HEMORRHOIDS EXTERNAL OR INTERNAL

Summary

The veteran, who served from October 1962 to October 1966, appeals the denial of service connection for several conditions and seeks to reopen claims based on new and relevant evidence. The Board granted service connection for residuals of thyroidectomy, hemorrhoids (including anal itching), and a repaired abdominal hernia, applying the benefit of the doubt to these claims. The decision noted that the Veteran had a history of hemorrhoids in service and underwent surgery, but physical evaluations during the appeal period did not consistently find active hemorrhoids, though anal itching was diagnosed. For the abdominal hernia, the Board found a link to service, citing medical literature on weightlifting and intra-abdominal pressure. However, the Board remanded claims for bilateral hearing loss, lumbar spine disorder, right eye disorder (including partial blindness and toxoplasmosis), and hiatal hernia. The remand is necessary due to the need for further development, including obtaining SSA records, workers' compensation records, private treatment records for eye surgeries, and new VA medical opinions. The Board found that existing VA and private medical opinions were either insufficient, did not consider all relevant evidence, or contained inaccuracies. The remand instructions require VA to obtain these records and provide fully articulated medical opinions addressing nexus to service, TERA exposure, and aggravation by service-connected conditions where applicable.

Rationale

Grant of service connection based on benefit of the doubt; Developed during active service; Physical evaluations during appeal period did not find active hemorrhoids, but anal itching diagnosed

Full Decision Text

Citation Nr: A26038823
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250826-573353
DATE: April 27, 2026

ORDER

Entitlement to service connection for non-malignant thyroid nodular disease, status-post thyroidectomy (residuals of thyroidectomy), is granted.

New and relevant evidence has been received to reopen the claim for entitlement to service connection for bilateral hearing loss; the claim to reopen is granted.

New and relevant evidence has been received to reopen the claim for entitlement to service connection for hemorrhoids; the claim to reopen is granted.

New and relevant evidence has been received to reopen the claim for entitlement to service connection for hiatal hernia (also claimed as abdominal hernia); the claim to reopen is granted.

Entitlement to service connection for residuals of hemorrhoids status-post surgery, to include anal itching (claimed as hemorrhoids) is granted.

Entitlement to service connection for a repaired abdominal hernia is granted.

REMANDED

Entitlement to service connection for bilateral hearing loss is remanded.

Entitlement to service connection for a lumbar spine disorder, to include residuals of spine injury, is remanded.

Entitlement to service connection for a right eye disorder, to include claimed partial blindness of the right eye and toxoplasmosis, is remanded.

Entitlement to service connection for hiatal hernia is remanded.

FINDINGS OF FACT

1. Giving the Veteran the benefit of the doubt, his residuals of thyroidectomy are related to an in-service injury, event, or disease.

2.  New evidence was received after the June 2007 denial that is relevant to the issue of entitlement to service connection for bilateral hearing loss.  

3. New evidence was received after the October 2009 denial that is relevant to the issue of entitlement to service connection for hemorrhoids and hernia.  

4. Giving the Veteran the benefit of the doubt, the Veteran has residuals of hemorrhoids status-post surgery, to include anal itching (claimed as hemorrhoids) that began during active service, or is otherwise related to an in-service injury, event, or disease.

5.  Giving the Veteran the benefit of the doubt, the Veteran has a repaired abdominal hernia that began during active service, or is otherwise related to an in-service injury, event, or disease.

CONCLUSIONS OF LAW

1. Giving the Veteran the benefit of the doubt, the criteria for service connection for residuals of thyroidectomy are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 

2. The criteria for readjudicating the claim for service connection for bilateral hearing loss based on new and relevant evidence have been met.  38 U.S.C. § 5108; 38 C.F.R. § 3.156.

3. The criteria for readjudicating the claim for service connection for hemorrhoids and hernia based on new and relevant evidence have been met.  38 U.S.C. § 5108; 38 C.F.R. § 3.156.

4.  Giving the Veteran the benefit of the doubt, the criteria for service connection for residuals of hemorrhoids status-post surgery, to include anal itching (claimed as hemorrhoids) are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 

5. Giving the Veteran the benefit of the doubt, the criteria for service connection for repaired abdominal hernia 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 had active duty from October 1962 to October 1966.

For the residuals of thyroidectomy issue, in July 2023, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the residuals of thyroidectomy most recently addressed in an October 2009 rating decision.  On June 11, 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

For the claim for partial blindness of the right eye, following a July 2023 supplemental claim, the AOJ issued
 a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the residuals of thyroidectomy most recently addressed in an October 2009 rating decision.  On June 11, 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

For the claim for partial blindness of the right eye, following a July 2023 supplemental claim, the AOJ issued a December 2024 supplemental claim decision finding that new and relevant evidence had been received and denying the claim based on the evidence of record at the time of that decision.  Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

For the claim residuals of spinal injury, following an April 2025 claim, the AOJ issued a June 2025 supplemental claim decision, which found that new and relevant evidence had been received.  Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

For the claims for service connection for bilateral hearing loss, hemorrhoids, and hernia, in August 2025, the AOJ issued a supplemental claim decision (following an April 2025 claim), which found that new and relevant evidence had not been received.  Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement or NOD), the Veteran elected the Hearing docket.  A Board hearing was held in January 2026.  

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

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim[s], 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 claims remanded below, 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 Board notes that although it is remanding for Social Security Administration (SSA) records, the Veteran is not prejudiced by the failure to obtain such records for the claims decided herein as such claims are being granted.

1. Entitlement to service connection for residuals of thyroidectomy is granted.

The Veteran asserts that he had a thyroid disorder due to TERA exposure, specifically gamma radiation exposure in service.  Per the June 2025 rating decision, the Veteran had a diagnosis of non-malignant thyroid nodular disease, status-post thyroidectomy.  Also, the condition was one that may be related to radiation exposure when radiation exposure is confirmed.  

The Board concludes that the Veteran has a current disability that is related to in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Service treatment records include a record of exposure to ionizing radiation, of the gamma type, in January 1964 and November 1964.

The June 2025 rating decision has already conceded a current diagnosis, which the Board has characterized as residuals of thyroidectomy.  Thus, the question becomes whether the current disability is related to service. 


 Board concludes that the Veteran has a current disability that is related to in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Service treatment records include a record of exposure to ionizing radiation, of the gamma type, in January 1964 and November 1964.

The June 2025 rating decision has already conceded a current diagnosis, which the Board has characterized as residuals of thyroidectomy.  Thus, the question becomes whether the current disability is related to service. 

A September 2024 VA examiner opined that there was objective evidence of a diagnosis of non-malignant thyroid nodular disease, status-post thyroidectomy in 2008, 42 years after service.  He opined that thyroid nodules of all types and sizes, including small ones only detected by screening methods, are increased by radiation exposure.  The thyroid is among the most radiation-sensitive tissues in the body.  After low-dose exposure, there is a linear dose-response curve with essentially no evidence of a threshold.  There is medical or scientific evidence available that notes a relationship between the development of the non-malignant thyroid nodular disease, status-post thyroidectomy condition(s) at issue and the Veteran's TERA [including ionizing radiation, cleaning solvents, and paints (to likely include lead based paint)].  He opined that the Veteran's non-malignant thyroid nodular disease, status-post thyroidectomy condition was at least as likely as not caused by the indicated TERA after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran.  Nexus has established.

A January 2026 private medical opinion of R.P., D.O. similarly found that it was at least as likely as not that the Veteran's non-malignant thyroid nodular disease, status post thyroidectomy, was caused or permanently aggravated by his in service radiation exposure and toxic exposure to lead -based paints.

Upon review of the record, the Board finds the evidence is at least evenly balanced as to whether the Veteran's current residuals of thyroidectomy are related to service.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for residuals of thyroidectomy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. New and relevant evidence has been received to reopen the claim for entitlement to service connection for bilateral hearing loss; the claim to reopen is granted.

3. New and relevant evidence has been received to reopen the claim for entitlement to service connection for hemorrhoids; the claim to reopen is granted.

4. New and relevant evidence has been received to reopen the claim for entitlement to service connection for hernia; the claim to reopen is granted.

The Veteran is seeking to readjudicate the claim for entitlement to service connection for bilateral hearing loss, hemorrhoids, and hiatal hernia/hernia.  

VA will readjudicate a claim under the AMA framework if new and relevant evidence is presented or secured.  38 C.F.R. § 3.156(d).  "Relevant evidence" is evidence that tends to prove or disprove a matter in issue and includes evidence that raises a theory of entitlement that was not previously addressed.  38 C.F.R. § 3.2501(a)(1).

Thus, the initial questions for the Board are whether new evidence was added to the claims file after the prior final June 2007 denial for bilateral hearing loss and October 2009 denial for hemorrhoids and hiatal hernia/hernia, respectively, and, if so, whether that evidence is relevant the respective claim.

For each of the claims, new evidence added to the record since the prior final decisions includes a January 2026 private medical opinion by R.P., D.O.  The Board finds this new and relevant evidence after the prior final rating decision in the AMA system, evidence that was not already of record and may prove or disprove the nexus element of the claims for service connection for the claim.  Readjudication of each claim is thus warranted and will be addressed below.  38 U.S.C. § 5108; 38 C.F.R. § 3.156(d).

5. Entitlement to service connection for residuals of hemorrhoids status-post surgery, to include anal itching (claimed as hemorrhoids) is granted.

The Veteran contends that he has hemorrhoids due to service.  During his January 2026 Board hearing, he reported that he has had hemorrhoids since service.  At that time the Veterans Law Judge informed the Veteran
 the prior final rating decision in the AMA system, evidence that was not already of record and may prove or disprove the nexus element of the claims for service connection for the claim.  Readjudication of each claim is thus warranted and will be addressed below.  38 U.S.C. § 5108; 38 C.F.R. § 3.156(d).

5. Entitlement to service connection for residuals of hemorrhoids status-post surgery, to include anal itching (claimed as hemorrhoids) is granted.

The Veteran contends that he has hemorrhoids due to service.  During his January 2026 Board hearing, he reported that he has had hemorrhoids since service.  At that time the Veterans Law Judge informed the Veteran that part of the reason his claim had been denied was because he did not have a diagnosis of hemorrhoids on the VA examination and asked him if he was experiencing hemorrhoids during the appeal period and if it just was not present on the VA examination and he had noticed it himself.  The Veteran responded, "I guess that's correct."  

The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

The September 1966 separation report of medical history noted that the Veteran had hemorrhoids with an onset of 1963.  The hemorrhoids were not treated and were asymptomatic at that time, with no sequelae.

A post-active duty, August 1984 Reserve enlistment evaluation also noted that the Veteran had asymptomatic hemorrhoids.

A February 2007 VA medical record indicated that the Veteran had prolapsed hemorrhoids, with an onset of 4 days.  A June 2007 VA medical record subsequently indicated that the Veteran had undergone hemorrhoid surgery.  The Veteran reported that he was good and had an itchy rectum that he believed was related to hemorrhoids for which he had recently had surgery; he was unsure that all of them had been gotten but had not noticed any blood.

In June 2025, the Veteran underwent a VA examination for hemorrhoids.  On physical evaluation of the Veteran, the examiner did not find any hemorrhoids.  The examiner diagnosed the Veteran with pruritus ani (anal itching).

During the VA examination, the Veteran reported that he had hemorrhoids in the 1960s, and he had them removed around 2006 and that he no longer has hemorrhoids but gets occasional anal discomfort and itchiness whenever he does not take regular baths and hygiene.  

The June 2025 VA examiner is the only evaluator of record during the appeal period to have physically examined the Veteran and the VA examiner specifically found that the Veteran did not have hemorrhoids but did diagnose him with anal itching.  

The January 2026 private medical opinion of R.P., D.O. did not include a physical examination of the Veteran.  R.P. diagnosed chronic hemorrhoids, including inflamed and prolapsed hemorrhoids, but did not include a physical evaluation.  He cited to February 2007 VA diagnoses of prolapsed and inflamed hemorrhoids, noted the surgical treatment and highlighted a November 2009 VA indication of hemorrhoids and itchy rectum, and listed a September 2023 VA notation of hemorrhoids.

The Board notes, however, that the VA medical records cited by the January 2026 private medical opinion of R.P., D.O., after the Veteran's initial hemorrhoids surgery in 2007, do not indicate any actual physical evaluation of the Veteran for hemorrhoids.  In contrast, a July 2008 VA surgery consult, specifically found that although the Veteran had a pre-operative diagnosis of hemorrhoids, post anoscopy there were "no hemorrhoids seen."  Operative findings were no hemorrhoids, fissures, or fistula.

Similarly, the June 2025 VA examiner on physical evaluation of the Veteran did not find hemorrhoids and only diagnosed the Veteran with ani puritis (anal itching). 

The Board also notes that other VA medical records similarly indicate that the Veteran was physically evaluated for hemorrhoids but did note the Veteran's reports of hemorrhoids.  A March 2024 VA medical record indicated that the Veteran reported that his hemorrhoids were still there but not complaining.

Additionally, during his January 2026 Board hearing, the Veteran never clearly indicated that he had hemorrhoids during the appeal period.  When specifically asked if he had experienced hemorrhoids during the appeal period, his response was "I guess that's correct."  

The Board finds that the medical findings by the medical professionals who physically evaluated whether the Veteran has hemorrhoids to be more probative than the findings, such as those
 Veteran with ani puritis (anal itching). 

The Board also notes that other VA medical records similarly indicate that the Veteran was physically evaluated for hemorrhoids but did note the Veteran's reports of hemorrhoids.  A March 2024 VA medical record indicated that the Veteran reported that his hemorrhoids were still there but not complaining.

Additionally, during his January 2026 Board hearing, the Veteran never clearly indicated that he had hemorrhoids during the appeal period.  When specifically asked if he had experienced hemorrhoids during the appeal period, his response was "I guess that's correct."  

The Board finds that the medical findings by the medical professionals who physically evaluated whether the Veteran has hemorrhoids to be more probative than the findings, such as those by R.P. and in VA medical records, based solely on the Veteran's reported history.  The Board does not dispute that the Veteran had hemorrhoids in service or after service but is merely finding that during the appeal period the most probative evidence as to the actual presence of hemorrhoids would have been based on the physical evaluation made by the June 2025 VA examiner.

The Board finds that that the Veteran developed asymptomatic hemorrhoids in service, subsequently underwent surgery to treat the hemorrhoids, and that the physical evaluations of the Veteran following his hemorrhoids surgery did not find hemorrhoids.  During the appeal period, the June 2025 VA examiner physically evaluated the Veteran for hemorrhoids and did not find them but did diagnose the Veteran with anal itchiness.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for residuals of hemorrhoids status-post surgery, to include anal itching, is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

6. Entitlement to service connection for a repaired abdominal hernia is granted.

The Board notes that the Veteran appears to have initially claimed service connection for hiatal hernia (which will be addressed in the REMAND portion of this decision), per his April 2025 claim.  Also during his January 2026 Board hearing, he made similar indications but also indicated that he believed his hiatal hernia was caused by excessive physical exertion repeatedly over a number of years, including lifting weights in the gymnasium without supervision or guidance for proper technique.  He also noted that he had surgery on an abdominal hernia but did not believe the abdominal hernia was due to service.  The Board notes that the January 2026 private medical opinion of R.P., D.O. included an opinion on the abdominal hernia.  Giving the Veteran the benefit of the doubt, the Board has considered the repaired abdominal hernia as part of the Veteran's hernia claim.

The Board concludes that the Veteran has a current disability of a repaired right umbilical hernia (or more generally an abdominal hernia as characterized by the Board), per a September 2024 VA medical record.  

The Board also concludes that the repaired abdominal hernia is related to is related to service.  38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

In the January 2026 private medical opinion of R.P., D.O., the provider found that taken together, medical literature provides a coherent, biologically plausible framework linking repetitive heavy weightlifting to the development and progression of inguinal and abdominal wall hernias.  Through repeated elevations in intra-abdominal pressure, cumulative fascial microtrauma, and interaction with connective tissue susceptibility, heavy lifting during the Veteran's military service represents a credible and medically supported mechanism for the later development of his hernia condition.

Upon review of the record, the Board finds the evidence is at least evenly balanced as to whether the Veteran's current repaired abdominal hernia is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a repaired abdominal hernia is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral hearing loss is remanded.

2. Entitlement to service connection for a lumbar spine disorder is remanded.

3. Entitlement to service connection for a right eye disorder, to include claimed partial blindness of the right eye and toxoplasmosis, is remanded.

4. Entitlement to service connection for a hiatal hernia is remanded.

For the bilateral hearing loss claim, the Veteran contends that his hearing loss developed due to noise exposure in service, to include proximity to the flight line from his office.

For the right eye
  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral hearing loss is remanded.

2. Entitlement to service connection for a lumbar spine disorder is remanded.

3. Entitlement to service connection for a right eye disorder, to include claimed partial blindness of the right eye and toxoplasmosis, is remanded.

4. Entitlement to service connection for a hiatal hernia is remanded.

For the bilateral hearing loss claim, the Veteran contends that his hearing loss developed due to noise exposure in service, to include proximity to the flight line from his office.

For the right eye claim, he contends that he was exposed to cats in service as a veterinary technician.  Per his January 2026 Board hearing testimony, he subsequently had toxoplasmosis due to that exposure.

Per his January 2026 Board hearing testimony, the Veteran provided general testimony of his hemorrhoids, hernias, and lumbar spine disorder were due to lifting weights in service.  

For all the remanded claims, an October 2008 VA examination for the spine indicates that there may be outstanding and relevant Social Security Administration (SSA) records, as the Veteran was in receipt of Social Security disability benefits.  A remand is required to allow VA to request these records.

Additionally, during that 2008 VA examination, the Veteran reported that he received workers' compensation for a post-service low back injury.  Also in VA medical records, such as a March 2009 record where the Veteran reported prior eye surgeries, both Lasik and RK.  The Veteran has identified relevant outstanding private treatment records.  A remand is required to allow VA to obtain authorization and request these records.

The Board notes that although a private medical opinion was provided in January 2026, by R.P. D.O., addressing the Veteran's claims, such medical opinion did not consider pertinent evidence and at times incorrectly characterized evidence.  For example, R.P. indicated that the Veteran was crushed between closing automatic doors in service, but the evidence of record indicates that such was a post-service, work-related injury.  For the bilateral hearing loss claim, R.P. also did not consider the Veteran's well-documented post-service noise exposure.  Also, as noted above, there are relevant records that have not been associated with the claims file that should be considered with these claims.

Although VA medical opinions for bilateral hearing loss were obtained in December 2008 and June 2025, they did not address the question of whether the Veteran had hearing loss that was aggravated by his service-connected tinnitus, as he has claimed.  The Board finds that a new VA medical opinion is necessary to fully address the Veteran's contentions.

Additionally, although a November 2024 VA medical opinion was obtained for the right eye claim, like the January 2026 private medical opinion of R.P., D.O. neither appears to have considered the Veteran's medical history of the eye, to include unassociated records regarding the Veteran's Lasik and RK surgical treatment of the eyes.  A new VA medical opinion is also necessary to fully address the Veteran's claim.

For the lumbar spine claim, although a VA examination was previously obtained in October 2008, no VA examination or VA medical opinion has been obtained in conjunction with the current appeal.  Given the Veteran's reports of in-service injury and current diagnoses, a new VA medical opinion is necessary to fully address the claim.

This remand is required to cure the above-described pre-decisional duty to assist errors. 

The matters are REMANDED for the following actions:

1. Obtain the Veteran's federal records from SSA.  Document all requests for information as well as all responses in the claims file.

2.  Ask the Veteran to complete a VA Form 21-4142 for his workers' compensation records.  Additionally, in his Make two requests for the authorized records from his workers' compensation, prior eye surgeries (both Lasik and RK), and any other pertinent private medical provider(s), unless it is clear after the first request that a second request would be futile.

3.  After the above record development has been accomplished, obtain a new VA medical opinion for the claim for service connection for bilateral hearing loss?  The examiner must review the claims file.  A new VA examination should only be conducted if deemed necessary by the VA medical opinion provider.

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

Is bilateral hearing loss at least as likely as not related to active service, including his report of working in an office near the flight line?  

Is bilateral hearing loss at least as likely as not due to OR aggravated, i.e., made worse, by service-connected tinnitus?  

Is bilateral hearing loss at least as likely as not related to the
 the first request that a second request would be futile.

3.  After the above record development has been accomplished, obtain a new VA medical opinion for the claim for service connection for bilateral hearing loss?  The examiner must review the claims file.  A new VA examination should only be conducted if deemed necessary by the VA medical opinion provider.

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

Is bilateral hearing loss at least as likely as not related to active service, including his report of working in an office near the flight line?  

Is bilateral hearing loss at least as likely as not due to OR aggravated, i.e., made worse, by service-connected tinnitus?  

Is bilateral hearing loss at least as likely as not related to the Veteran's in-service TERA exposure (see TERA memorandums)?  

The VA medical opinion provider should consider:

1) the total potential exposure through all applicable deployments; and 

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

A fully articulated medical rationale for any opinion expressed must be set forth in the medical report.  The VA medical opinion provider should discuss the particulars of this Veteran's medical history (including lay statements, service treatment records, reserve records, post-service hearing evaluations, prior VA examinations and the January 2026 private medical opinion of R.P., D.O.) and relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case.

4. After the above record development has been accomplished, obtain a new VA medical opinion for the claim for service connection for a right eye disorder, to include claimed partial blindness of the right eye and toxoplasmosis?  The examiner must review the claims file.  A new VA examination should only be conducted if deemed necessary by the VA medical opinion provider.

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

Is a right eye disorder at least as likely as not related to active service, including his report of working with cats in service?  

Is a right eye disorder at least as likely as not related to the Veteran's in-service TERA exposure (see TERA memorandums)?  

The VA medical opinion provider should consider:

1) the total potential exposure through all applicable deployments; and 

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

A fully articulated medical rationale for any opinion expressed must be set forth in the medical report.  The VA medical opinion provider should discuss the particulars of this Veteran's medical history [including service treatment records, reserve records, VA and private medical records, post-service eye surgeries (both Lasik and RK), prior VA examinations and the January 2026 private medical opinion of R.P., D.O.] and relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case.  

5. After the above record development has been accomplished, obtain a new VA medical opinion for the claim for service connection for a lumbar spine disorder?   The examiner must review the claims file.  A new VA examination should only be conducted if deemed necessary by the VA medical opinion provider.

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

Is a lumbar spine disorder at least as likely as not related to active service, to include reports of weightlifting?

A fully articulated medical rationale for any opinion expressed must be set forth in the medical report.  The VA medical opinion provider should discuss the particulars of this Veteran's medical history [including service treatment records, reserve records, post-service work-related spine injuries, SSA records, prior VA examinations and the January 2026 private medical opinion of R.P., D.O.] and relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case.

 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Lindio

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. 


.1303.