POSTTRAUMATIC STRESS DISORDER, OBSESSIVE-COMPULSIVE DISORDER, GENERALIZED ANXIETY DISORDER, AND UNSPECIFIED DEPRESSIVE DISORDER

ERIC S. LEBOFF · 2026 · Case ID: A26040178

MIXED

Summary

The veteran, who served, appeals the denial of increased ratings for PTSD, OCD, GAD, and unspecified depressive disorder, as well as for post-salpingectomy residuals and TMJ disorders. The veteran also sought a compensable rating for non-allergic rhinitis and headaches associated with it, and for diplopia, vitreous floaters, convergence insufficiency, and meibomian gland dysfunction. The Board denied increased ratings for the psychiatric conditions, finding that while the veteran experiences significant occupational and social impairment, her symptoms do not rise to the level of total impairment required for a 100% rating. Both the LCSW and C&P examiner concluded her impairment was severe but not total. For post-salpingectomy residuals, the Board denied an increased rating, finding the 10% rating for symptoms requiring continuous treatment was appropriate, as the evidence did not support symptoms not controlled by treatment. The Board granted a 30% rating for TMJ disorders, based on objective findings of limited jaw opening and dietary restrictions to soft foods, which the Board found warranted this rating for the entire appeal period. Service connection for headaches associated with rhinitis was granted, but a compensable rating for rhinitis itself was denied due to lack of objective findings like polyps or significant nasal obstruction. Claims for diplopia and related eye conditions were denied, as the Board found the diplopia was occasional and correctable with spectacles, and other eye conditions did not meet the criteria for a compensable rating.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250811-572974

Full Decision Text

Citation Nr: A26040178
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250811-572974
DATE: April 29, 2026

ORDER

Entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and unspecified depressive disorder, is denied.

Entitlement to a disability rating in excess of 10 percent for post-salpingectomy residuals is denied.

Entitlement to a disability rating of 30 percent for temporomandibular joint (TMJ) disorders is granted.

Entitlement to a compensable disability rating for non-allergic rhinitis is denied.

Entitlement to service connection for headaches due to service-connected non-allergic rhinitis is granted.

Entitlement to a compensable disability rating for diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction, is denied.

FINDINGS OF FACT

1. Throughout the rating period on appeal, the Veteran's PTSD, OCD, GAD, and unspecified depressive disorder have been manifested by symptoms resulting in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood but without total social and occupational impairment.

2. Throughout the rating period on appeal, the Veteran's post-salpingectomy residuals are manifested by symptoms that require continuous treatment.

3. Throughout the rating period on appeal, TMJ disorders are manifested by interincisal range of 21 to 29 mm of maximum unassisted vertical opening with dietary restrictions to soft and semi-solid foods.

4. Non-allergic rhinitis has not been manifested by nasal polyps or obstruction of the nasal passage.

5. The evidence is at least in equipoise as to whether the Veteran's headaches are due to service-connected rhinitis.

6. Throughout the rating period on appeal, diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction, have been manifested by occasional diplopia that is correctable with spectacles with noncompensable visual acuity and normal visual fields without incapacitating episodes.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a disability rating in excess of 70 percent for PTSD, OCD, GAD, and unspecified depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.130, Diagnostic Code (DC) 9411.

2. The criteria for entitlement to a disability rating in excess of 10 percent for post-salpingectomy residuals have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.116, DC 7614.

3. The criteria for entitlement to a disability rating of 30 percent for TMJ disorders have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.73 DC 9905.

4. The criteria for entitlement to a compensable disability rating for non-allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.97, DC 6522.

5. The criteria for entitlement to service connection for headaches associated with non-allergic rhinitis have been met. 38 C.F.R. §§ 3.303, 3.310.

6. The criteria for entitlement to a compensable disability rating for diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.76, 4.79, DCs 6090-6066.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

In an April 2025 rating decision, the Agency of Original Jurisdiction (AOJ) granted a 10 percent disability rating for post-salpingectomy residuals, effective October 3, 2024; and denied increased ratings for PTSD, OCD, GAD, and unspecified depressive disorder (70%), TMJ disorders (10%), non-allergic rhinitis (0%), and diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction (0%). In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 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 order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his 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.

If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7.

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21.

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, 593 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also
sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21.

With her supplemental claim, the Veteran submitted a private opinion written in November 2024. The opinion states that it is a Report of Consultation and Examination in support of the Veteran's claims, which was prepared by Dr. Alison Nida, D.C., a Doctor of Chiropractic medicine. Notably, the report indicates that the Veteran presented to her office "for assistance in military medical issues." Dr. Nida further explains that "It is the intent of this consultation, examination, and report to assist the Veteran with defining and explaining any applicable injuries or illnesses on which benefits will be applied for." Additionally, it was also her intent "to provide the VA reader with acceptable objective data supporting any illness or injury, as well as the basis on which service connection will be claimed by the Veteran." To be clear, the Veteran is unrepresented in this matter and Alison Nida is not included on the list of agents who are accredited to provide representation to Veterans before VA.

Entitlement to a disability rating in excess of 70 percent for PTSD, OCD, GAD, and unspecified depressive disorder, is denied.

The General Rating Formula for Mental Disorders provides for a 70 percent rating when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or PTSD affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships.

A 100 percent evaluation is warranted for total occupational and social impairment, due to symptoms such as the following: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130.

Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). When determining the appropriate disability evaluation to assign, however, the Board's "primary consideration" is the Veteran's symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record.

Service connection is in effect for PTSD, OCS, GAD and unspecified depressive disorder rated 70 percent disabling effective June 14, 2023. On October 3, 2024, the Veteran filed an Intent to File, and in January 2025 filed an increased rating claim.

In November 2024, the Veteran underwent an evaluation with M.M. Phelps, a licensed clinical social worker. The examiner diagnosed PTSD and depressive disorder due to another medical condition. She has PTSD manifested by hypervigilance, hyperarousal, avoidance of interacting, feeling disconnected, problems sleeping, and being easily agitated. She has depression with loss of interest in things once enjoyed due to pain and physical limitations,
connection is in effect for PTSD, OCS, GAD and unspecified depressive disorder rated 70 percent disabling effective June 14, 2023. On October 3, 2024, the Veteran filed an Intent to File, and in January 2025 filed an increased rating claim.

In November 2024, the Veteran underwent an evaluation with M.M. Phelps, a licensed clinical social worker. The examiner diagnosed PTSD and depressive disorder due to another medical condition. She has PTSD manifested by hypervigilance, hyperarousal, avoidance of interacting, feeling disconnected, problems sleeping, and being easily agitated. She has depression with loss of interest in things once enjoyed due to pain and physical limitations, and she felt hopeless to improve her health and physical abilities. The examiner checked the box for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran reported being married with one child. She did not feel physically fit to have another child and had been struggling with intimacy due to her fear of getting pregnant and emotional disconnect. She reported current employment.

Her symptoms were depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, and inability to establish and maintain effective relationships. The examiner noted that the Veteran felt anxious at work. She is easily startled due to hypervigilance and hyperarousal. She was not good when a plan changes, especially when the changes are going to affect people. She is routine-oriented and rule-driven. She has only been in the position for a week; however, she endorsed feeling worried about the role. She has lost confidence in her abilities due to her military experiences. She was obsessive and perfection-seeking. She felt that if she had a strong plan it would be easier to manage her stress; however, when the routine is disrupted she is emotionally withdrawn and avoids interacting with others. She endorsed feeling suspicious of others as they walked by her cubical. She is unable to rearrange the area to help her see the opening to the cubicle which is behind her. As a result, she often turns to see who is walking by the area which is distracting her in her role. She reported a lack of positive emotional experiences and a lack of interest. She likely presents with anhedonia. She reported various negative emotional experiences and likely is inhibited behaviorally by these emotions. She also likely is self-critical and guilt-prone.

In particular, she reports multiple fears that significantly restrict normal activity in and outside the home. She also reports multiple anxiety related experiences including generalized anxiety, reexperiencing, intrusive ideation, startle response, and panic. She very likely experiences significant anxiety and anxiety-related problems, PTSD features include intrusive ideation, nightmares, and panic. In additional, she reports multiple problems involving stress and feeling nervous. She very likely complains about stress and feels incapable of controlling her anxiety level. She reports excessive worry, including worries about misfortune and finances, as well as preoccupation with disappointments. She likely worries excessively and ruminates. She also reports engaging in compulsive behavior, including repetitive checking and counting and making sure things are in place. She very likely engages in compulsive behavior such as repeated checking, experiences obsessions and is rigid and perfectionistic. She reports feeling overwhelmed and being extremely unhappy, sad and dissatisfied with her life. She very likely complains about significant depression and experiences sadness and despair. She reports conflictual family relationships and a lack of support from family members. She likely has family conflicts and experiences poor family functioning. Her responses indicated a higher-than-average level of behavioral constraint.

In January 2025, the Veteran underwent a C&P examination with a psychologist wherein the examiner diagnosed PTSD, OCS, GAD, and unspecified depressive disorder. The examiner noted that PTSD is associated with recurrent memories and dreams, triggers or reminders (visual, auditory, or olfactory) that result in emotional and physiological distress, avoidance of situations and places, negatively altered world view, loss of interest in things once enjoyed, feeling more detached from others, hypervigilance, irritability, poor sleep, poor focus/memory, startle reactions. Unspecified depressive disorder is associated with depressive symptoms that are not consistent (come and go). The claimant reports having days that are experienced as "normal or better." On depressed days symptoms include feeling low or empty, unmotivated, and fatigued. Poor sleep was also reported. GAD is associated
unspecified depressive disorder. The examiner noted that PTSD is associated with recurrent memories and dreams, triggers or reminders (visual, auditory, or olfactory) that result in emotional and physiological distress, avoidance of situations and places, negatively altered world view, loss of interest in things once enjoyed, feeling more detached from others, hypervigilance, irritability, poor sleep, poor focus/memory, startle reactions. Unspecified depressive disorder is associated with depressive symptoms that are not consistent (come and go). The claimant reports having days that are experienced as "normal or better." On depressed days symptoms include feeling low or empty, unmotivated, and fatigued. Poor sleep was also reported. GAD is associated with excessive worry, poor focus, irritability, rumination, poor sleep, panic symptoms, and avoids various activities as a result. OCD is associated with obsessions and time consuming and frustrating rituals. PTSD, depression, GAD, and OCD are all associated with avoidance behaviors, poor focus, poor sleep, irritability, decrease interest in activities, and negative alterations in mood and cognition.

The examiner summarized the Veteran's level of occupational and social impairment as occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood. The Veteran reported being married with one child. She is employed. She has taken Prozac in the past and is involved in therapy. She denied any excessive alcohol use or illegal substances. Her symptoms were depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, obsessional rituals which interfere with routine activities, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene.

On mental status exam, she was wearing casual civilian clothing and had no abnormal motor movements. She had good eye contact. She was a reliable historian and cooperative. Her mood was depressed. Her affect was congruent with mood with full range. Her speech was normal in rate, volume and tone. She has had suicidal thoughts but denied suicidal ideation at the time of the examination. She was alert and fully oriented times 4. She denied homicidal thoughts/intent. She denied audio/visual hallucinations. She denied delusions. She endorses checking rituals. Her attention and concentration were good but memory issues were reported. Her insight/judgment was fair to good.

Based on the objective findings of record and the Veteran's documented subjective complaints, the Board finds that the 70 percent disability rating in effect contemplates her symptoms and the resultant impairment associated with her PTSD, GAD, OCD and unspecified depressive disorder. As detailed, both the November 2024 LCSW and January 2025 C&P psychologist determined that her psychiatric disabilities were manifested by occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood which is contemplated by the 70 percent rating in effect.

Based on review of the evidence of record, it is clear that the Veteran suffers from deficiencies in most areas of her life due to her psychiatric disabilities, but her disabilities do not result in total social or occupational impairment. The clinical findings do not reflect gross impairment in thought processes or communications; persistent danger of hurting herself or others; persistent delusions or hallucinations; grossly inappropriate behavior; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. The Board acknowledges that the January 2025 C&P examiner checked the box for intermittent inability to perform activities of daily living, which is contemplated by a 100 percent rating, but the report does not reflect any specific detail regarding this symptom. Also, the November 2024 examiner did not make a finding that this symptom was present. Again, both examiners concluded that her symptoms were manifested by occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood, and not total occupational and social impairment. Despite the Veteran's mental health symptoms, the symptoms that have been demonstrated have not resulted in total social impairment nor occupational impairment. The Veteran was married and was a parent of one child. At the time of both examinations, the Veteran reported being employed. Based on the above, there is no basis for a finding of a total rating for the period in question. In sum, the Veteran's symptoms associated with her PTSD, GAD, OCD, and unspecified depressive disorder do not warrant a 100 percent disability rating for the appeal period.

Entitlement to a disability rating
and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood, and not total occupational and social impairment. Despite the Veteran's mental health symptoms, the symptoms that have been demonstrated have not resulted in total social impairment nor occupational impairment. The Veteran was married and was a parent of one child. At the time of both examinations, the Veteran reported being employed. Based on the above, there is no basis for a finding of a total rating for the period in question. In sum, the Veteran's symptoms associated with her PTSD, GAD, OCD, and unspecified depressive disorder do not warrant a 100 percent disability rating for the appeal period.

Entitlement to a disability rating in excess of 10 percent for post-salpingectomy residuals is denied.

Service connection is in effect for post-salpingectomy residuals, rated noncompensably disabling effective June 14, 2023. On October 3, 2024, the Veteran filed an Intent to File, and in January 2025 filed an increased rating claim. In the April 2025 rating decision, a 10 percent disability rating was assigned to post-salpingectomy residuals, effective October 3, 2024. The Board notes that service connection is also in effect for surgical scars (10% 06/14/2023); such rating is not in appellate status.

The Veteran's post-salpingectomy residuals are rated pursuant to DC 7614 and the General Rating Formula for Diseases, Injury, or Adhesions of Female Reproductive Organs. A 0 percent rating is warranted with symptoms that do not require continuous treatment. A 10 percent rating is warranted with symptoms that require continuous treatment. A 30 percent rating is warranted with symptoms not controlled by continuous treatment.

The November 2024 report from Chiropractor Nida reflects that since surgery the Veteran has continued to suffer from consistent pelvic pain located around the left lower quadrant. Her pain varied in intensity and intensified with her menstrual cycle, as well as with sexual intercourse. She also found increased pain with sitting and when arising from a seated position. The diagnosis was extension of service-connected post-salpingectomy residuals. 01/15/2025 Medical Opinion at 1.

A January 2025 C&P gynecological conditions examination reflects a diagnosis of salpingectomy. The Veteran had post-salpingectomy residuals due to surgery on left in January 2018 for ectopic pregnancy. She reported left lower stabbing burning pain, and has been told she has scar tissue by CT evaluation. Current symptoms include stabbing pain, worse with running, sitting, and intercourse. Twisting and stretching were better with acupuncture. She had a trial of saline injections for hot prickly pain at her scar line. She has an antalgic gait due to pain. Her symptoms were moderate pain that was constant. She had been treated for symptoms, specifically with a saline injection to the scar line in 2022. She currently undergoes acupuncture. Her symptoms required continuous treatment for conditions of the fallopian tubes. The examiner did not check the box indicating that her symptoms were not controlled by continuous treatment. She has not been diagnosed with any conditions of the vulva or clitoris, vagina, and cervix. She has not had a hysterectomy or oophorectomy.

With regard to the fallopian tubes, she had ectopic post left ovary removal, now with adhesions. She was not in menopause. She did not have evidence of complete atrophy of 1 or both ovaries. She had not been diagnosed with any other diseases, injuries, adhesions and/or other conditions of the ovaries. She did not have urinary incontinence/leakage. She did not have a rectovaginal fistula or urethrovaginal fistula. She did not have endometriosis. She did not have pelvic organ prolapse. She had continued pain in the abdomen and scar. The examiner referenced an October 2018 CT of the abdomen which showed a small amount of free fluid in the pelvis. This was likely physiologic, though could also indicate an infectious or inflammatory process. There was no discrete abscess. She had difficulty concentrating and lifting with abdominal pain.

Based on review of the evidence of record, to include the Veteran's lay assertions, the Board finds that the 10 percent disability rating in effect compensates the Veteran for her post-salpingectomy residuals, which require continuous treatment. This rating most nearly approximates the disability picture shown. Specifically, she is currently undergoing acupuncture, and has undergone saline injections at her scar line, although her scars
the abdomen and scar. The examiner referenced an October 2018 CT of the abdomen which showed a small amount of free fluid in the pelvis. This was likely physiologic, though could also indicate an infectious or inflammatory process. There was no discrete abscess. She had difficulty concentrating and lifting with abdominal pain.

While acknowledging the Veteran's subjective complaints, a 30 percent rating is not warranted for post-salpingectomy residuals as the evidence of record does not reflect that she has symptoms not controlled by continuous treatment. Specifically, the C&P examiner conducted an in-person examination and reviewed records and determined that while her symptoms require continuous treatment, there was no finding that symptoms were not controlled by continuous treatment. Additionally, while the report noted constant pain, it was determined that such was moderate in degree, supporting a finding that treatment was controlling (though not eliminating) her symptoms. There are no other diagnostic criteria which could provide the basis for a rating in excess of the 10 percent disability rating in effect. For such reasons, entitlement to an increased rating for post-salpingectomy residuals is denied.

Entitlement to a disability rating in excess of 10 percent for TMJ disorders is denied.

Service connection is in effect for TMJ disorders, rated 10 percent disabling effective June 14, 2023. On October 3, 2024, the Veteran filed an Intent to File, and in January 2025 filed an increased rating claim.

The Veteran's service-connected TMJ disorders is rated 10 percent disabling per DC 9905 which pertains to temporomandibular disorder per 38 C.F.R. § 4.150. Per DC 9905, when the interincisal range is 30 to 34 mm of maximum unassisted vertical opening, a 10 percent rating is assigned when there are no dietary restrictions to mechanically altered foods, a 20 percent rating is assigned with dietary restrictions to soft and semi-solid foods; and, a 30 percent rating is assigned with dietary restrictions to full liquid and pureed foods. When the interincisal range is 21 to 29 mm of maximum unassisted vertical opening, a 20 percent rating is assigned without dietary restrictions to mechanically altered foods; a 30 percent rating is assigned with dietary restrictions to soft and semi-solid foods; and, a 40 percent rating is assigned with dietary restrictions to full liquid and pureed foods. When the interincisal range is 11 to 20 mm of maximum unassisted vertical opening, a 30 percent rating is assigned without dietary restrictions to mechanically altered foods; and a 40 percent rating is assigned with dietary restrictions to all mechanically altered foods. When the interincisal range is 0 to 10 mm of maximum unassisted vertical opening, a 40 percent rating is assigned without dietary restrictions to mechanically altered foods; and a 50 percent rating is assigned with dietary restrictions to all mechanically altered foods. 38 C.F.R. § 4.150 DC 9905.

Note (1): Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion. Note (2): For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm. Note (3): For VA compensation purposes, mechanically altered foods are defined as altered by blending, chopping, grinding, or mashing so that they are easy to chew and swallow. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. To warrant evaluation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician. 38 C.F.R. § 4.150, DC 9905, Notes (1), (2), and (3).

Separate ratings cannot be assigned for TMJ symptoms affecting each side of the jaw. See Vilfranc v. McDonald, 28 Vet. App. 357 (2017).

In the November 2024 opinion, Chiropractor Nida stated that the Veteran treats her TMJ with self-massage, as well as use of a night guard. She suffered from pain of the jaw, with clicking, grinding, and popping. On evaluation, there was loss of the ability to fully open the jaw/mouth. There was pain to palpation throughout
verified by a physician. 38 C.F.R. § 4.150, DC 9905, Notes (1), (2), and (3).

Separate ratings cannot be assigned for TMJ symptoms affecting each side of the jaw. See Vilfranc v. McDonald, 28 Vet. App. 357 (2017).

In the November 2024 opinion, Chiropractor Nida stated that the Veteran treats her TMJ with self-massage, as well as use of a night guard. She suffered from pain of the jaw, with clicking, grinding, and popping. On evaluation, there was loss of the ability to fully open the jaw/mouth. There was pain to palpation throughout the right and left TMJ and associated musculature. The diagnosis was extension of service-connected TMJ condition.

A February 2025 C&P examination reflects that when the condition began the symptoms were tooth pain, tooth sensitivity to hot and cold items, and headaches. She treated with occupational therapy for TMJ and was given a night guard. Current symptoms included headaches. Pain in the teeth and jaw were progressively getting worse. She treated with TMJ therapy, a night guard, and occasionally had to take Tylenol. Regarding the impact of her sometimes, sometimes it was very difficult to eat, and there were some days on which she could not eat on her left side at all. She had to take time off work when the pain in her teeth causes the headaches to be very severe. Flare-ups of the right and left TMJ occurred 3-4 times per week, which were moderate to severe and would last a couple of hours to all day. The flare-ups were precipitated by grinding teeth at night, clenching her jaw during the day. The flare-ups were alleviated by ice, rest, and occasional Tylenol. There was no functional impairment of the right and left TMJ due to flare-ups. It was noted that it was very difficult to eat and there are some days she cannot eat on her left side at all. She had to take time off work when the pain in her teeth causes the headaches to be very bad.

Objectively, the examiner noted that incisal range of motion diminishes after 3 active tests. A passive test was abnormal with range of motion 29 mm. On range of motion testing, right and left TMJ were normal. Active range of motion for interincisal distance was 21-29mm (26, 24, 23) and for both right (5mm) and left (7mm) lateral excursion was greater than 4mm. Range of motion on both right and left exhibited pain with mouth opening. Passive range of motion was the same with the examiner commenting that there is limitation of motion of interincisal distance attributable to fatigability. She had pain with chewing (mastication), with active motion and with passive motion, which caused function loss. Incisal range of motion diminishes markedly after 2 repetitions. There was crepitus and objective evidence of localized tenderness or pain on palpation or associated soft tissue of the right and left TMJ. There was no additional loss of function on repetitive range of motion. Fatigability significantly limited functional ability with repeated use over time and during flare-ups. The examiner commented that while the Veteran's range of motion was unchanged, functional ability was limited due to painful incisal opening observed/observed pain. She has dietary restrictions to soft and semi-solid food.

Based on the subjective complaints and objective findings contained in the February 2025 C&P examination report, a 30 percent disability rating is warranted for TMJ disorders. Specifically, the exam reflects an interincisal range of 21 to 29 mm of maximum unassisted vertical opening, and the Veteran has dietary restrictions to soft and semi-solid foods. Thus, based on the subjective complaints and objective findings a 30 percent disability rating is warranted effective October 3, 2024. A disability rating in excess of 30 percent is not warranted as the Veteran does not have dietary restrictions to full liquid and pureed foods; and the interincisal range is not from 11-20 mm nor 0-10 mm. Thus, based on the above a 30 percent disability rating is warranted for the entire appeal period, but the record is persuasively against a rating in excess of 30 percent.

Entitlement to a compensable disability rating for non-allergic rhinitis is denied.

Entitlement to a separate award of service connection for headaches associated with rhinitis is granted.

Service connection is in effect for non-allergic rhinitis, rated 0 percent disabling effective June 14,
A disability rating in excess of 30 percent is not warranted as the Veteran does not have dietary restrictions to full liquid and pureed foods; and the interincisal range is not from 11-20 mm nor 0-10 mm. Thus, based on the above a 30 percent disability rating is warranted for the entire appeal period, but the record is persuasively against a rating in excess of 30 percent.

Entitlement to a compensable disability rating for non-allergic rhinitis is denied.

Entitlement to a separate award of service connection for headaches associated with rhinitis is granted.

Service connection is in effect for non-allergic rhinitis, rated 0 percent disabling effective June 14, 2023. On October 3, 2024, the Veteran filed an Intent to File, and in January 2025 filed an increased rating claim.

The Veteran's non-allergic rhinitis is evaluated under DC 6522, which addresses both allergic and vasomotor rhinitis. 38 C.F.R. § 4.97. Under DC 6522, a 10 percent evaluation is assigned when there are no polyps, but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. A 30 percent evaluation is assigned when there are polyps as well.

The November 2024 report from Chiropractor Nida reflects that the Veteran has symptoms including congestion, postnasal drainage, facial pressure/pain, and watering eyes.

In January 2025, the Veteran underwent a C&P examination wherein the examiner diagnosed non-allergic rhinitis. The Veteran reported that she began experiencing daily nasal congestion in 2017 which she attributed to a deviated septum. She reported no change in symptoms. She reported a sinus infection once every year to 1.5 years. She reported continued nasal congestion and drainage. She did not have greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis; did not have complete obstruction on the left or right side due to rhinitis; did not have permanent hypertrophy of the nasal turbinates; and did not have nasal polyps. She does not have any granulomatous conditions. She had no other objective findings associated with her rhinitis, although she reported difficulty concentrating. The examiner noted that she reported having frontal headaches.

Based on the subjective complaints and objective findings, in consideration of DC 6522, the Board has determined that a 10 percent disability rating is not warranted for non-allergic rhinitis, as the objective medical evidence has not shown that the Veteran has rhinitis with polyps nor greater than 50 percent obstruction of the nasal passage or complete obstruction on one side. In sum, the evidence does not more nearly approximate a compensable disability rating for allergic rhinitis for any period contemplated by this appeal.

As detailed, however, the Veteran has reported frontal headaches associated with her rhinitis, and the January 2025 C&P examiner opined that this was a progression of her previous diagnosis. To account for these symptoms associated with her rhinitis, the Board will grant service connection for headaches. The AOJ will assign a schedular rating in the first instance.

Entitlement to a compensable disability rating for diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction, is denied.

Service connection is in effect for diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction, rated 0 percent disabling effective June 14, 2023. On October 3, 2024, the Veteran filed an Intent to File, and in January 2025 filed an increased rating claim.

The Veteran's diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction is rated pursuant to 38 C.F.R. § 4.79 DCs 6090 (Diplopia (double vision))-6066 (Visual acuity).

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).

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. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c).

When the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye (and the difference is not due to congenital or developmental refractive error), and either the poorer eye or both eyes are service connected, the visual acuity of the poorer eye will be evaluated using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity. 38 C.F.R. § 4.76(b)(1).

Provided that the claimant customarily wears contact lenses, evaluate the visual acuity of any individual affected by a corneal disorder that results in severe irregular astigmatism that can be improved more by contact lenses than by eyeglasses, as corrected by contact lenses. 38 C.F.R. § 4.76(b)(2).

Per DC 6090 Diplopia (double vision): (a) Central 20 degrees of diplopia is equivalent to 5/200 (1.5/6) visual acuity; (b) 21 degrees to 30 degrees (1) Down to 15/200 (4.5/60), (2) Lateral to 20/100 (6/30), (3) Up to 20/70 (6/21); and (c) 31 degrees to 40 degrees (1) Down to 20/200 (6/60), (2) Lateral to 20/70 (6/21), (3) Up to 20/240 (6/12). Note: In accordance with 38 C.F.R. § 4.31, diplopia that is occasional or that is correctable with spectacles is evaluated at 0 percent.

The November 2024 Report of Consultation and Examination with Chiropractor Nida reflects that the Veteran had floaters affecting both the left and right eyes. She reported that the right eye worse, with floaters are consistently present and located in her central vision zone. Left floaters occurred intermittently. She continued to suffer from diplopia. This will trigger headaches. She was monitored every six months by her ophthalmologist.

While consideration has been given to the opinion, this examiner is a chiropractor, not a medical doctor, and is not a specialist with regard to the eye or vision disabilities. The examiner has reported no training or expertise with eye disabilities. Thus, while the Board will accept this evaluation with regard to the Veteran's subjective complaints, there is no indication that the examiner conducted any testing, to include visual field or acuity. As such, the evaluation is not afforded any probative value.

A March 2025 C&P examination reflects diagnoses of vitreous floaters, convergence insufficiency with diplopia, meibomian gland dysfunction, and dry eye syndrome both eyes. The Veteran has noticed floating spots since 2018. She was diagnosed with this while in the military. This has worsened over time, and it has never been treated. It distracted the Veteran while completing tasks. The Veteran noticed that she saw double in 2019 when reading or focusing on things. She was diagnosed with convergence insufficiency while in the military. She was told to wear her glasses more regularly, but they did not treat the convergence insufficiency. This made it difficult to perform tasks up close/focusing tasks for long periods of time without going double/fatigued. She noticed her eyes burned toward the end of the day in 2021
and dry eye syndrome both eyes. The Veteran has noticed floating spots since 2018. She was diagnosed with this while in the military. This has worsened over time, and it has never been treated. It distracted the Veteran while completing tasks. The Veteran noticed that she saw double in 2019 when reading or focusing on things. She was diagnosed with convergence insufficiency while in the military. She was told to wear her glasses more regularly, but they did not treat the convergence insufficiency. This made it difficult to perform tasks up close/focusing tasks for long periods of time without going double/fatigued. She noticed her eyes burned toward the end of the day in 2021. She was later diagnosed with meibomian gland dysfunction. This was never treated, and it has worsened over time. The burning forced the Veteran to take breaks. She noticed her eye started feeling dry around 2021. She was never diagnosed with dry eye, and it has worsened over time. She was, however, told she could use eye drops if she needed them.

On examination, visual acuity in both eyes was 20/40 uncorrected distance, 20/20 or better corrected distance, 20/40 uncorrected near (reading), and 20/20 or better corrected near (reading). The Veteran does not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision with the near vision being worse. Her pupils were round and reactive to light and there was no afferent pupillary defect present. She does not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. She does not have a corneal irregularity that results in severe irregular astigmatism. She has diplopia with central 20 degrees, 21 to 30 degrees - down, lateral, up, 31 to 40 degrees - down, lateral, up, and greater than 40 degrees - down, lateral, up. The frequency is occasional and is correctable with standard spectacle correction. Slit lamp was abnormal with meibomian gland dysfunction. Conjunctiva/sclera was normal. Cornea showed decreased tear film. Anterior chamber, iris, and lens were normal. Fundus was abnormal, with normal optic disc, macula and vessels. Vitreous showed floaters with normal periphery. She had a documented visual field defect.

Visual field testing was performed using Goldmann's equivalent III/4e target. On testing, Up (90 degrees) was normal; Up Temporally (45 degrees OD/135 degrees OS) was normal; Temporally was 63 in the right eye and 67 in the left eye; Down Temporally was 70 in the right eye and 68 in the left eye; Down (270 degrees) was normal; Down Nasally (225 degrees OD/315 degrees OS) was normal; Nasally (180 degrees OD/0 degrees OS) was 59 in the right eye and normal in the left eye; and Up Nasally (135 degrees OD/45 degrees OS) was normal. She did not have loss of a visual field. She does not have scotoma. She did not have legal (statutory) blindness based upon visual field loss. She had lacrimal system condition, including dry eye syndrome; retina, macula or vitreous conditions; and other eye conditions. She had dry eye syndrome. She had not had laser eye surgery. She used over-the-counter artificial tear drops. Her decrease in visual acuity or other visual impairment was attributable to dry eye syndrome. Her vitreous floaters did not cause a decrease in visual acuity or other visual impairment. She had convergence insufficiency with diplopia both eyes which causes a decrease in visual acuity or other visual impairment. She had not had any incapacitating episodes. Vitreous floaters distract the Veteran while working; convergence insufficiency causes problems with long-term focusing tasks - double vision and eyestrain/fatigue; meibomian gland dysfunction causes fluctuating vision while performing long-term focusing tasks. It also causes dry, watery, burning eyes, forcing the Veteran to take breaks. Dry eye syndrome caused fluctuating vision while performing long-term focusing tasks. It also caused dry, watery, burning eyes, forcing the Veteran to take breaks.

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Based on the above, a compensable disability rating for diplopia is not warranted as her diplopia is occasional and is correctable with spectacles. A compensable disability rating is not warranted for
ers distract the Veteran while working; convergence insufficiency causes problems with long-term focusing tasks - double vision and eyestrain/fatigue; meibomian gland dysfunction causes fluctuating vision while performing long-term focusing tasks. It also causes dry, watery, burning eyes, forcing the Veteran to take breaks. Dry eye syndrome caused fluctuating vision while performing long-term focusing tasks. It also caused dry, watery, burning eyes, forcing the Veteran to take breaks.

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Based on the above, a compensable disability rating for diplopia is not warranted as her diplopia is occasional and is correctable with spectacles. A compensable disability rating is not warranted for visual acuity as his left eye shows corrected near vision of 20/20 and corrected far vision of 20/40, and the right eye shows corrected near vision of 20/40 and corrected far vision of 20/40. Moreover, there was no loss of visual fields bilaterally. The medical evidence of record also does not reflect incapacitating episodes associated with her eye disabilities. In consideration of the rating criteria, there is no basis for the assignment for a compensable rating for diplopia, vitreous floaters, convergence insufficiency, convergence insufficiency OU and meibomian gland dysfunction.

Eric S. Leboff

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kreindler, Marcy W.

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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