Case A26039129

K. PARAKKAL · 2026 · Case ID: A26039129

MIXED

Summary

The Veteran, an Army veteran who served from May 1984 to December 2004, including service in Southwest Asia during the Persian Gulf War, appeals decisions regarding chronic allergic rhinitis, left carpal tunnel syndrome, left cubital tunnel syndrome, trigeminal neuralgia, and right eye conditions. The Board granted service connection for chronic allergic rhinitis with an effective date of November 26, 2023, but denied a compensable rating for this condition, finding it did not meet the criteria for a higher evaluation. The Board also granted service connection for left carpal tunnel syndrome and left cubital tunnel syndrome, finding a continuity of symptomatology since service, supported by the Veteran's credible lay statements about in-service onset and continuation of pain and tingling, despite the absence of specific treatment records for these conditions in service. The Board remanded claims for trigeminal neuralgia, a right eye condition, and bilateral dry eye syndrome due to pre-decisional errors, including inadequate medical opinions and failure to address theories of entitlement. For trigeminal neuralgia, the Board found the TERA opinion speculative and the lack of a direct service connection opinion and consideration of the chronic disease presumption to be errors. For the eye conditions, the Board noted conflicting diagnoses between VA examinations and inadequate TERA opinions regarding toxic exposures and the onset of symptoms.

Rationale

Veteran presumed exposed to fine particulate matter due to Southwest Asia service; Veteran has current diagnosis of allergic rhinitis; Symptoms began in 2011 and continued daily; VA examination found no significant nasal obstruction or polyps; Evidence persuasively weighed against a higher rating

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6522

Docket No.

250313-530046

Full Decision Text

Citation Nr: A26039129
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250313-530046
DATE: April 27, 2026

ORDER

Entitlement to an effective date of November 26, 2023, but no earlier, for the award of service connection for chronic allergic rhinitis is granted.

Entitlement to an initial compensable rating for the Veteran's service-connected chronic allergic rhinitis is denied.

Entitlement to service connection for left carpal tunnel syndrome is granted.

Entitlement to service connection for left cubital tunnel syndrome is granted.

REMANDED

Entitlement to service connection for trigeminal neuralgia is remanded.

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

Entitlement to service connection for bilateral dry eye syndrome is remanded.

FINDINGS OF FACT

1. The Veteran served in Southwest Asia during the Persian Gulf War and is presumed to have been exposed to fine particulate matter during such service. The effective date of the amended VA regulations allowing for presumptive service connection for chronic rhinitis based on exposure to fine particulate matter is August 5, 2021. VA received the Veteran's claim for entitlement to service connection for chronic rhinitis (as well as an intent to file) on November 26, 2024, and there is no evidence of any formal or informal claim for service connection for chronic rhinitis prior to November 26, 2024. The onset of the Veteran's chronic allergic rhinitis symptoms was around 2011.

2. The Veteran's chronic allergic rhinitis does not result in greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side.

3. The Veteran has experienced a continuity of symptomatology related to his left carpal tunnel syndrome since service.

4. The Veteran has experienced a continuity of symptomatology related to his left cubital tunnel syndrome since service.

CONCLUSIONS OF LAW

1. The criteria for an effective date of November 26, 2023, but no earlier, for the award of service connection for chronic allergic rhinitis have been met. 38 U.S.C. §§ 5110, 5107; 38 C.F.R. §§ 3.2, 3.114 (a), 3.155, 3.317, 3.320, 3.400.

2. The criteria for entitlement to an initial compensable rating for service-connected chronic allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.31, 4.97, Diagnostic Code 6522.

3. The criteria for entitlement to service connection for left carpal tunnel syndrome have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

4. The criteria for entitlement to service connection for left cubital tunnel syndrome have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 1984 to December 2004.

This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in July 2024, November 2024, and February 2025 by a Department of Veterans Affairs (VA) Regional Office (hereinafter Agency of Original Jurisdiction (AOJ)) in the modernized review system, also known as the Appeals Modernization Act (AMA).

As procedural background, the Veteran requested Higher-Level Review (HLR) of a July 2024 rating decision that, in pertinent part, denied entitlement to service connection for trigeminal neuralgia and a right eye condition. In a November 2024 HLR decision, in pertinent part, the AOJ continued the denial of entitlement to service connection for trigeminal neuralgia, but due to an identified duty to assist error, the AOJ returned the issue of entitlement to service connection for a right eye condition to the supplemental claim lane for further development. In a February 2025 rating decision, in pertinent part, the AOJ granted entitlement to service connection for chronic rhinitis with a noncompensable rating assigned from November 26, 2024, and denied entitlement to service connection for a right eye condition,
2024 rating decision that, in pertinent part, denied entitlement to service connection for trigeminal neuralgia and a right eye condition. In a November 2024 HLR decision, in pertinent part, the AOJ continued the denial of entitlement to service connection for trigeminal neuralgia, but due to an identified duty to assist error, the AOJ returned the issue of entitlement to service connection for a right eye condition to the supplemental claim lane for further development. In a February 2025 rating decision, in pertinent part, the AOJ granted entitlement to service connection for chronic rhinitis with a noncompensable rating assigned from November 26, 2024, and denied entitlement to service connection for a right eye condition, left and right carpal tunnel syndrome, left and right cubital tunnel syndrome, and dry eye syndrome.

In the Veteran's March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, with respect to the issue of entitlement to service connection for trigeminal neuralgia, the Board may only consider the evidence of record at the time of the AOJ's July 2024 rating decision, which was subsequently subject to HLR. 38 C.F.R. § 20.301. If evidence related to the issue of entitlement to service connection for trigeminal neuralgia was submitted during the period after the AOJ issued the July 2024 decision, which was subsequently subject to HLR, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

With respect to the issues of entitlement to a compensable rating for chronic rhinitis and entitlement to service connection for a right eye condition, left carpal tunnel syndrome, left cubital tunnel syndrome, and dry eye syndrome, the Board may only consider the evidence of record at the time of the AOJ's February 2025 rating decision on appeal. 38 C.F.R. § 20.301. With respect to these issues, any evidence submitted after the AOJ's February 2025 decision 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 claims of entitlement to service connection for trigeminal neuralgia, a right eye condition, and bilateral dry eye syndrome, 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).

With respect to the issue of chronic allergic rhinitis, the Veteran indicated in his March 2025 VA Form 10182 that he disagreed with the March 2025 rating decision regarding chronic rhinitis. Although the Veteran stated that his disagreement was in the area of service connection, because the March 2025 rating decision granted entitlement to service connection for chronic rhinitis, the Board will interpret the Veteran's disagreement broadly as being with the effective date assigned for the grant of service connection for chronic rhinitis as well as with the noncompensable rating assigned for his service-connected chronic rhinitis.

Earlier Effective Dates

Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400.

VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015.

Under the former legal authority, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (a) (in effect prior to March 24, 2015).

There is no set form that an informal written claim must take. All that is required is that the communication indicate an intent to apply for one or more benefits under the laws administered by VA, and identify the benefits sought. Rodriguez v. West, 189 F.3d 1351 (1999).

Under the revised regulations, although informal claims are no longer recognized, a claimant may submit an Intent to File a claim, and VA may recognize the receipt date of the Intent to File a claim as the date of claim so long as VA receives the successfully completed claim form within one year of receipt of the Intent to File a claim. An Intent to File a claim must identify the general benefit (e.g., compensation, pension) but need not identify the specific benefit claimed or any medical condition(s) on which the claim is based. 38 C.F.R. § 3.155 (b) (in effect from March 24, 2015).

Moreover, under the Appeals Modernization Act (AMA), an effective date can be preserved if the claim is continuously pursued by filing an appropriate administrative review option to an AMA decision, generally within one year from when the notice of a decision was issued. 38 C.F.R. § 3.2500 (c). If an AMA claim is continuously pursued, it will be considered filed as of the date of the first claim in the continuously pursued chain, not the date the most recent request for review was received. 38 C.F.R. § 3.2500 (h). Following notice of a decision on an initial claim or a supplemental claim, continuous pursuit can be established by filing a supplemental claim, requesting higher-level review, or requesting an appeal to the Board. 38 C.F.R. § 3.2500 (c)(1).

1. Entitlement to an effective date earlier than November 26, 2024, for the award of service connection for chronic rhinitis

As pertinent to this case, where compensation is awarded pursuant to a liberalizing law, the effective date of such award shall be fixed in accordance with the facts found but shall not be earlier than the effective date of the act. Where compensation is awarded pursuant to a liberalizing law that became effective on or after the date of its enactment, in order for a claimant to be eligible for a retroactive payment under the provisions of this paragraph the evidence must show that the claimant met all eligibility criteria for the liberalized benefit on the effective date of the liberalizing law and that such eligibility existed continuously from that date to the date of claim. 38 C.F.R. § 3.114 (a).

If a claim is reviewed on the initiative of VA within one year from the effective date of the liberalizing law, or at the request of a claimant received within one year from that date, benefits may be authorized from the effective date of the law. 38 C.F.R. § 3.114 (a)(1). If a claim is reviewed on the initiative of VA more than one year after the effective date of the liberalizing law, benefits may be authorized for a period of one year prior to the date of administrative determination of entitlement. 38 C.F.R. § 3.114 (a)(2). If a claim is reviewed at the request of the claimant more than one year after the effective date of the liberalizing law, benefits may be authorized for a period of one year prior to the date of receipt of such request. 38 C.F.R. § 3.114 (a)(3).

Effective August 5, 2021, VA issued an interim final rule amending its adjudication
3.114 (a)(1). If a claim is reviewed on the initiative of VA more than one year after the effective date of the liberalizing law, benefits may be authorized for a period of one year prior to the date of administrative determination of entitlement. 38 C.F.R. § 3.114 (a)(2). If a claim is reviewed at the request of the claimant more than one year after the effective date of the liberalizing law, benefits may be authorized for a period of one year prior to the date of receipt of such request. 38 C.F.R. § 3.114 (a)(3).

Effective August 5, 2021, VA issued an interim final rule amending its adjudication regulations and establishing presumptive service connection for three chronic respiratory health conditions, to include chronic rhinitis, in association with presumed exposures to fine particulate matter. These presumptions apply to veterans with a qualifying period of service, which includes active military, naval, air, or space service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.320.

The Persian Gulf War began on August 2, 1990, and the Southwest Asia theater of operations encompasses Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, and the Red Sea. 38 C.F.R. §§ 3.2 (i), 3.317(e)(2).

In this case, the Board finds that an effective date of November 26, 2023, but no earlier, for the award of service connection for chronic rhinitis is warranted.

VA received the Veteran's claim for entitlement to service connection for chronic rhinitis on November 26, 2024. See Veteran's November 2024 VA 21-526EZ. On the same day, VA also received the Veteran's associated November 26, 2024, intent to file. There is no evidence of any formal or informal claim of service connection for rhinitis prior to November 26, 2024, and no intent to file (that was not associated with another claim) was received within one year prior to November 26, 2024.

The Veteran's claims file reflects that he served in the Southwest Asia theater of operations during service on or after August 2, 1990. Thus, he is presumed exposed to fine particulate matter during such service, and there is no affirmative evidence to establish he was not exposed to fine particulate matter during such service.

The Veteran attended a VA examination for sinusitis/rhinitis in December 2024. The examiner diagnosed the Veteran with allergic rhinitis during the examination. The examiner noted the Veteran's reports that, since 2011, he has experienced daily symptoms, including itchy, watery eyes and sneezing that have stayed the same since their onset. The Veteran is competent to report these types of lay-observable symptoms and the history of their onset and persistence. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board finds that the Veteran's reports of suffering from daily itchy, watery eyes and sneezing since 2011 are credible.

Here, the Veteran's intent to file and his claim for entitlement to service connection for allergic rhinitis were both received on November 26, 2024. The Veteran is presumed exposed to fine particulate matter during service in Southwest Asia, he experiences current chronic allergic rhinitis, and his November 2024 claim was received more than one year after the August 5, 2021, effective date of the liberalizing law that established presumptive service connection for rhinitis in association with presumed exposures to fine particulate matter. Additionally, given the Veteran's competent and credible reports that his rhinitis symptoms began in 2011 and have continued daily since then, all eligibility criteria for the liberalized benefit were met as of August 5, 2021. Therefore, an effective date of November 26, 2023, (one year prior to the date of receipt of the Veteran's request for benefits) for the award of service connection for rhinitis is warranted. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.114(a)(3), 3.155(b) (effective March 24, 2015), 3.303, 3.320.

An effective date earlier than November 26, 2023, is not
that his rhinitis symptoms began in 2011 and have continued daily since then, all eligibility criteria for the liberalized benefit were met as of August 5, 2021. Therefore, an effective date of November 26, 2023, (one year prior to the date of receipt of the Veteran's request for benefits) for the award of service connection for rhinitis is warranted. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.114(a)(3), 3.155(b) (effective March 24, 2015), 3.303, 3.320.

An effective date earlier than November 26, 2023, is not warranted because there is no evidence of any unadjudicated formal or informal claim for entitlement to service connection for rhinitis prior to November 26, 2024, and no intent to file that was not associated with another claim was received within one year prior to November 26, 2024. Therefore, November 26, 2023, is the earliest possible effective date for the grant of entitlement to service connection for chronic allergic rhinitis.

Increased Ratings, Generally

Disability evaluations (ratings) are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.

In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 38 C.F.R. §§ 4.1, 4.2, 4.10.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3.

Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Separate ratings may be assigned for separate periods of time based on the facts found; this practice is known as staged ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007).

When there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination, 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 Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

2. Entitlement to an initial compensable rating for chronic allergic rhinitis

The Veteran's chronic allergic rhinitis is evaluated under Diagnostic Code (DC) 6522 for allergic or vasomotor rhinitis, which assigns a 10 percent rating where the disability is without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. A maximum 30 percent rating is warranted where the disability is with polyps.

In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31.

As previously noted, the Veteran attended a VA examination for sinusitis/rhinitis in December 2024. The examiner diagnosed the Veteran with allergic rhinitis. The examiner noted the Veteran's reports that, since 2011, he has experienced daily symptoms, including itchy, watery eyes and sneezing. The Veteran reported that he does not currently use any treatments for these symptoms. Upon examination, the examiner found that x-rays taken in conjunction with the examination were within normal limits. The examiner also found that the Veteran did not have greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, and the examiner found that the Veteran did not have complete obstruction on either the left or right side due to rhinitis. The examiner found that the Veteran did have permanent hypertrophy of the nasal turbinates but that he did not have nasal polyps or granulomatous conditions.

The Board finds that the December 2024 VA examination is adequate for appellate review. The VA examination was based on the Veteran's statements, in-person examination, and the examiner's observations. The Board finds it is entitled to significant probative weight with respect to the severity of the Veteran's service-connected chronic allergic rhinitis at the time of the examination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

The Board finds that the evidence does not support that the Veteran's allergic rhinitis results in polyps. Additionally, the Board finds that the evidence does not support that the Veteran's allergic rhinitis is characterized by greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side such that a 10 percent rating would be warranted.

As the Veteran's chronic allergic rhinitis does not meet the requirements for a compensable evaluation under DC 6522, an initial noncompensable evaluation has been assigned. 38 C.F.R. §4.31.

The evidence is neither evenly balanced nor approximately so regarding whether a higher rating is warranted for the Veteran's chronic allergic rhinitis. Rather, the evidence persuasively weighs against the claim, and therefore the benefit of the doubt doctrine does not apply. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other). Accordingly, the claim for entitlement to an initial compensable rating for the Veteran's service-connected chronic allergic rhinitis must be denied.

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; 38 C.F.R. § 3.303 (a). 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).

Establishing service connection generally requires evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service event, injury, or disease and the present injury or disease. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of a "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With a chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303 (b).

In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including (as pertinent to this appeal) organic diseases of the nervous system
sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With a chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303 (b).

In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including (as pertinent to this appeal) organic diseases of the nervous system to include carpal and cubital tunnel syndrome and trigeminal neuralgia, shown to have manifested to a compensable degree within (in most cases) one year of separation from service are presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a), 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Service connection for listed chronic diseases may also be established by showing continuity of symptomatology from service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331, 1338 (Fed. Cir. 2013).

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance, which includes but is not limited to equipoise, the claimant receives the benefit of the doubt. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt rule does not apply.

3. Entitlement to service connection for left carpal tunnel syndrome

4. Entitlement to service connection for left cubital tunnel syndrome

The Veteran contends that his currently diagnosed left carpal tunnel syndrome and left cubital tunnel syndrome began during and have continued since his military service. See Veteran's November 2024 VA Form 21-526EZ and December 2024 VA examination. The Board finds that service connection is warranted for the Veteran's left carpal and cubital tunnel syndrome based on a continuity of symptomatology.

In the February 2025 rating decision, the AOJ made favorable findings that the Veteran has a current diagnosis of both left carpal tunnel syndrome and left cubital tunnel syndrome. Therefore, the first element required for service connection has been met.

As far as an in-service event, illness, or injury, the Veteran's service treatment records are silent regarding complaints or treatment for his left upper extremity. The Veteran was treated for right wrist pain in October 1992 at Fort Hood. In an October 1992 service treatment record, the provider noted the Veteran's reports that, for three days, he had been having right wrist pain with grasping and when pressure was applied, with no history of trauma. The Veteran was diagnosed with right wrist tendinitis and given a right wrist splint. In his Report of Medical History completed in May 2004 prior to his Army retirement, the Veteran denied having a painful elbow or wrist or numbness or tingling, and in the associated May 2004 Report of Medical Examination, the provider checked boxes indicating that the Veteran had normal upper extremities and neurologic functioning.

In June 2004, while he was still on active duty, the Veteran submitted an informal claim for pain in his fingers and wrists. Instead of obtaining an examination for the Veteran's upper extremities, the AOJ denied the Veteran's claims for entitlement to service connection for bilateral wrist pain and pain in the fingers of his hands on the basis that those conditions were not diagnosed during the Veteran's earlier June 2024 VA examination (which was an examination for hearing loss, left ankle pain, left knee pain, neck pain, and lower back pain that was conducted prior to the submission of his wrist and finger claims). The AOJ also stated (without relying on a medical opinion) that the Veteran's right wrist pain that was treated during service had been acute rather than chronic.

In a June 2019
, the Veteran submitted an informal claim for pain in his fingers and wrists. Instead of obtaining an examination for the Veteran's upper extremities, the AOJ denied the Veteran's claims for entitlement to service connection for bilateral wrist pain and pain in the fingers of his hands on the basis that those conditions were not diagnosed during the Veteran's earlier June 2024 VA examination (which was an examination for hearing loss, left ankle pain, left knee pain, neck pain, and lower back pain that was conducted prior to the submission of his wrist and finger claims). The AOJ also stated (without relying on a medical opinion) that the Veteran's right wrist pain that was treated during service had been acute rather than chronic.

In a June 2019 treatment record, the Veteran complained of having a tingling left forearm that was worse when his elbow was extended and that radiated to the ulnar aspect of his hand.

In his November 2024 VA Form 21-526EZ, the Veteran stated that he had been diagnosed with carpal tunnel syndrome and cubital tunnel syndrome at Fort Hood during service and that he had been told it was due to repetitive stress/movement.

The Veteran attended a VA examination for peripheral nerve conditions in December 2024. The examiner noted the Veteran's reports that his carpal and cubital tunnel syndromes began with shooting pain in the left forearm and left hand in 1991 due to typing. The Veteran stated that the pain had gotten worse over the years and that he treats it with rest. He stated that these disabilities cause difficulty with typing and heavy lifting due to pain.

The AOJ obtained medical opinions finding that the Veteran's carpal tunnel syndrome and cubital tunnel syndrome were not undiagnosed illnesses or medically unexplained chronic multisystem illnesses and that they were not etiologically related to the toxic exposure risk activities that the Veteran participated in during service. The AOJ did not obtain a medical opinion regarding direct service connection and did not address the Veteran's lay statements or the chronic disease presumption in the February 2025 rating decision on appeal.

The Veteran is competent to report lay-observable symptoms, such as ongoing pain and tingling in his left forearm and hand since service. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran's service treatment records only show treatment for right wrist pain in service, the absence of evidence of treatment for the Veteran's left wrist/hand in his service treatment records is not substantive negative evidence that the Veteran did not experience left wrist/hand pain in service. See, e.g. Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015); Buczynski v. Shinseki, 24 Vet. App. 221, 223-24 (2011); Jones v. Shinseki, 23 Vet. App. 382, 389-90 (2010). Rather, the Veteran has made competent lay statements dating back to his June 2004 claim when he was still in the military that he had pain in his fingers and wrists. As noted on his DD Form 214, the Veteran's military occupational specialty (MOS) was electronic warfare and signals intelligence, which, according to www.goarmy.com involves examining and analyzing foreign communications and activity to find intelligence that is then relayed to senior leaders through strategic and tactical reports. The Board finds that the Veteran's MOS and personnel records support that the Veteran engaged in copious amounts of typing across his more than 20 years of service. In one of the Veteran's performance evaluations from September 1989, for example, the Veteran's job as a senior voice analyst was noted to involve writing and editing detailed technical reports, and in a September 2000 performance evaluation from later in his career, the Veteran was noted to have produced more than 4,100 intelligence reports while serving as a senior intelligence analyst. Such evidence is consistent with the Veteran's statement that he made during the December 2024 VA examination that his in-service left forearm and hand pain was associated with the repetitive stress/movement of typing. As such, the Board finds the Veteran's lay statements about the in-service onset and continuation of his left forearm and hand pain to be credible and assigns them significant weight.

While the Veteran is not competent to diagnose or provide a medical nexus opinion for his carpal and cubital tunnel syndrome, he did provide competent and credible lay statements that his left forearm and wrist/hand pain began during and has continued ever since his military service. The Veteran's post-service diagnoses of left carpal tunnel syndrome and left cubital tunnel syndrome are the first competent evidence of record of a diagnosis of those conditions. However, the Board finds that the Veteran's competent, credible lay statements of having ongoing left wrist, hand, and forearm pain since service establishes
typing. As such, the Board finds the Veteran's lay statements about the in-service onset and continuation of his left forearm and hand pain to be credible and assigns them significant weight.

While the Veteran is not competent to diagnose or provide a medical nexus opinion for his carpal and cubital tunnel syndrome, he did provide competent and credible lay statements that his left forearm and wrist/hand pain began during and has continued ever since his military service. The Veteran's post-service diagnoses of left carpal tunnel syndrome and left cubital tunnel syndrome are the first competent evidence of record of a diagnosis of those conditions. However, the Board finds that the Veteran's competent, credible lay statements of having ongoing left wrist, hand, and forearm pain since service establishes a continuity of symptomatology. For chronic diseases like the Veteran's carpal and cubital tunnel syndrome, this continuity of symptomatology serves to link the Veteran's currently diagnosed left carpal and cubital tunnel syndrome disabilities to his period of military service.

In sum, resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran has experienced a continuity of symptomatology since service related to left carpal and cubital tunnel syndrome, which are chronic diseases for purposes of presumptive service connection. Service connection is therefore warranted for the Veteran's left carpal tunnel syndrome and left cubital tunnel syndrome, and the claims are granted. 38 C.F.R. §§ 3.303 (b), 3.307 (a)(3), 3.309 (a); see also Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

REASONS FOR REMAND

1. Entitlement to service connection for trigeminal neuralgia

2. Entitlement to service connection for a right eye condition

3. Entitlement to service connection for bilateral dry eye syndrome

In his August 2023 VA Form 21-526EZ, the Veteran seeks service connection for trigeminal neuralgia and also contends that the microvascular decompression surgery he underwent through Naval Medical Center Portsmouth to treat his trigeminal neuralgia has caused him to suffer from a steady increase of pain, twitching, floaters, and dryness in his right eye. In his December 2024 VA Form 21-526EZ, the Veteran also seeks service connection for bilateral dry eye syndrome, which he contends is related to toxic exposures during service.

Upon review, the Board finds that before these issues can be adjudicated a remand is necessary to correct pre-decisional errors.

First, with respect to trigeminal neuralgia, the Veteran attended a VA examination in June 2024 for cranial nerves diseases. The examiner noted the Veteran's reports that his right trigeminal neuralgia began in 2006 and that he underwent microvascular decompression surgery in 2010 to treat it. The examiner diagnosed right trigeminal neuralgia status post microvascular decompression surgery and noted that the Veteran has moderate right side upper face, eye, or forehead intermittent trigeminal nerve pain, impaired right side muscle strength and facial sensation, and right side incomplete moderate paralysis of the trigeminal nerve.

The Board notes that in a June 2024 VA examination for eye conditions, the examiner stated that the Veteran has noticed floating spots since he was diagnosed with trigeminal neuralgia around the time of his second deployment in Iraq. This lay evidence suggests an in-service onset of trigeminal neuralgia symptoms.

The claims file contains treatment records from Naval Medical Center Portsmouth, which is not affiliated with VA. In a February 2010 treatment record, the provider noted that, despite medication, the Veteran had relentlessly suffered from right facial pain, right eyelid twitching, pain behind his right eye, right eye visual disturbance, and numbness involving all three branches of the trigeminal nerve for more than two years. The Veteran was referred to a neurosurgeon at UVA, Dr. J.S. (initials used to protect privacy). In a May 2010 treatment record, the provider stated that Dr. J.S. had performed the Veteran's right microvascular decompression surgery in May 2010.

Prior to issuing the July 2024 rating decision on appeal, which was subjected to HLR, the AOJ obtained Gulf War and toxic exposure risk activities (TERA) medical opinions for trigeminal neuralgia. The examiner found that trigeminal neuralgia is not an undiagnosed illness or medically unexplained chronic multi-symptom illness of unknown etiology. In the TERA opinion, the examiner stated that it was less likely than not that the Veteran's trigeminal neuralgia was caused by his TERAs. As rationale, the examiner stated that there is no medical literature that shows a correlation between trigeminal neuralgia and the Veteran's TERA and that risk factors such as age, trauma, or infections "outweigh the TERA." The Board finds this TERA opinion for the Veteran's trigeminal neuralgia to be speculative and conclusory and thus inadequate. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (stating that a medical opinion must support its conclusion with an analysis that the Board can weigh, and a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision). To correct this pre-decisional duty to assist error, a remand is necessary for the AOJ to obtain a sufficiently reasoned TERA opinion.

Additionally, the AOJ did not obtain a direct opinion regarding the Veteran's trigeminal neuralgia (to include consideration of presumptive service connection for trigeminal neuralgia as a chronic disease), despite the lay evidence of record suggesting that the condition began during service or shortly after the Veteran's retirement from service. Therefore, a remand is also necessary for the AOJ to correct this pre-decisional duty to assist error.

Second, with respect to a right eye condition, the Veteran contended in his VA 21-526EZ that it was caused by VA care as a result of his microvascular decompression surgery performed to treat his trigeminal neuralgia. Although it appears from the evidence of record that the Veteran was seen for trigeminal neuralgia at Naval Medical Center Portsmouth and referred by that provider to a neurosurgeon affiliated with the University of Virginia for the surgery, the AOJ failed to address this theory of entitlement to compensation under 38 U.S.C. § 1151 as raised by the Veteran. See Robinson v. Peake, 21 Vet. App. 545, 554 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). The AOJ's failure to address a theory raised by the Veteran constitutes a failure to satisfy a regulatory or statutory duty. Accordingly, remand is required.

Third, with respect to the Veteran's claims for a right eye condition and bilateral dry eye syndrome, the July 2024 VA examiner diagnosed the Veteran with right eye periorbital pain, bilateral vitreous floaters, bilateral allergic conjunctivitis, bilateral meibomian gland dysfunction (MGD) (which the examiner indicated was a disorder of the lacrimal apparatus), bilateral peripapillary atrophy, and bilateral nuclear sclerosis cataracts. The July 2024 examiner indicated in the examination report that the Veteran does not have dry eye syndrome. The January 2025 VA examiner, however, diagnosed the Veteran with right eye periorbital pain, bilateral vitreal floaters, bilateral MGD, bilateral dry eye syndrome (which the examiner indicated was not a disorder of the lacrimal apparatus), and bilateral cataracts. The AOJ did not seek to reconcile the differences in the diagnoses rendered by these two different examiners prior to issuing the rating decision on appeal. The AOJ also did not request direct service connection opinions for the Veteran's dry eye syndrome, floaters, MGD, or allergic conjunctivitis, despite evidence in the two VA examination reports that the Veteran's dry eye syndrome, MGD, and allergic conjunctivitis symptoms manifested during his first deployment to Iraq in the 1990s and that he first noticed floaters when he was diagnosed with trigeminal neuralgia around the time of his second deployment to Iraq. Therefore, a remand is also necessary for the AOJ to correct these pre-decisional duty to assist errors.

Moreover, the TERA opinions provided by the January 2025 examiner for the Veteran's eye conditions were inadequate. The examiner did not define the "environmental factors" that were referred to in "clinical reports and epidemiological observations regarding dry eye syndrome" or explain why a straight cause-and-effect relationship means that once someone is removed from the (unspecified) environmental factors the dry eye symptoms "should" improve or resolve. The examiner also improperly relied
to Iraq in the 1990s and that he first noticed floaters when he was diagnosed with trigeminal neuralgia around the time of his second deployment to Iraq. Therefore, a remand is also necessary for the AOJ to correct these pre-decisional duty to assist errors.

Moreover, the TERA opinions provided by the January 2025 examiner for the Veteran's eye conditions were inadequate. The examiner did not define the "environmental factors" that were referred to in "clinical reports and epidemiological observations regarding dry eye syndrome" or explain why a straight cause-and-effect relationship means that once someone is removed from the (unspecified) environmental factors the dry eye symptoms "should" improve or resolve. The examiner also improperly relied on the mere passage of time to support a conclusion that the Veteran's current MGD and dry eye syndrome were "unlikely" to be related to his toxic exposures and environmental stresses from more than 20 years ago. Additionally, the Board finds the examiner's statement that the Veteran's cataracts and vitreal floaters are "most likely a result of his age and not related to his toxic exposures" to be speculative and conclusory and thus inadequate. As such, a remand is also required for the AOJ to obtain adequate TERA opinions regarding the Veteran's eye disabilities.

The matters are REMANDED for the following action:

1. Undertake the development necessary to address the theory of entitlement to compensation under 38 U.S.C. § 1151 for a right eye condition due to treatment for trigeminal neuralgia.

2. Request that the Veteran clarify the approximate date that he noticed symptoms of trigeminal neuralgia. Then obtain a medical opinion from an appropriate examiner to determine the etiology of the Veteran's diagnosed trigeminal neuralgia. The examiner should review the claims file and then provide an opinion with a detailed rationale that responds to the following:

(a). Is it at least as likely as not (likelihood at least approximately balanced or nearly equal, if not higher) that the Veteran's trigeminal neuralgia (1) began during, or is otherwise related to, active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service?

In responding to the above questions, the examiner should address the Veteran's lay statements regarding the onset and progression of his trigeminal neuralgia, which the Veteran is competent to report. Such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports of symptoms and history, the examiner must provide a reason for doing so. Lay statements of record cannot be disregarded solely due to lack of contemporaneous medical evidence.

(b). Is it at least as likely as not (likelihood at least approximately balanced or nearly equal, if not higher) that the Veteran's trigeminal neuralgia was due to his exposure to environmental toxins during service, 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? Why or why not?

3. Obtain a medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's bilateral eye disabilities. An in-person examination is not required unless the examiner finds it necessary. The examiner should review the claims file and then provide an opinion with a detailed rationale that responds to the following:

(a) First, identify/diagnose all current eye disabilities, reconciling any differences in diagnoses between the June 2024 and January 2025 VA examinations. A favorable finding in the February 2025 rating decision states that the Veteran has been diagnosed with myopia, periorbital pain, vitreous floaters, allergic conjunctivitis, meibomian gland dysfunction, peripapillary atrophy, and cataracts. If the examiner disagrees with a diagnosis already established in the medical records, the examiner should explain why.

(b) For each diagnosed eye disability, is it at least as likely as not (likelihood at least approximately balanced or nearly equal, if not higher) that the disability was incurred in or otherwise etiologically related to the Veteran's military service?

In responding to the above question, the examiner should address the lay evidence of record, including but not limited to evidence in the June 2024 and January 2025 VA examination reports that the Veteran's dry eye syndrome, meibomian gland dysfunction, and allergic conjunctivitis symptoms manifested during his first deployment to Iraq in the 1990s and that he first noticed floaters when he was diagnosed with trigeminal neuralgia around the time of his second deployment to Iraq. If the examiner rejects the Veteran's reports of symptoms and history, the examiner must provide a reason for doing so. The Veteran is competent to report the history of his lay-observable symptoms
or otherwise etiologically related to the Veteran's military service?

In responding to the above question, the examiner should address the lay evidence of record, including but not limited to evidence in the June 2024 and January 2025 VA examination reports that the Veteran's dry eye syndrome, meibomian gland dysfunction, and allergic conjunctivitis symptoms manifested during his first deployment to Iraq in the 1990s and that he first noticed floaters when he was diagnosed with trigeminal neuralgia around the time of his second deployment to Iraq. If the examiner rejects the Veteran's reports of symptoms and history, the examiner must provide a reason for doing so. The Veteran is competent to report the history of his lay-observable symptoms, and such reports cannot be disregarded solely due to lack of contemporaneous medical evidence.

(c) For each diagnosed eye disability, is it at least as likely as not (likelihood at least approximately balanced or nearly equal, if not higher) that the disability was due to the Veteran's exposure to environmental toxins during military service, 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? Why or why not?

K. Parakkal

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Eisenstatt, R.

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.

Analyze in VA Law Explorer