THORACOLUMBAR OR LUMBAR SPINE LIMITATION OF MOTION

MICHAEL MARTIN · 2026 · Case ID: A26039310

MIXED

Summary

The Veteran served from August 1979 to June 1998. This case comes before the Board of Veterans' Appeals (Board) on appeal from the February 2025 and April 2025 rating decisions. The Veteran elected the Direct Review docket, limiting the Board's review to evidence of record at the time of the prior RO decisions. The Veteran's appeal concerns several conditions, including lower back strain, right knee disability, prostate cancer, hypertension, degenerative arthritis in both hands and the right foot, plantar calcaneal spurs, and bilateral eye conditions. The Board dismissed the appeal for lower back strain, finding the criteria for dismissal met as the issue was not properly raised as an error of fact or law. Service connection for right knee disability and prostate cancer were denied, as the evidence persuasively weighed against a service connection or in-service onset, with no indication of toxic exposure contributing to the prostate cancer. The Board found duty to assist errors occurred prior to the February and April 2025 decisions for hypertension, degenerative arthritis in the hands, and plantar calcaneal spurs. Specifically, for hypertension, private treatment records showing elevated blood pressure and a plan for further evaluation should have been secured. For hand and foot arthritis, the RO failed to obtain an aggravation medical opinion for the left hand and did not fully address pain as a diagnosis for the right hand, referencing the Federal Circuit's decision in Saunders v. Wilkie. Consequently, these claims are remanded for further development and adjudication.

Rationale

Failure to allege specific error of fact or law; Dismissed per 38 U.S.C. § 7105

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260104-620030

Full Decision Text

Citation Nr: A26039310
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 260104-620030
DATE: April 28, 2026

ORDER

Entitlement to service connection for lower back strain, middle back strain is dismissed.

Entitlement to service connection for right knee disability is denied.

Entitlement to service connection for prostate cancer is denied.

REMANDED

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for degenerative arthritis in left hand or fingers is remanded.

Entitlement to service connection for degenerative arthritis in right hand is remanded.

Entitlement to service connection for degenerative arthritis right foot is remanded.

Entitlement to service connection for plantar calcaneal spurs is remanded.

Entitlement to service connection for retinal detachment and pseudophakia, right eye is remanded.

Entitlement to service connection for retinal detachment, corectopia and pseudophakia, left eye is remanded.

Entitlement to service connection for sleep apnea is remanded.

FINDINGS OF FACT

1. Prior to the promulgation of this decision, in the May 2025 rating decision, the Veteran was awarded service connection for degenerative disc disease of the spine (claimed as lower and middle back strain).

2. The evidence of record persuasively weighs against finding that right knee strain began during active service or is otherwise related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that prostate cancer began during active service or is otherwise related to an in-service injury or disease, including toxic exposure.

CONCLUSIONS OF LAW

1. The criteria for dismissal of entitlement to service connection for lower back strain, middle back strain have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for entitlement to service connection for right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for prostate cancer have not been 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 service from August 1979 to June 1998.

This matter is before the Board of Veterans' Appeals (Board) on appeal of the February 2025 and April 2025 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO).

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2025 and April 2025 RO decisions (respectively) on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the RO 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 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 listed in the remand section, any evidence the Board could not consider will be considered by the RO in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues considered in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to
. § 3.103(c)(2)(ii).

The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in this decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).

1. Entitlement to service connection for lower back strain, middle back strain

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. In the January 2026 Notice of Disagreement, the Veteran appealed service connection of his back disability from an April 2025 rating decision that identified a duty to assist error, which is not a final decision. In addition, in the May 2025 rating decision, the Veteran was awarded service connection for degenerative disc disease of the spine.

Therefore, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal for the Veteran's claim for entitlement to service connection for degenerative disc disease of the spine and the claim is dismissed.

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. §§ 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).

A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. Clear and unmistakable evidence is required to rebut the presumption of aggravation where the preexisting disability underwent an increase in severity during service. However, aggravation may not be conceded where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306(b). In addition, temporary flare-ups, even in service, will not be considered sufficient to establish an increase in severity unless the underlying condition, as contrasted with the symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292 (1991).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of section 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

The claimant bears the burden of presenting and supporting his claim for benefits. 38 U.S.C. § 5107(a); see also Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). However, when there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

1. Entitlement to service connection for right knee disability

The Veteran seeks service connection for a right knee strain and right
225 (1992).

1. Entitlement to service connection for right knee disability

The Veteran seeks service connection for a right knee strain and right knee instability. The Veteran contends that he twisted his knee terribly while putting up a tent, and he received treatment during service.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, while the Veteran has a current diagnosis of right knee strain, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of right knee strain began during service or is otherwise related to an in-service injury, event, or disease.

The Veteran's service treatment records reflect that the Veteran received treatment for his right knee in April 1988, as the Veteran reported he twisted his knee while putting up a tent.

The Board has considered the Veteran's assertions that his claimed right knee disabilities are etiologically related to his active service. Although the Veteran is competent to report his current symptoms, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), he is not considered competent to render an opinion as to the likely etiology of a right knee disability, as doing so requires specialized medical knowledge and expertise he has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the Board instead turns to the competent medical evidence of record to determine whether such an etiological connection exists.

In an October 2024 VA medical report, the Veteran was diagnosed with right knee strain, but the Veteran was not diagnosed with instability. The examiner opined, that the Veteran's right knee disability was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. As to the rationale, the examiner explained that the Veteran's service treatment records indicated that there was a tear so he was treated with a knee immobilizer. However, the Veteran's treatment records are negative for any persistent right knee symptoms afterwards. He underwent a military physical in March 1993. This was completely negative for knee symptoms/treatment and there was a normal exam of knees. The current exam shows very mild right knee findings of slightly decreased range of motion. There is no evidence that his right knee strain condition had its onset over 25 years ago during service. Therefore, it is less likely than not the right knee strain was incurred in or caused by (the) knee pain during service.

The examiner also indicated that the Veteran does not have a diagnosis of right knee instability as there is no pathology to warrant a diagnosis. The Board finds that the October 2024 VA examiner's opinions are probative, because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board finds that the probative evidence is against finding that the Veteran's current right knee disability is related to the Veteran's active military service. The Board acknowledges that the Veteran injured his right knee in 1988, but his treatment records reflect that he did not have any knee complaints or treatment during a March 1993 physical examination, or in close proximity to separating from service. The Board finds that the October 2024 VA medical opinion is the most probative evidence, as the examiner addressed the Veteran's service treatment records, and his current right knee disability.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). If the evidence is not in approximate balance or nearly equal in the veteran's favor, the claim must be denied. Lynch v. McDonough, 21 F.4th 776
separating from service. The Board finds that the October 2024 VA medical opinion is the most probative evidence, as the examiner addressed the Veteran's service treatment records, and his current right knee disability.

In this case, the Board does not find that there is an approximate balance of positive and negative evidence, as the probative evidence weighs against finding that right knee strain began during active service or is otherwise related to an in-service injury or disease.

2. Entitlement to service connection for prostate cancer

The Veteran contends that his prostate cancer is related to PFAS at Fort Leonard Wood and Fort Riley. The Veteran stated that he believes his service time at Fort Leonard Wood, Missouri for basic training in 1979 and his 3 years at Fort Riley, Kansas from 1988-1991 exposed him to enough PFAS to cause my current diagnosis of prostate cancer. Additionally, he used AFFF (aqueous film forming foam) as a function of serving in the military. See September 2024 Developed Claim.

The Veteran's service treatment records do not reflect any complaints, treatment, or diagnosis of prostate cancer. The Veteran's post-service treatment records reflect that the Veteran was diagnosed with prostate cancer in approximately 2022, decades after separating from service.

In a November 2024 VA medical opinion, the examiner indicated that the Veteran's prostate cancer was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), 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. As to the rationale, the examiner stated that he reviewed the exposure information and the review showed no increased exposure risk. The examiner acknowledged that the records reviewed do not indicate any risk factors outside of military service.

The examiner stated that based upon claimed exposure(s) to PFAS, the place of exposure is CONUS. The reported activity that resulted in exposure is described as Track Vehicle Repairer. The duration of exposure is described as Aug 07, 1979- June 30, 1998. The route of exposure is described as dermal. The frequency of exposure is reported as unable to locate relevant information in TERA memo/ILER and medical records. PPE was reportedly not used. The Veteran is diagnosed with adenocarcinoma prostate cancer and erectile dysfunction. The examiner concluded that the medical literature does not identify increased incidence of diagnosed prostate cancer and exposure to PFAS. The Veteran's erectile dysfunction is directly related to hormone therapy associated with prostate cancer treatment and is not increased by claimed toxic exposure.

The Board finds that the probative evidence is against finding that the Veteran's prostate cancer is related to his active military service. The Veteran's service treatment records do not reflect any complaints, diagnosis, or treatment for prostate cancer. The Veteran was not diagnosed with prostate cancer in near proximity to separating service. The Board finds the November 2024 VA examiner's medical opinion to be the most probative evidence because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner found that the medical literature does not identify increased incidence of diagnosed prostate cancer and exposure to PFAS.

In this case, the Board does not find that there is an approximate balance of positive and negative evidence, as the evidence of record persuasively weighs against finding that prostate cancer began during active service or is otherwise related to an in-service injury or disease, including toxic exposure.

REASONS FOR REMAND

1. Entitlement to service connection for hypertension

The Veteran contends that he has hypertension
see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). If the evidence is not in approximate balance or nearly equal in the veteran's favor, the claim must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to service connection for hypertension

The Veteran contends that he has hypertension, as he had elevated blood pressure during his retirement physical.

The October 1998 VA examiner determined that, while the Veteran experienced symptoms of elevated blood pressure during his separation examination, the Veteran did not have a diagnosis of hypertension. During the October 1998 VA examination, the Veteran had a sitting blood pressure of 120/80. The examiner indicated that the Veteran's blood pressure was normal on examination, and there is insufficient clinical evidence of hypertension.

In March 2024, the Veteran's private treatment records reflect, screening for hypertension: plan: blood pressure elevated, retake once home, rested, continue medications as prescribed. If remaining elevated follow-up with primary care for further evaluation. Asymptomatic.

The Board finds a duty to assist error occurred prior to the February 2025 rating decision on appeal. Specifically, the March 2024 private treatment records reflect that the Veteran was screened for hypertension, as his blood pressure was elevated. While the Veteran's private treatment records do not show a diagnosis, the records show testing was performed, and the Board finds that the Veteran's private treatment records should have been secured to determine if the Veteran has a diagnosis.

Thus, the Board finds a remand is required to address the duty to assist error, and the Veteran's private treatment records should be secured.

2. Entitlement to service connection for degenerative arthritis in left hand or fingers is remanded.

3. Entitlement to service connection for degenerative arthritis in right hand is remanded.

The Veteran contends that his left-hand arthritis is related to his injury of his thumb during service. He contends that his right hand had bad swelling during service which he was treated for but has gotten worse over time.

The Board finds that duty to assist errors occurred prior to the April 2025 rating decision on appeal. Specifically, for the Veteran's left hand the RO did not secure an aggravation medical opinion. For the Veteran's right hand, the examiner indicated that the Veteran did not have a diagnosis but did not address whether pain itself could be considered a diagnosis. The Board notes that in 2018, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) issued a precedential decision regarding pain as a disability. See Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018). In Saunders, the Federal Circuit held that pain alone may serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id.

The Board finds a remand is necessary to address the duty to assist errors and obtain addendum medical opinions.

4. Entitlement to service connection for degenerative arthritis right foot is remanded.

5. Entitlement to service connection for plantar calcaneal spurs is remanded.

The Veteran contends that his degenerative arthritis right foot condition and plantar calcaneal spurs are secondary to his service-connected residuals fractured fourth and fifth toes on the right foot condition.

The Board finds that duty to assist errors occurred prior to the April 2025 rating decision on appeal. Specifically, the VA examiners did not provide aggravation medical opinions. A medical opinion as to secondary service connection is inadequate for the Board's decision as to aggravation if the issue of aggravation is not sufficiently addressed by the examiner. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). An examiner's determination that the disease or injury at issue is not "related to" the service-connected condition is not sufficient to address the aggravation issue. Id. Thus, these medical opinions are inadequate, because they only addressed the causation prong of secondary service connection.

Thus, the Board finds a remand is required to address the duty to assist errors.

6. Entitlement to service connection for retinal detachment and pseudophakia, right eye is remanded.

7. Entitlement to service connection for retinal detachment and pseudophakia, left eye is remanded.

The Veteran contends that his pre-existing left eye disability was worsened during the Veteran's active military service. The Veteran contends that his right eye disability was related to
examiner's determination that the disease or injury at issue is not "related to" the service-connected condition is not sufficient to address the aggravation issue. Id. Thus, these medical opinions are inadequate, because they only addressed the causation prong of secondary service connection.

Thus, the Board finds a remand is required to address the duty to assist errors.

6. Entitlement to service connection for retinal detachment and pseudophakia, right eye is remanded.

7. Entitlement to service connection for retinal detachment and pseudophakia, left eye is remanded.

The Board finds that duty to assist errors occurred prior to the February 2025 rating decision on appeal. The VA examiners used the Veteran's right and left eye interchangeably throughout the medical opinions. The Veteran's service treatment records reflect that the Veteran had a pre-existing left eye disability, and the Veteran injured his left eye during service with a piece of paper. The opinions provided do not clearly differentiate the Veteran's eye disabilities. The Board also finds that the TERA medical opinion does not adequately discuss the exposures that are under consideration beyond general terms. Thus, the Board finds a remand is required to address the duty to assist errors, and secure addendum medical opinions.

8. Entitlement to service connection for sleep apnea is remanded.

The Veteran contends that he has sleep apnea related to his active military service. Specifically, within his September 2024 formal claim he stated,

Whereas, there is no immediate evidence that PFAS and AFFF contributes to sleep apnea, and this is playing out in the courts, Over the course of my career my sleeping has worsened, and my partner tell me I snore and stop breathing several times a night. I'd appreciate this being considered.

The Board finds that duty to assist errors occurred prior to the February 2025 rating decision on appeal. Specifically, the RO secured a TERA medical opinion that did not link the Veteran's sleep apnea to the toxic exposure. However, no medical opinion was secured addressing the nature and etiology of the Veteran's sleep apnea which addressed the Veteran's contentions that his condition began in the 1980's and manifested as fatigue, insomnia, and snoring.

Thus, the Board finds a remand is required to secured an addendum direct service medical opinion.

The matter is REMANDED for the following action:

1. With any necessary assistance from the Veteran, obtain any relevant outstanding private treatment records from Lake Regional Health systems related to hypertension screening results, and associate them with the Veteran's claims file.

2. Obtain an addendum opinion from an appropriate medical professional who has the requisite experience to render the requested medical opinions. Provide the examiner with the Veteran's complete record, to include a copy of all remands, and the claims folder. No examination of the Veteran is necessary unless the examiner deems otherwise.

(a.) Whether the Veteran's left-hand arthritis was at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated beyond its natural progression by the Veteran's service-connected left thumb disability.

(b.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed right hand disability had its onset during or is otherwise etiologically related to the Veteran's active service.

The examiner must discuss whether the Veteran's pain alone results in a functional impairment that affects his earning capacity, that can constitute a disability even if there was no identified underlying diagnosis during the Veteran's active military service. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

3. Obtain an addendum opinion from an appropriate medical professional who has the requisite experience to render the requested medical opinions. Provide the examiner with the Veteran's complete record, including copies of all remands, and the claims folder. No examination of the Veteran is necessary unless the examiner deems otherwise.

(a.) Whether the Veteran's degenerative arthritis right foot condition was at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated beyond its natural progression by the Veteran's service-connected residuals fractured fourth and fifth toes on the right foot condition.

(b.) Whether the Veteran's plantar calcaneal spurs condition was at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated beyond its natural progression by the Veteran's service-connected residuals fractured fourth and fifth toes on the right foot condition.

i. The examiner must provide the underlying reasons for any opinions provided. If the examiner is unable to provide this opinion without resorting to speculation, he or she must indicate why this
Whether the Veteran's degenerative arthritis right foot condition was at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated beyond its natural progression by the Veteran's service-connected residuals fractured fourth and fifth toes on the right foot condition.

ii. If aggravation is shown, the examiner should quantify the degree of aggravation, if possible. The question of secondary aggravation must be addressed separately from the question of secondary causation. The examiner must note that an opinion to the effect that one disability is not "caused by," "a result of," or "secondary to" another disability does not answer the question of aggravation and will necessitate a further opinion.

4. Obtain an addendum opinion from an appropriate medical professional who has the requisite experience to render the requested medical opinions. Provide the examiner with the Veteran's complete record, to include a copy of all remands, and the claims folder. No examination of the Veteran is necessary unless the examiner deems otherwise.

(a.) Clarify whether the Veteran's left eye conditions clearly and unmistakably pre-existed service and whether any pre-existing left eye conditions, clearly and unmistakably were NOT aggravated beyond its normal progression by active service. Any such evidence should be identified with specificity.

The examiner must specifically discuss the Veteran's service treatment records that reflected that the Veteran injured his left eye with paper.

i. The term "clear and unmistakable means "obvious or manifest," "cannot be misinterpreted and misunderstood," or "undebatable." See 38 C.F.R. § 3.304(b); see also Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009).

ii. A complete rationale must be provided for all opinions offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training.

iii. If the examiner finds that he/she cannot provide an opinion without resorting to speculation, he/she should explain the inability to provide an opinion and identify precisely what facts could not be determined. He/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). The AOJ should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained.

Left Eye

(b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the diagnosed left eye conditions (excluding the pre-existing left eye disabilities) were incurred in, or are otherwise etiologically related to his military service;

i. Determine the nature and etiology of the left eye disabilities (excluding the pre-existing left eye disability).

ii. The examiner must specifically discuss the Veteran's service treatment records that reflected that the Veteran injured his left eye with paper.

(c.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the diagnosed left eye conditions (excluding the pre-existing left eye disabilities) are due to the total potential exposure from the Veteran's military deployments; or,

(d.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the diagnosed left eye conditions (excluding the pre-existing left eye disabilities) are due to the synergistic, combined effect of all toxic exposure risk activities (TERA)?

Right Eye

(e.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the diagnosed right eye conditions were incurred in, or are otherwise etiologically related to his military service;

Determine the nature and etiology of the right eye disabilities.

(f.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the diagnosed right eye conditions are due to the total potential
approximately balanced or nearly equal, if not higher) that any of the diagnosed left eye conditions (excluding the pre-existing left eye disabilities) are due to the synergistic, combined effect of all toxic exposure risk activities (TERA)?

Right Eye

Determine the nature and etiology of the right eye disabilities.

(g.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any of the diagnosed right eye conditions are due to the synergistic, combined effect of all toxic exposure risk activities (TERA)?

5. Obtain an addendum opinion from an appropriate medical professional who has the requisite experience to render the requested medical opinions. Provide the examiner with the Veteran's complete record, to include a copy of all remands, and the claims folder. No examination of the Veteran is necessary unless the examiner deems otherwise.

(a.) Determine the nature and etiology of the Veteran's sleep apnea.

(b.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's sleep apnea disability had its onset during or is otherwise etiologically related to the Veteran's active service.

The examiner must address the Veteran's contention that his condition began in the 1980's and manifested as fatigue, insomnia, and snoring. Over the course of his career his sleeping has worsened, and his partner tells him he snores and stops breathing several times a night.

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Quist, Counsel

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

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