Citation Nr: 21063469 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-48 514 DATE: October 14, 2021 ORDER The application to reopen the previously denied claim for entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is granted. The application to reopen the previously denied claim for entitlement to service connection for traumatic brain injury (TBI), memory loss, concentration problems, and behavioral changes; also claimed as skull fracture is granted. Entitlement to a compensable disability rating for sinus headaches associated with chronic allergic rhinitis prior to June 23, 2017, is denied. Entitlement to a disability rating in excess of 30 percent for sinus headaches associated with chronic allergic rhinitis from June 23, 2017, is denied. Entitlement to a compensable disability rating for corneal scar of the left eye is denied. REMANDED ISSUES Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is remanded. Entitlement to service connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture, is remanded. Entitlement to service connection for irritable bowel syndrome associated with PTSD is remanded. FINDINGS OF FACT 1. In a July 1997 rating decision, the Regional Office (RO) denied the Veteran's claim for entitlement to service-connection for an acquired psychiatric disability, to include PTSD. The Veteran did not perfect his appeal or submit any new and material evidence within the appeal period. 2. In a November 2008 Board decision, the Board denied the Veteran's claim to reopen his claim for entitlement to service-connection for an acquired psychiatric disability, to include PTSD. The November 2008 Board decision was final upon issuance and the Veteran did not appeal his claim to the Court of Appeals for Veteran Claims. 3. Evidence received since the November 2008 Board decision that denied the Veteran's claim to reopen his claim for entitlement to service-connection for an acquired psychiatric disability, to include PTSD, includes a lay witness statement which, if presumed true, corroborates details of an alleged personal assault which was not previously of record. 4. In a July 1997 rating decision, the RO denied the Veteran's claim for entitlement to service-connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture. The Veteran did not perfect his appeal or submit any new and material evidence within the appeal period. 5. In a November 2008 Board decision, the Board denied the Veteran's claim to reopen his claim for entitlement to service-connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture. The Veteran did not perfect his appeal or submit any new and material evidence within the appeal period. 6. Evidence received since the November 2008 Board decision that denied the Veteran's claim to reopen his claim for entitlement to service-connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture includes a lay witness statement which, if presumed true, corroborates details of an alleged personal assault which was not previously of record. 7. During the appeal period, prior to June 23, 2017; the Veteran experienced sinus headaches with less frequent attacks. His sinus headaches did not manifest in characteristic prostrating attacks averaging one in 2 months over the last several months. 8. During the appeal period, from June 23, 2017; the Veteran experienced sinus headaches with characteristic prostrating attacks occurring on average no more than once a month over the last several months. His sinus headaches did not manifest in very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 9. The Veteran's corneal scar of the left eye manifests as impaired visual acuity to no worse than 20/40 bilaterally. CONCLUSIONS OF LAW 1. The criteria for to reopen the Veteran's claim for entitlement to service connection for an acquired psychiatric disability, to include PTSD, have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 2. The criteria for to reopen the Veteran's claim for entitlement to service connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture, have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 3. The criteria for a compensable rating for sinus headaches associated with chronic allergic rhinitis have prior to June 23, 2017; not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 4. The criteria for a disability rating in excess of 30 percent for sinus headaches associated with chronic allergic rhinitis from June 23, 2017; have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 5. The criteria for a compensable disability rating for corneal scar of the left eye have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.75-4.79 Diagnostic Code 6009. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1982 until his honorable discharge in February 1985. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by the Huntington, West Virginia Regional Office (RO) of the United States Department of Veterans Affairs (VA). In December 2019, the Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ). Unfortunately, there is no transcript of the Veteran's hearing and the Veteran elected to not have an additional Board hearing. New and Material Evidence In general, decisions of the RO and the Board that are not appealed in the prescribed time period are final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.104, 20.1100, 20.1103. A finally disallowed claim, however, may be reopened when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108. Regardless of the action taken by the RO, the Board must determine whether new and material evidence has been received subsequent to an unappealed RO denial. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). As part of this review, the Board considers evidence of record at the time of the previous final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim, and evidence submitted since a prior final disallowance. Evans v. Brown, 9 Vet. App. 273, 285-86 (1996). New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156. For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, to include by triggering the Secretary's duty to assist or consideration of a new theory of entitlement. Shade, 24 Vet. App. at 117-18. Service connection is established for a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during periods of active service. 38 U.S.C. § 1110. In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for PTSD has unique evidentiary requirements. It generally requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a) (i.e., DSM-IV or DSM-5); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). See also Cohen v. Brown, 10 Vet. App. 128 (1997). 1. New and material evidence to reopen the claim of service connection for entitlement to service connection for an acquired psychiatric disability, to include PTSD 2. New and material evidence to reopen the claim of service connection for entitlement to service connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture The Veteran applied for entitlement to service connection for an acquired psychiatric disability, specifically a nervous condition, short term memory loss, difficulty concentrating, panic attacks, anxiety disorder, and phobias in February 1997; and entitlement to service connection for a skull fracture. These claims were denied in the July 1997 rating decision because the Veteran did not have a clear diagnosis of a psychiatric disability and did not have credible supporting evidence that the claimed in-service stressor occurred; and treatment records, a report of the incident (causing the skull fracture), nor competent medical evidence to substantiate any finding of a skull fracture have been received. The Veteran timely filed a notice of disagreement (informal) in December 1997. In May 1998, the RO issued a Statement of the Case (SOC) affirming the July 1997 rating decision. The Veteran did not perfect his appeal for this claim, and it became final in July 1998. The Veteran applied for entitlement to service connection for PTSD; and entitlement to service connection for a skull fracture in May 2002. These claims were denied in the November 2002 rating decision because the Veteran did not submit new and material evidence. The Veteran timely filed a notice of disagreement (informal) in November 2003. In April 2004, the RO issued a SOC affirming the November 2002 rating decision. In November 2004, the Veteran perfected his appeal by filing an Appeal to the Board of Veterans' Appeals (VA Form 9) and would be considered untimely. In March 2008, the RO issued a Supplemental Statement of the Case (SSOC) affirming the previous denial(s). Despite the untimely VA Form 9, the Board issued a decision in November 2008 denying the Veteran's claims to reopen his claims for entitlement to service connection for an PTSD and entitlement to service connection for a skull fracture because new and material evidence had not been presented, and that decision is final. Evidence before the Board in November 2008 included the Veteran's allegation of an assault by 3 individuals during service with varying versions of the specific circumstances of the incident. The Veteran had alleged that this assault was a separate incident from a service treatment record recording an eye trauma caused by a friend. In support of his claim, he submitted a statement from a witness, R.T., who generally recalled seeing the Veteran being assaulted. The Veteran applied for entitlement to service connection for PTSD and skull fracture, now claimed as TBI, in October 2010. The Veteran timely filed a notice of disagreement (informal) in September 2013. In July 2017, the RO issued a SOC affirming the September 2012 rating decision. In September 2017, the Veteran timely perfected his appeal to the Board. Evidence submitted since the November 2008 final Board decision includes another statement from the witness, R.T., who reported additional details of the alleged attack which involved a sexual aspect. The Board must presume the truth of this statement for reopening purposes. The Board finds that this witness statement satisfies the low threshold for reopening as it may provide corroboration of the event claimed to have resulted in disability. As such, the criteria to reopen the claims of entitlement to service connection for an acquired psychiatric disability, to include PTSD, as well as entitlement to service connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010); see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998) (noting that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a claimant's injury or disability, even where it would not be enough to convince the Board to grant the claim). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The 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. 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. 3. Entitlement to a compensable disability rating for sinus headaches associated with chronic allergic rhinitis prior to June 23, 2017 4. Entitlement to a disability rating in excess of 30 percent for sinus headaches associated with chronic allergic rhinitis from June 23, 2017 The Veteran contends that he is entitled to a higher disability rating for his sinus headaches. As a preliminary matter, the record indicates that the Veteran has both sinus headaches, which he is service connected for, and migraine headaches due to his acquired psychiatric disability, which he is not service connected for. Regardless, both disabilities are rated under Diagnostic Code 8100 for symptoms of migraine headaches. Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100, for migraine. Under Diagnostic Code 8100, a noncompensable disability rating is warranted for migraines with less frequent attacks. A 10 percent disability rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent disability rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent disability rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent disability rating is the highest schedular rating under Diagnostic Code 8100. The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252. The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under Diagnostic Code 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. The rating criteria for a 50 percent disability rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent disability rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent disability rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent disability rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). Prior to June 23, 2017 The Veteran was afforded a VA examination in March 2012. The March 2012 VA examiner diagnosed the Veteran with two distinct disabilities. Specifically, migraine headaches, including migraine variants; and sinus headaches. The Veteran reported frequent headaches that he described as three to five headaches per week that may last all day or could be shorter, lasting 4 hours or less. The Board notes that the first notation in his treatment records pertaining to any complaints of headaches is in an addendum on November 7, 2011 that is treated by medication (Norco 10/325) four times daily. The Veteran reported that the headaches produce pulsating or throbbing head pain in the central frontal area, produces sensitivity to light that produce characteristic of prostrating attacks of migraine headache pain more frequently than once per month, reporting that he must leave work early two days per month due to his migraine headaches. However, the Board notes that the March 2012 VA examiner opined that the Veteran's prostrating attacks causing him to leave work are due to the Veteran's nonservice-connected migraine headaches that are related to his nonservice connected psychiatric disabilities. In contrast, the March 2012 VA examiner noted that the Veteran's service-connected sinus headaches resolve without any routine treatment, he gets up and moves around, clears his nasal drainage or post-nasal discharge. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran's credibility concerning the differences between sinus headaches and migraine headaches has been consistent. Considering all relevant evidence of record, the Board finds that the Veteran's sinus headaches do not cause prostrating attacks and that the Veteran's prostrating attacks are due to his nonservice connected acquired psychiatric disabilities. Accordingly, the Board concludes that although the Veteran has had migraines with characteristic prostrating attacks occurring on average twice a month over the last several months throughout the appeal period, corresponding to the criteria for a 30 percent rating under Diagnostic Code 8100, those prostrating attacks are not due to his service-connected sinus headaches. A higher 10 percent disability rating under Diagnostic Code 8100 is not warranted unless there are migraines with at least one prostrating attack due to his service-connected sinus headaches. Because the Veteran's prostrating attacks are due to his nonservice-connected psychiatric disabilities, they are not applicable for a higher disability rating. Thus, the Board concludes that the Veteran did not have sinus headaches with prostrating and prolonged attacks productive of severe economic inadaptability at any time during the appeal period. Therefore, a compensable disability rating is not warranted under Diagnostic Code 8100. From June 23, 2017 The Veteran was afforded a VA examination in June 2017. As a preliminary matter, the Board notes that the June 2017 VA examiner started under a faulty premise for his VA examination. Under Section 2, the Medical History portion, the June 2017 VA examiner stated "[the] Veteran is [service connected] for migraine headaches and sinus headaches..." However, as noted above, the record indicates that the Veteran is only service-connected for sinus headaches. The Board concludes that the Veteran has had migraines with characteristic prostrating attacks occurring on average once a month over the last several months throughout the appeal period, corresponding to the criteria for a 30 percent rating under Diagnostic Code 8100. However, as noted above, the Veteran is not service connected for migraine headaches and the current VA examination does not clearly distinguish between migraine headaches and sinus headaches. Even considering both the Veteran's service connected (and nonservice-connected) headaches, the criteria for a disability rating in excess of 30 percent is not warranted. Considering all relevant evidence of record, the Board finds that the Veteran has no more than one prostrating attack per month. Accordingly, the Board concludes that the Veteran has had migraines with characteristic prostrating attacks occurring on average once a month over the last several months throughout the appeal period, corresponding to the criteria for a 30 percent rating under Diagnostic Code 8100. A higher 50 percent rating under Diagnostic Code 8100 is not warranted unless there are sinus headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Thus, the Board concludes that the Veteran did not have sinus headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability at any time during the appeal period. A higher 50 percent rating is not warranted under Diagnostic Code 8100. 5. Entitlement to a compensable disability rating for corneal scar of the left eye The Veteran asserts that he is entitled to a higher disability rating. Evaluations of defective vision 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 found. 38 C.F.R. § 4.76(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, evaluate diseases of the eye 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. The Veteran is rated under Diagnostic Code 6009. Diagnostic Code 6009 is rated under the General Rating Formula For Diseases of the Eye. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15,316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Under the former criteria, the General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent disability rating is warranted. A Note following the General Rating Formula for Diseases of the Eye indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. Under the revised criteria, the General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent disability rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent disability rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent disability rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent disability rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, Diagnostic Codes 6061-6091. The criteria for visual impairment, including impairments of visual acuity, visual fields, and/or muscle function, have remained unchanged. Impaired visual acuity is rated under Diagnostic Codes 6061-6066 based on the best corrected distance vision. 38 C.F.R. §§ 4.76, 4.79. Impairment of visual fields are rated under Diagnostic Codes 6080-6081 based on the average concentric contraction of the visual field of each eye; asymmetric impairments are converted to their visual acuity equivalents. 38 C.F.R. §§ 4.77, 4.79. Impaired muscle function is rated under Diagnostic Codes 6090-6091 with an evaluation for diplopia being assigned to only one eye. 38 C.F.R. §§ 4.78, 4.79. Impairment of central visual acuity is evaluated on the basis of corrected distance vision with central fixation, even if a central scotoma is present. 38 C.F.R. § 4.76. Visual acuity is evaluated from noncompensable to 100 percent based upon the degree of the resulting impairment of visual acuity or field loss, pain, rest-requirements, or episodic incapacity, combining an additional disability rating of 10 percent during continuance of active pathology. 38 C.F.R. § 4.79, Diagnostic Codes 6061 to 6066. A 10 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) if corrected visual acuity is 20/100 in one eye and 20/40 in the other eye; (2) if corrected visual acuity is 20/70 in one eye and 20/40 in the other eye; (3) if corrected visual acuity is 20/50 in one eye and 20/40 in the other eye; (4) or when corrected visual acuity is 20/50 in both eyes. 38 C.F.R. § 4.84a, Diagnostic Codes 6078, 6079; 38 C.F.R. § 4.79, Diagnostic Code 6066. A 20 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) if corrected visual acuity is 15/200 in one eye and 20/40 in the other eye; (2) if corrected visual acuity is 20/200 in one eye and 20/40 in the other eye; (3) if corrected visual acuity is 20/100 in one eye and 20/50 in the other eye; or (4) corrected visual acuity of 20/70 in one eye and 20/50 in the other eye. 38 C.F.R. § 4.84a, Diagnostic Codes 6077, 6078; 38 C.F.R. § 4.79, Diagnostic Code 6066. A 30 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity in both eyes is 20/70; (2) corrected visual acuity in one eye is 20/100 and the other eye is 20/70; (3) corrected visual acuity in one eye is 20/200 in one eye and 20/50 in the other eye; (4) corrected visual acuity in one eye is 15/200 and 20/50 in the other eye; (5) corrected visual acuity in one eye is 10/200 and 20/40 in the other eye; (6) corrected visual acuity in one eye is 5/200 and 20/40 in the other eye; or (7) blindness of one eye and corrected vision to 20/40 in the other eye. 38 C.F.R. § 4.84a, Diagnostic Codes 6070, 6074, 6076, 6077, and 6078; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, 6066. A 40 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 20/200 and 20/70 in the other eye; (2) corrected visual acuity of one eye is to 15/200 and 20/70 in the other eye; (3) corrected visual acuity in one eye is to 10/200 and 20/50 in the other eye; (4) corrected visual acuity is to 5/200 in one eye and 20/50 in the other eye; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/50 and 20/40, respectively, in the other eye. 38 C.F.R. § 4.84a, Diagnostic Codes, 6066, 6070, 6073, 6076; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, and 6066. A 50 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity is to 20/100 in both eyes; (2) corrected visual acuity is to 10/200 in one eye and to 20/70 in the other eye; (3) corrected visual acuity is to 5/200 in one eye and 20/70 in the other eye; or (4) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/70 and 20/50, respectively. 38 C.F.R. § 4.84a, Diagnostic Codes, 6065, 6069, 6073, 6076, and 6078; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, and 6066. A 60 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 20/200 and the other eye is 20/100; (2) corrected visual acuity of one eye is to 15/200 and the other eye is to 20/100; (3) corrected visual acuity of one eye is to 10/200 and the other eye is to 20/100; (4) corrected visual acuity of one eye is to 5/200 and the other eye is to 20/100; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/100 or 20/70 or 20/100, respectively. 38 C.F.R. § 4.84a, Diagnostic Codes, 6065, 6069, 6073, 6076; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, and 6066. A 70 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 20/200 and the other eye is 20/200; (2) corrected visual acuity of one eye is to 15/200 and the other eye is to 20/200; (3) corrected visual acuity of one eye is to 10/200 and the other eye is to 20/200; (4) corrected visual acuity of one eye is to 5/200 and the other eye is to 20/200; or (5) blindness or anatomical loss of one eye and corrected vision in the other eye to 20/200. 38 C.F.R. § 4.84a, Diagnostic Codes 6064, 6068, 6072, and 6075; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, and 6066. An 80 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 15/200 and the other eye is 15/200; (2) corrected visual acuity of one eye is to 10/200 and the other eye is to 15/200; (3) corrected visual acuity of one eye is to 5/200 and the other eye is to 15/200; or (4) blindness or anatomical loss of one eye and corrected vision in the other eye to 15/200. 38 C.F.R. § 4.84a, Diagnostic Codes 6064, 6068, 6072, and 6075; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, and 6066. A 90 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 10/200 and the other eye is 10/200; (2) corrected visual acuity of one eye is to 5/200 and the other eye is to 10/200; or (3) blindness or anatomical loss of one eye and corrected vision in the other eye to 10/200. 38 C.F.R. § 4.84a, Diagnostic Codes 6064, 6068, 6072, and 6075; 38 C.F.R. § 4.79, Diagnostic Codes 6064, 6065, and 6066. A 100 percent disability rating is warranted for impairment of central visual acuity in the following situations: (1) corrected visual acuity of one eye is to 5/200 and the other eye is 5/200; (2) blindness or anatomical loss of one eye and corrected vision in the other eye to 5/200; or (3) blindness or anatomical loss of both eyes. 38 C.F.R. § 4.84a, Diagnostic Codes 6061, 6062, 6063, 6067, and 6071; 38 C.F.R. § 4.79, Diagnostic Codes 6064 and 6065. The evaluation for visual impairment of one eye must not exceed 30 percent unless there is anatomical loss of the eye. 38 C.F.R. § 4.75(d). Combine the evaluation for visual impairment of one eye with evaluation for other disabilities of the same eye that are not based on visual impairment (e.g., disfigurement under diagnostic code 7800). Id. Subject to the provisions of 38 C.F.R. § 3.383(a), if visual impairment of only one eye is service connected, the visual acuity of the other eye will be considered to be 20/40 for purposes of evaluating the service-connected visual impairment. 38 C.F.R. § 4.75(c). 38 C.F.R. § 3.383(a) provides that compensation is payable for the combination of service-connected and nonservice-connected disabilities when the impairment of vision in each eye is rated at a (corrected distance) visual acuity of 20/200 or less; or the peripheral field of vision for each eye is 20 degrees or less. When the Veteran has anatomical loss of one eye and is unable to wear a prosthesis, increase the evaluation for visual acuity under diagnostic code 6063 by 10 percent, but the maximum evaluation for visual impairment of both eyes must not exceed 100 percent. A 10-percent increase under the paragraph precludes an evaluation under diagnostic code 7800 based on gross distortion or asymmetry of the eye but not an evaluation under diagnostic code 7800 based on other characteristics of disfigurement. Examinations of visual acuity must include the central uncorrected and corrected visual acuity for distance and near vision using Snellen's test type or its equivalent. 38 C.F.R. § 4.76(a). Evaluation of central visual acuity on the basis of corrected distance vision with central fixation, even if a central scotoma is present. 38 C.F.R. § 4.76(b). However, 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, evaluate the visual acuity of the poorer eye using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity. Id. A March 2012 VA examination reveals that the Veteran some blur at a distance in his left eye. 03.26.2012 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/25 20/20 20/20 20/20 LEFT 20/25 20/20 20/20 20/20 The March 2012 VA examination also revealed that the Veteran does not have a documented visual field defect. Based on the evidence above, a compensable disability rating for the Veteran's loss of visual acuity is not warranted. The Veteran's visual acuity of 20/20 corrected distance bilaterally warrants a noncompensable disability rating. A June 2017 VA examination reveals that the Veteran had no reduction in vision, but the Veteran was diagnosed with dry eye syndrome (not service connected). 06.19.2017 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/40 or better 20/40 or better 20/100 20/40 or better LEFT 20/40 or better 20/40 or better 20/100 20/40 or better The June 2017 VA examination also revealed that the Veteran has a documented visual field defect. Based on the evidence above, a compensable disability rating for the Veteran's loss of visual acuity is not warranted. The Veteran's visual acuity of 20/40 or better corrected distance bilaterally warrants a noncompensable disability rating. Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to a compensable disability rating. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REMAND 1. Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is remanded. 2. Entitlement to service connection for TBI, memory loss, concentration problems, and behavioral changes; also claimed as skull fracture, is remanded. 3. Entitlement to service connection for irritable bowel syndrome associated with PTSD is remanded. Generally, where the Board reopens a claim, but the RO did not, the case must be remanded for RO consideration. Hickson v. Shinseki, 23 Vet. App. 394, 399 (2010). This requirement derives from the language of 38 U.S.C. § 7104(a) which affords the claimant "one review on appeal." Id. at 399 citing Disabled Am. Veterans (DAV) v. Sec'y of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). To avoid potential prejudice to the Veteran, the Board remands this case to the RO to adjudicate the claims on the merits. Notably, the RO has questioned the authenticity of the witness statements from R.T. On remand, the RO should undertake all necessary steps to determine the authenticity of the witness statements from R.T. The Board further notes that the Veteran has claimed that his irritable bowel syndrome is associated with his PTSD. The Board defers consideration of this inextricably intertwined issue at this time. Accordingly, these matters are REMANDED for the following: 1. Undertake all necessary steps to determine the authenticity of the witness statements from R.T. (continued on the next page) 2. Readjudicate the claims on the merits. If any benefit sought on appeal remains denied, furnish the Veteran and his representative a supplemental statement of the case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Deemer, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.