DISORDERS OF THE LACRIMAL APPARATUS

Summary

The Veteran served from May 1996 to May 2001. The Veteran appeals the denial of service connection for a bilateral eye disorder, for which a noncompensable evaluation was granted, and the denial of service connection for left hip disorder. The Veteran also appeals the remand of claims for left and right knee disorders, including medial and patellofemoral osteoarthritis. The Board denied the bilateral eye disorder claim, finding that the Veteran's symptoms, including dry eye syndrome and a corneal scar, did not meet the criteria for a compensable rating under the applicable diagnostic code (DC 6099-6025). The Board noted that while the Veteran reported symptoms like blurriness and dryness, the VA examination did not find a disorder of the lacrimal apparatus or other criteria for a higher rating. The Board gave more weight to the medical evidence from specialists over the Veteran's lay testimony regarding her eye condition. The Board found the evidence against the claim for an initial compensable rating for the bilateral eye disorder. The claims for bilateral knee disorders were remanded due to a pre-decisional duty to assist error, as the Board found the Veteran's assertions of knee pain since service, coupled with current and in-service diagnoses, warranted a medical examination and opinion. The left hip disorder claim was remanded as secondary to the bilateral knee disorders, making it inextricably intertwined with the knee claims.

Rationale

Symptoms did not meet criteria for compensable rating; No disorder of the lacrimal apparatus found; No disfigurement, scarring, decreased visual acuity, or incapacitating episodes noted

Full Decision Text

Citation Nr: A26039928
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 201225-129136
DATE: April 29, 2026

ORDER

Entitlement to an initial compensable evaluation for bilateral dry eye syndrome with corneal scar, left eye (bilateral eye disorder) is denied.

REMANDED

Entitlement to service connection for left knee disorder, to include medial and patellofemoral osteoarthritis, is remanded.

Entitlement to service connection for right knee disorder, to include medial and patellofemoral osteoarthritis, is remanded. 

Entitlement to service connection for left hip disorder, to include postsurgical sequelae from left hip arthroplasty, and to include as secondary to bilateral knee disorder, is remanded.

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FINDING OF FACT

The Veteran's bilateral eye disorder manifested with blurriness, dryness, and use of eye drops, but did not manifest as a disorder of the lacrimal apparatus, or with disfigurement, scarring, decrease in visual acuity, or other symptoms.

CONCLUSION OF LAW

The criteria for an initial compensable evaluation for the Veteran's bilateral eye disorder are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1-4.14, 4.79, Diagnostic Code (DC) 6099-6025.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from May 1996 to May 2001.

This case comes before the Board of Veterans' Appeals (Board) from a December 2020 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), hereinafter the Agency of Original Jurisdiction (AOJ), which granted service connection for bilateral eye disorder with a noncompensable evaluation effective August 24, 2020, and denied service connection for left hip disorder and bilateral knee joint pain. In December 2020, the Veteran submitted a timely Board Appeal: Notice of Disagreement (NOD), VA Form 10182, identifying issues decided in that decision, and electing the Hearing docket.

A hearing with a Veterans Law Judge was held on March 25, 2024; a transcript of the hearing is of record. Because the Veteran elected the Hearing docket, the Board may only consider the evidence of record at the time of the notification of the AOJ decision on appeal (December 7, 2020), as well as any evidence submitted by the Veteran at the hearing and within 90 days of the hearing (March 25, 2024 through June 24, 2024). 38 C.F.R. § 20.302. The Board cannot consider (1) evidence submitted during the period after the AOJ promulgated and issued the decision on appeal and before the hearing was held (December 8, 2020 through March 24, 2024), or (2) evidence submitted more than 90 days after the hearing was held (on or after June 25, 2024). 38 C.F.R. § 20.302. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300.

With regard to the denied eye claim, if the Veteran wishes VA to consider any evidence that falls into any period that the Board may not consider in this case, the Veteran may file a Supplemental Claim within one year of the Board's decision and submit or identify this evidence for review. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

With regard to the remanded claims, any evidence that is not considered by the Board at this time will be considered by the AOJ upon readjudication of this claim.

As a final initial matter, the Veteran indicated that she has issues with her eyes if she is working at the computer for hours at a time, and that she has to have the overhead lighting dimmed while working on the computer to avoid irritating her eyes; however, the evidence of record shows the Veteran is employed. See March 2024 Board Hearing. 

In this regard, the Veteran has not argued, nor does the evidence show, that the Veteran is precluded from obtaining or maintaining substantially gainful employment due to her service-connected disabilities; as such, the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is not implicated in this decision. See Rice v. Shinseki, 22 Vet. App. 447 (2009); see also Phillips
 if she is working at the computer for hours at a time, and that she has to have the overhead lighting dimmed while working on the computer to avoid irritating her eyes; however, the evidence of record shows the Veteran is employed. See March 2024 Board Hearing. 

In this regard, the Veteran has not argued, nor does the evidence show, that the Veteran is precluded from obtaining or maintaining substantially gainful employment due to her service-connected disabilities; as such, the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is not implicated in this decision. See Rice v. Shinseki, 22 Vet. App. 447 (2009); see also Phillips v. McDonough, 37 Vet. App. 394 (2024) (noting that TDIU is not a separate claim, but is a rating option available whenever a claimant attempts to get service connection or a higher rating from VA and the record includes evidence of unemployability). Nevertheless, the Board notes that the Veteran may file a Supplemental Claim within one year of the Board's decision and submit evidence for review regarding entitlement to a total disability based on individual unemployability (TDIU), and/or the Veteran may specifically file an application for a TDIU (VA Form 21-8940). 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

The Veteran asserts an initial compensable rating is warranted for her service-connected bilateral eye disorder. In her claim, the Veteran reported difficulty seeing at night in the left eye, blurred vision in the left eye, and decreased tear production due to this service-connected disorder. See August 2020 Claim.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4.  The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service.  The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).  If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7.  It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.  After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran.  38 C.F.R. § 4.3.  The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, are to be avoided.  38 C.F.R. § 4.14.

Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required.  See Fenderson v. West, 12 Vet. App. 119 (1999).  Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made.  Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007
 of different ratings for distinct periods of time, based on the facts found) is required.  See Fenderson v. West, 12 Vet. App. 119 (1999).  Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made.  Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

The period on appeal for this initial rating claim is from the effective date of the grant of service connection, which is August 24, 2020. See  Fenderson, supra. The Veteran has been awarded a noncompensable evaluation for her bilateral eye disorder under DC 6099-6025.

The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. 38 C.F.R. § 4.75(b). Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Visual impairment may also be rated based on impairment of visual field (DC 6080) and impairment of muscle function (DC 6090). Additional ratings may also be warranted for incapacitating episodes.

38 C.F.R. § 4.79 provides that unless otherwise directed, evaluation of diseases of the eye are under the General Rating Formula for Diseases of the Eye provides evaluation for overall visual impairment(s). Specific diagnostic codes that provide a separate disability rating are 6020 (Ectropion), 6021 (Entropion), 6022 (Lagophthalmos), 6023 (loss of eyebrows), 6024 (loss of eye lashes), and 6025 (disorders of the lacrimal apparatus).

The Veteran is currently assigned a noncompensable disability rating under DC 6099-6025. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned; the additional code is shown as a hyphen. 38 C.F.R. § 4.27. In the present case, unlisted disabilities requiring rating by analogy are coded with the first two numbers of the schedule provisions most closely related body part and 99. Here, the hyphenated diagnostic code indicates that the Veteran's bilateral dry eyes are currently rated as analogous to disorders of the lacrimal apparatus (DC 6025). 38 C.F.R. § 4.79, DC 6025. Therefore, the AOJ determined that the Veteran's disability was most closely analogous to DC 6025, for disorders of the lacrimal apparatus. Disabilities rated under analogous code sections will not show all of the objective criteria of the analogous rating. See Stankevich v. Nicholson, 19 Vet. App. 470 (2006).

Under DC 6025, a 10 percent rating is warranted for unilateral involvement and a 20 percent rating is warranted for bilateral involvement of a lacrimal apparatus disorder. 38 C.F.R. § 4.79, DC 6025. DC 6025 does not provide a noncompensable rating.

During the November 2020 VA eye examination, the Veteran reported she was told she had a severe corneal abrasion/ulcer left eye in 2004, and she was sent to a corneal specialist and had corneal scraping. She stated the condition resolved however she still had corneal scarring. The Veteran reported her current symptoms included dryness, irritation, and eye strain while on the computer. She reported using artificial tears as needed for treatment with little relief. She reported she has not had an occurrence of the ulcers or conjunctivitis in 10 years. 

The November 2020 VA examination report shows a checked box indicating that the Veteran had disorder of the lacrimal system, which is specifically noted to include dry eye syndrome on the VA examination reports. However, the examination report clarified that there was no "disorder of the lacrimal apparatus," but only dry eye syndrome. As there is not a disorder of the
 corneal scraping. She stated the condition resolved however she still had corneal scarring. The Veteran reported her current symptoms included dryness, irritation, and eye strain while on the computer. She reported using artificial tears as needed for treatment with little relief. She reported she has not had an occurrence of the ulcers or conjunctivitis in 10 years. 

The November 2020 VA examination report shows a checked box indicating that the Veteran had disorder of the lacrimal system, which is specifically noted to include dry eye syndrome on the VA examination reports. However, the examination report clarified that there was no "disorder of the lacrimal apparatus," but only dry eye syndrome. As there is not a disorder of the lacrimal apparatus, such as epiphora and dacryocystitis, a higher disability rating under DC 6025 is not warranted. 

In addition, the Veteran is service connected for a corneal scar left eye, for which the VA examiner stated "corneal scarring left eye (secondary to history of corneal ulcers)"; however, the Board notes that a corneal scar does not meet the requirement for scar or disfigurement DCs. The VA examination report noted bilateral dry eye syndrome was a corneal condition due to reduced tear film, and also noted for the left eye "trace superficial punctate keratitis (dry eye syndrome), stromal scarring central." The Board notes there was no disfigurement or scarring, no decrease in visual acuity, no visual field defect, and no incapacitating episodes due to the service-connected eye disorder or other service-connected eye disability. 

During the March 2024 Board Hearing, the Veteran testified that she was not receiving any treatment for her eye disorders at the time and she had not been prescribed any drops or ointments by any optometrists. She testified she had to keep dry eye eyedrops handy for her disorder, especially when working on the computer. She testified that she experienced sensitivity to light, so she had to keep the overhead lights dimmed, and her left eye got blurry and watery when overstimulated by lights. She stated she bought her eye drops over the counter at the drug store. She stated when working in an office, she cannot handle the neon lights and the constant flickering agitated her eye so that it twitched constantly. At the office, she has asked to turn off the overhead lights, and if not many people are there, they allow this. However, if there are a lot of people, the Veteran has asked to finish her work at home. She stated she has not had an issue with her peripheral vision or seeing black spots or anything of the sort; she stated she does not see double, she stated it is more of a blurring when she overstrains her eye. She stated she does not regularly see a doctor for her eye problems. She stated her up close vision has gotten worse. She stated she feels there has been some deterioration in her vision since the December 2020 eye examination, but that it may be due to old age. She stated she has not had a recent, full examination of the eyes.

The Board acknowledges the Veteran's lay statements and arguments that she is entitled to a higher rating; however, more weight is given to the medical evidence, which was undertaken by medical specialists in the treatment of the eye. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue).

The Board has also considered whether a disability rating for any other DC pertaining to the eye is warranted. The Board finds that the Veteran's service-connected disabilities do not have any relevant symptoms contemplated by those DCs, to include incapacitating episodes (General Rating Formula for Diseases of the Eye), the specific disorders listed in DCs 6010-6046 (besides dry eye syndrome and pinguecula), impairment of central visual acuity (6061- 6066), visual field defects (DC 6080), diplopia (DC 6090), or any alike symptoms contemplated by the schedule of ratings-eye. See 38 CFR § 4.79.

Accordingly, the evidence of record is against the claim of entitlement to an initial compensable disability rating for bilateral eye disorder. 38 C.F.R. § 4.79, DC 6099-6025. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt
 Formula for Diseases of the Eye), the specific disorders listed in DCs 6010-6046 (besides dry eye syndrome and pinguecula), impairment of central visual acuity (6061- 6066), visual field defects (DC 6080), diplopia (DC 6090), or any alike symptoms contemplated by the schedule of ratings-eye. See 38 CFR § 4.79.

Accordingly, the evidence of record is against the claim of entitlement to an initial compensable disability rating for bilateral eye disorder. 38 C.F.R. § 4.79, DC 6099-6025. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

REASONS FOR REMAND

The Veteran asserts that she has bilateral knee pain that began during service and has continued since that time.

The Veteran has a current diagnosis of a bilateral knee disorder, namely medial and patellofemoral osteoarthritis. See Medical Treatment Records (received by VA on June 14, 2024). The Board notes these records that contain the bilateral knee diagnoses were made part of the claims file after the rating decision on appeal; however, the Veteran complained of knee pain in the August 2020 Fully Developed Claim. Despite these lay statements of knee pain, the AOJ did not consider the fact that pain that causes functional impairment can qualify as a disability for VA compensation purposes. See Saunders v. Wilkie, 886 F.3d 1356 (2018) (despite lack of a formal diagnosis, symptoms may count as a disability for VA compensation purposes if they cause functional impairment). Thus, remand is required in order to rectify this pre-decisional duty to assist error. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Saunders, supra.

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Additionally, the Veteran's service treatment records (STRs) show a diagnosis of patellofemoral pain syndrome (PFPS) on May 6, 1998; the Veteran's February 22, 2001 Separation Examination has a notation of PFPS on the last page; the Veteran's March 12, 2001 Separation Report of Medical History shows "PFPS - evaluated and does self rehab" and leg cramps; and the Veteran's July 26, 2002 Report of Medical History for the Reserves shows knee trouble (during the March 2024 Board Hearing the Veteran stated she applied for reserve service but never did it).

In this regard, the Board notes the Veteran has not been afforded a medical examination in connection with this claim. In sum, the Veteran asserts that her knee pain began in service, the Veteran has current diagnoses for her bilateral knees, and there are in-service diagnoses for her bilateral knees. Thus, the low threshold for obtaining a medical examination and opinion under McLendon for these disorders have been met. As such, remand for such to be obtained is necessary in order to correct this pre-decisional duty to assist error. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); Barr, supra.

Lastly, for the left hip, the Veteran has alleged, in addition to a direct service connection theory of entitlement, that her left hip disorder is secondary to her bilateral knee disorders. As such, the issue is inextricably intertwined with the issue of service connection for bilateral knee disorder; thus, it would be premature to decide this issue at this time. Therefore, the Board must also remand this issue as intertwined with the above remanded issues. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).

The matters are REMANDED for the following action:

Schedule the Veteran for an examination with an appropriate examiner in order to determine whether the Veteran's bilateral knee disorder is related to service. The claims file must be made available to, and reviewed by, the examiner in conjunction with the examination. All tests deemed necessary should be conducted and the results reported in detail. 

During the examination, the examiner must obtain an extensive and detailed medical history of the bilateral knee disorder, including onset of symptoms and the medical course of those symptoms
anded issues. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).

The matters are REMANDED for the following action:

Schedule the Veteran for an examination with an appropriate examiner in order to determine whether the Veteran's bilateral knee disorder is related to service. The claims file must be made available to, and reviewed by, the examiner in conjunction with the examination. All tests deemed necessary should be conducted and the results reported in detail. 

During the examination, the examiner must obtain an extensive and detailed medical history of the bilateral knee disorder, including onset of symptoms and the medical course of those symptoms.

After review of the record and examination of the Veteran, the examiner should state any and all knee disorders found, including any arthritic conditions thereof.  

Thereafter, the examiner must then opine whether the Veteran's identified knee disorders, to include medial and patellofemoral osteoarthritis, began in service, within one year of discharge therefrom, or is otherwise related to military service, to include as due to overuse as a hospital corpsman.

In addressing the above, the examiner should address: (i) the May 6, 1998 STRs showing a diagnosis of patellofemoral pain syndrome (PFPs), (ii) the February 22, 2001 Separation Examination showing PFPs, (iii) the March 12, 2001 Separation Report of Medical History showing PFPs - evaluated and does self rehab, and leg cramps, (iv) the July 26, 2002 Report of Medical History for the Reserves showing knee trouble (during the Board Hearing the Veteran stated she applied for reserve service but never did it), (v) the Veteran's lay statements in the August 2020 Claim, (vi) the Veteran's testimony during the March 2024 Board Hearing, (vii) the Veteran's June 2024 Statement in Support of Claim, and (viii) any other lay statements regarding onset of her symptomatology and the continuity of symptomatology since onset and/or since discharge from service.

All findings should be reported in detail and all opinions must be accompanied by a clear rationale.

 

 

MARTIN B. PETERS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Garfield, Jeannine F.

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.