DISORDERS OF THE LACRIMAL APPARATUS

THOMAS H. O'SHAY · 2026 · Case ID: A26040336

MIXED

Summary

The Veteran served from September 1980 to March 1983. The Veteran appeals the denial of increased ratings for bilateral dry eye syndrome and urinary frequency, and the remand of claims for bilateral pes planus, right leg weakness, bilateral knee strain with degenerative arthritis, and right ankle degenerative arthritis. For bilateral dry eye syndrome, the Board found the objective medical findings from a January 2021 VA examination, which noted corrected visual acuity of 20/40 in both eyes and a disorder of the lacrimal apparatus, did not support a rating higher than the granted 20 percent. For urinary frequency, the Board found the July 2020 VA examination, which noted nighttime awakenings to void three to four times, was persuasive and did not support a higher rating than the granted 20 percent. The Board noted that the rating criteria for genitourinary conditions were revised after the decision on appeal, but the prior criteria applied. For the remanded issues, the Board found that the VA examinations did not adequately consider the ameliorative effects of the Veteran's medications, citing Jones v. Shinseki and Ingram v. Collins. Additionally, the July 2020 ankle examination was deficient for failing to provide painful weight-bearing range of motion findings as required by Correia v. McDonald. The Board remanded these issues for new examinations that comply with these directives, including assessing the severity of the conditions if medications were removed and providing proper range of motion measurements.

Rationale

VA examination noted bilateral dry eye syndrome with corrected visual acuity of 20/40 in both eyes.; Disorder of the lacrimal apparatus rated under DC 6025, which provides a fixed 20 percent for bilateral disorders.; No visual field defect, incapacitating episodes, or other findings warranted a higher rating.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6025

Docket No.

210601-163356

Full Decision Text

Citation Nr: A26040336
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210601-163356
DATE: April 29, 2026

ORDER

Entitlement to an initial rating higher than 20 percent for bilateral dry eye syndrome is denied.

Entitlement to an initial rating higher than 20 percent for urinary frequency is denied.

REMANDED

Entitlement to an initial rating higher than 30 percent for bilateral pes planus is remanded.

Entitlement to an initial rating higher than 20 percent for right leg weakness and abnormal gait is remanded.

Entitlement to an initial rating higher than 10 percent for right knee strain with degenerative arthritis is remanded.

Entitlement to an initial rating higher than 10 percent for right ankle degenerative arthritis is remanded.

FINDINGS OF FACT

1. The Veteran's bilateral dry eye syndrome manifests as a disorder of the lacrimal apparatus with corrected distance visual acuity of 20/40 in both eyes.

2. The Veteran's urinary frequency was manifested by nighttime awakening to void three to four times.

CONCLUSIONS OF LAW

1. The criteria for an initial rating higher than 20 percent for bilateral dry eye syndrome have not been met. 38 U.S.C. §§ 1155, 5017(b); 38 C.F.R. §§ 3.159, 4.7, 4.75-4.79, Diagnostic Codes 6025.

2. The criteria for an initial rating higher than 20 percent for urinary frequency have not been met. 38 U.S.C. §§ 1155, 5017(b); 38 C.F.R. §§ 3.102, 4.7, 4.115(a), 4.115(b) Diagnostic Code 7542 (prior to November 14, 2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from September 1980 to March 1983.

The appeal arises from a rating decision dated in February 2021 with a notice letter dated in April 2021; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the subsequent notice of disagreement, received in June 2021, the Veteran selected the Hearing review lane, and a Board hearing was held on June 27, 2022. As such, the Board will consider evidence at the time of the February 2021 rating decision with notice letter in April 2021, and evidence received within 90 days of the Board hearing in June 2022. The Board will not consider evidence added to the record between the pertinent rating decision and the June 2022 Board hearing, nor the evidence added following the expiration of 90 days from the Board hearing. If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.

There are multiple VA examinations of record. In February 2022 and October 2022, the Veteran's attorney requested a copy of the VA examiner's personnel file or CV. The Board notes that VA's duty to assist mandates that once the request is made for information as to the competency of the examiner, a claimant normally has the right, absent unusual circumstances, to the curriculum vitae and other information about the qualifications of a medical examiner. Francway v. Wilkie, 930 F. 3d. 1377 (2019). However, under the provisions of the AMA, the Board reviews the record to correct pre-decisional duty to assist errors. As in the instant case the challenge was received after the rating decision on appeal, the failure to provide a VA examiner's qualifications does not represent a pre-decisional duty to assist error. Thus, no further action on this matter is warranted. 38 C.F.R. §§ 20.300, 20.802.

Increased Ratings

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4.

The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to
. §§ 20.300, 20.802.

Increased Ratings

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Issue 1: Entitlement to an initial rating higher than 20 percent for bilateral dry eye syndrome.

By way of history, in the February 2021 rating decision the Agency of Original Jurisdiction (AOJ) granted service connection for dry eye syndrome effective August 7, 2013, and assigned a 30 percent rating by analogy under Diagnostic Codes 6099-6025.

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 eye syndrome disability is currently rated as analogous to a diseases of the eye (Diagnostic Code 6099) under the disorders of the lacrimal apparatus (Diagnostic Code 6025). Dry eye syndrome is a disorder of the lacrimal apparatus. Accordingly, the Board finds that the appropriate Diagnostic Code for the Veteran's disability is Diagnostic Code 6025.

Evaluations of defective vision are rated from noncompensable to 100 percent based on organic impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. §§ 4.76(a), 4.79. The examination for visual impairment must be conducted by a licensed optometrist or by a licensed ophthalmologist and the examiner must identify the disease, injury, or any other pathologic process found. 38 C.F.R. § 4.75(b). Examination of visual fields or muscle function will be conducted only when there is a medical indication of disease or injury that may be associated with visual field defect or impaired muscle function. Id. Unless medically contraindicated, the fundus must be examined with the Veteran's pupils dilated. Id.

Unless otherwise directed, diseases of the eye are evaluated under the General Rating Formula for Diseases of the Eye. 38 C.F.R. § 4.79, Diagnostic Codes 6000 through 6009. Impairment of Visual Acuity is rated under Diagnostic Codes 6061 through 6066. Impairment of Visual Fields is rated under Diagnostic Codes 6080 through 6081. Impairment of Muscle Function is rated under Diagnostic Codes 6090 through 6091.

The Veteran's dry eye syndrome is rated under 38 C.F.R. § 4.79, Diagnostic Code 6025. Under Diagnostic Code 6025, a 20 percent disability rating is warranted for bilateral disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.). A 10 percent disability rating is warranted for unilateral disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.).

During the June 2022 Board hearing the Veteran testified that he used eye drops and eye vitamins for his dry itchy eyes.

On VA eye examination in January 2021, the examiner noted the Veteran had an onset of bilateral dry eye syndrome in 2016 with visual fluctuation bilaterally. On examination correct distance visual acuity was 20/40 in both eyes. There was no visual field defect. The examiner determined that the Veteran had a disorder of the lacrimal apparatus to include epiphora, dacryocystitis, etc., manifested in both eyes as dry eye syndrome. The examiner determined that there was a decrease in visual acuity as there was tear film disturbance and cornea instability causing a decrease in vision. The Veteran did not have elective procedures such as laser eye surgery to include LASIK. The Veteran used artificial tear drops over the counter. There was no scarring, disfigurement and there were no incapacitating episodes. The examiner noted that there was no objective evidence to account for subjective complaints of eye pain and the subjective complaints were likely secondary to the discomfort of dry eye syndrome, migraine headaches, and sinus headaches.

The above findings are not controverted by the other competent evidence of record.

Diagnostic Code 6025 provides for a fixed 20 percent disability rating for bilateral dry eye syndrome, which is the highest rating available under this Code. A 20 percent rating was assigned for dry eye syndrome based on a disorder of the lacrimal process of both eyes. Corrected visual acuity for both near vision and far vision was 20/40 in both eyes, which under Diagnostic Code 6066 would not warrant a compensable rating. Visual fields were normal. There were no incapacitating episodes or any impairment of visual fields, or muscle function. There was no glaucoma.

The Board notes that during a period that the Veteran could submit evidence, the Veteran submitted correspondence from a private provider (after the June 2022 Board hearing) in September 2022 that was dated February 2019. In pertinent part, it was noted that the Veteran was evaluated for his eye disorder in service with visual studies. He was noted to have macular drusen as well as pigmentation that often lead to macular degeneration and dry eyes. The examiner noted that the Veteran had to use artificial tears for the dry eyes and had progressive visual loss. To the extent that the Veteran has other eye disorders to include macular drusen the AOJ in the February 2021 rating decision on appeal, stated that the issues of entitlement to service connection for macular drusen and cataracts were to be addressed in a subsequent decision. Thus, they are not part of the appeal stream currently before the Board. The AOJ considered the decision to grant a 20 percent rating under Diagnostic Code 6025 for dry eye syndrome to be a full grant of the benefit sought.

To the extent that the Veteran may believe that he is entitled to a higher initial rating for his bilateral dry eye syndrome, the Board finds the objective medical findings by skilled professionals are more persuasive which, as indicated above, do not support a higher rating.

For the above reasons the Board finds that the evidence is persuasively against the claim for an initial rating higher than 20 percent for bilateral dry eye syndrome and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Issue 2: Entitlement to an initial rating higher than 20 percent for urinary frequency.

By way of history, the AOJ in the February 2021 rating decision granted service connection for urinary frequency effective August 7, 2013, and assigned a 20 percent rating by analogy under Diagnostic Code 7542. Diagnostic Code 7542 is the Code for neurogenic bladder, which instructs to rate the disability as voiding dysfunction. The Board notes that the rating criteria for diseases of the genitourinary system were revised effective November 14, 2021. However, the revised criteria are not for application in this AMA case as the decision on appeal was issued in February 2021 with a notice letter in April 2021, which is prior to the November 2021 effective date.

Under the previous criteria, voiding dysfunction is to be rated as urine leakage, frequency, or obstructed voiding. 38 C.F.R. § 4.115a.
analogy under Diagnostic Code 7542. Diagnostic Code 7542 is the Code for neurogenic bladder, which instructs to rate the disability as voiding dysfunction. The Board notes that the rating criteria for diseases of the genitourinary system were revised effective November 14, 2021. However, the revised criteria are not for application in this AMA case as the decision on appeal was issued in February 2021 with a notice letter in April 2021, which is prior to the November 2021 effective date.

Under the previous criteria, voiding dysfunction is to be rated as urine leakage, frequency, or obstructed voiding. 38 C.F.R. § 4.115a. Only the predominant area of dysfunction shall be considered for rating purposes. Id.

With continual urine leakage, post-surgical urinary diversion, urinary incontinence or stress incontinence, a 20 percent rating is assigned when the wearing of absorbent materials is required and when the absorbent materials must be changed less than two times per day. Urinary incontinence or leakage requiring the wearing of absorbent materials that must be changed two to four times per day is assigned a 40 percent rating. Urinary incontinence or leakage requiring the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day is assigned a 60 percent rating. 38 C.F.R. § 4.115a.

In cases of urinary frequency, a 20 percent rating is assigned for a daytime voiding interval between one and two hours, or awakening to void three to four times per night. A maximum 40 percent schedular evaluation is assigned in cases of a daytime voiding interval of less than one hour, or awakening to void five or more times per night. Id.

In the case of obstructed voiding, a maximum 30 percent rating is assigned for urinary retention requiring intermittent or continuous catherization. A 10 percent rating is assigned for marked obstructive symptomatology with a combination of various factors listed in the rating criteria.

During the June 2022 Board hearing the Veteran testified that he urinated maybe every two hours during the day and about three to four times per night.

On VA examination for the central nervous system and neuromuscular diseases in July 2020 the examiner determined that the Veteran did not have voiding dysfunction causing urine leakage. He did not have voiding dysfunction causing findings, signs, and/or symptoms of obstructed voiding. He did have voiding dysfunction causing signs and/or symptoms of urinary frequency manifested by nighttime awakening to void three to four times. He did not have voiding dysfunction requiring the use of an appliance nor a history of recurrent symptomatic urinary tract infections.

The above findings are not controverted by the other competent evidence of record.

In the instant case the evidence shows that urinary frequency is the predominant disability manifested by nighttime awakening to void three to four times. To the extent that the Veteran may believe that he is entitled to a higher initial rating for his urinary frequency, the Board finds the objective medical findings by skilled professionals are more persuasive which, as indicated above, do not support a higher rating.

For the above reasons the Board finds that the evidence is persuasively against the claim for an initial rating higher than 20 percent for urinary frequency and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

REASONS FOR REMAND

Issues 3-7: Entitlement to an initial rating higher than 30 percent for bilateral pes planus; entitlement to an initial rating higher than 20 percent for right leg weakness and abnormal gait; entitlement to an initial rating higher than 10 percent for right knee strain with degenerative arthritis; entitlement to an initial rating higher than 10 percent for left knee strain with degenerative arthritis; and entitlement to an initial rating higher than 10 percent for right ankle degenerative arthritis.

During the June 2022 Board hearing the Veteran testified that he was taking medications for his service-connected bilateral pes planus, right leg weakness, bilateral knee disability, and right ankle disability. On VA examinations in July 2020 for the feet, knees, and central nervous system and neuromuscular diseases it was noted that the medications the Veteran has been taking included the following: Hydrocodone for the feet and knees, and Gabapentin and Aspirin for right leg weakness. His bilateral pes planus is rated under Diagnostic Code 5276, right leg weakness under Diagnostic Codes 8007-8521, knees under Diagnostic Codes 5003-5260, and right ankle under Diagnostic Codes 5003-5271
the June 2022 Board hearing the Veteran testified that he was taking medications for his service-connected bilateral pes planus, right leg weakness, bilateral knee disability, and right ankle disability. On VA examinations in July 2020 for the feet, knees, and central nervous system and neuromuscular diseases it was noted that the medications the Veteran has been taking included the following: Hydrocodone for the feet and knees, and Gabapentin and Aspirin for right leg weakness. His bilateral pes planus is rated under Diagnostic Code 5276, right leg weakness under Diagnostic Codes 8007-8521, knees under Diagnostic Codes 5003-5260, and right ankle under Diagnostic Codes 5003-5271. These rating criteria do not explicitly contemplate the ameliorative effects of medication. In Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), the United States Court of Appeals for Veterans Claims (the Court) held that VA has the duty to consider the ameliorative effects of medications when raised by the record and not explicitly considered by the rating schedule. In other words, "when relevant criteria do not explicitly contemplate a veteran using medication to allay the symptoms of a service-connected disability, the Board, in assessing the severity of that disability for rating purposes, must discount the beneficial effects of medication used." Ingram v. Collins, 38 Vet. App. 130, 135 (2025). Thus, a remand is necessary for correction of a procedural error which is essential for a proper appellate decision in order for VA examinations to be obtained that estimate the extent of the Veteran's functional loss if his medications were removed.

Further, the United States Court of Appeals for Veterans Claims (Court) in Correia v. McDonald, 28 Vet. App. 158 (2016) emphasized that 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.

On VA ankle examination in July 2020 the examiner determined that there was pain in the right ankle with weight-bearing but did not provide range of motion findings with pain on weight-bearing. Thus, this examination is not in compliance with Correia. The AOJ's reliance on a deficient VA examination is a pre-decisional duty to assist error. Thus, under the circumstances of this case, the July 2020 examination is inadequate, and the Veteran should be afforded a VA ankle examination that complies with the directives in Correia.

By this remand the Board makes no determination, expressed or implied, as to the credibility of any statements on file.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the severity under the rating criteria of his bilateral pes planus if his medications were removed. In other words, the examiner should describe the severity of the Veteran's bilateral pes planus and the impact of these symptoms on the Veteran's functional ability if the ameliorative effects of the medications used to treat this disability were removed. The examiner should provide a rationale for all opinions rendered. If the examiner is unable to provide a rationale he or she should explain why.

2. Schedule the Veteran for an examination by an appropriate clinician to determine the severity under the rating criteria of his right leg weakness if his medications were removed. In other words, the examiner should describe the severity of the Veteran's right leg weakness and the impact of these symptoms on the Veteran's functional ability if the ameliorative effects of medications used to treat this disability were removed. The examiner should provide a rationale for all opinions rendered. If the examiner is unable to provide a rationale he or she should explain why.

3. Schedule the Veteran for VA knee and ankles examinations to determine the severity of the Veteran's service-connected bilateral knee strain with degenerative arthritis and right ankle degenerative arthritis. The claims file must be made available to the examiner for review in conjunction with conducting the examination of the Veteran. The examiner is asked to do the following:

a.) Determine the severity under the rating criteria of his bilateral knee strain with degenerative arthritis and right ankle degenerative arthritis if his medications were removed. In other words, the examiner should describe the severity of the Veteran's bilateral knee and right ankle disabilities and the impact of these symptoms on the Veteran's functional ability if the ameliorative effects of medications used to treat these disabilities were removed. The examiner should provide a rationale for all opinions rendered. If the examiner is unable to provide a rationale he or she should explain why.

b.) Report range of motion findings for the right
must be made available to the examiner for review in conjunction with conducting the examination of the Veteran. The examiner is asked to do the following:

b.) Report range of motion findings for the right ankle that are painful with weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), or a deficiency in the record (additional facts are required).

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mac, M.

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

Analyze in VA Law Explorer