based on the evidence of record available prior to the issuance of the May 2021 rating decision, the Veteran should have been afforded a VA eye examination, and the failure to afford such an examination to the Veteran constitutes a duty to assist error warranting remand. 

The matter is REMANDED for the following action:

1. Schedule the Veteran for a VA examination for his left eye.  The examiner must review the claims file.

The examiner is asked to provide a response to the following:

(a.) Identify each left eye diagnosis.

(b.) If the Veteran is diagnosed with astigmatism, the examiner must determine if the disorder is the result of a congenital or developmental process, or another cause.

Then, state whether it is at least likely as not that the Veteran incurred any superimposed disease or injury on such defect during service that resulted in additional disability? If so, please describe the resultant disability.

(c.) For all other left eye diagnoses, state whether it is at least as likely as not related to service, including a 2008 in-service explosion.

(d.) For all other left eye diagnoses, state whether it is at least as likely as not due to a service-connected disability.

(e.) For all other left eye diagnoses, state whether it is at least as likely as not aggravated, i.e., made worse, by service-connected disability.

Provide a rationale to support the opinions.  

  

 

 

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Miller, 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.