Citation Nr: 21069448 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-13 322 DATE: November 18, 2021 ORDER The application to reopen a claim of service connection for posttraumatic stress disorder (PTSD) is granted. The application to reopen a claim of service connection for major depression disorder is granted. The application to reopen a claim of service connection for a right eye disability, other than blepharitis, is granted. The application to reopen a claim of service connection for a left eye disability, other than blepharitis, is granted. Service connection for bilateral dry eye syndrome and chalazion of the left lower lid, claimed as a bilateral eye disability other than blepharitis, is granted. Entitlement to an evaluation of 10 percent, but no higher, for bilateral blepharitis is granted. REMANDED Entitlement to service connection for osteoarthritis of left knee is remanded. Entitlement to service connection for osteoarthritis of right knee is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, adjustment disorder, mood disorder, and anxiety, is remanded. Entitlement to service connection for PTSD is remanded. Entitlement to an evaluation in excess of 40 percent prior to March 8, 2014 and in excess of 70 percent thereafter, for head injury with headaches, dizziness, memory loss, and skull damage (thereafter "traumatic brain injury (TBI)"), is remanded. Entitlement to an evaluation in excess of 30 percent for rhinitis is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to March 8, 2014 is remanded. FINDINGS OF FACT 1. The Veteran's application to reopen the claim of service connection for PTSD was denied in a December 2008 rating decision on the basis that there was no new and material evidence to substantiate, inter alia, a current diagnosis of PTSD; the Veteran did not perfect his appeal of this decision nor submitted new and material evidence within the appeal period. 2. Evidence received since the December 2008 rating decision includes information that was not previously considered and which relates to an unestablished fact necessary to substantiate the claim of service connection for PTSD, the absence of which was the basis of the previous denial. 3. The Veteran's claim of service connection for major depressive disorder was originally denied in a May 2012 rating decision on the basis that there was no medical evidence of diagnosis of the disability; the Veteran did not appeal this decision within one year of its issuance and new and material evidence was not received within that year. 4. Evidence received since the May 2012 rating decision includes information that was not previously considered and which relates to an unestablished fact necessary to substantiate the claim of service connection for major depressive disorder, the absence of which was the basis of the previous denial. 5. The Veteran's bilateral dry eye syndrome and chalazion of the left lower lid are proximately due to or aggravated beyond their natural progression by his service-connected bilateral blepharitis. 6. The evidence is at least evenly balanced as to whether the Veteran's bilateral blepharitis has resulted in chronic occurrence of active symptomatology for the entire appeal period; however, it has not resulted in any visual impairment or incapacitating episodes at any time during the appeal period. CONCLUSIONS OF LAW 1. The AOJ's December 2008 rating decision that denied the application to reopen a claim of service connection for PTSD is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. 2. The evidence received since the December 2008 AOJ decision is new and material and the criteria for reopening of the claim of service connection for PTSD have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 3. The AOJ's May 2012 rating decision that denied a claim of service connection for major depressive disorder is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. 4. The evidence received since the May 2012 AOJ decision is new and material and the criteria for reopening of the claim of service connection for major depressive disorder have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 5. The AOJ's May 2012 rating decision that denied the request to reopen a claim of service connection for a left eye disability and a claim of service connection for a right eye disability is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. 6. The evidence received since the May 2012 AOJ decision is new and material and the criteria for reopening of the claims of service connection for a left eye and right eye disability have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 7. The criteria for service connection for bilateral dry eye syndrome and chalazion of the left lower lid, claimed as bilateral eye disability other than blepharitis, as secondary to blepharitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 8. With resolution of reasonable doubt in the Veteran's favor, the criteria for an evaluation of 10 percent, but no higher, for bilateral blepharitis have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.3, 4.79, Diagnostic Code 6018. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1979 to November 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from Department of Veterans Affairs (VA) Regional Office (RO)'s rating decisions issued in October 2013 and May 2014. The Board previously remanded the issue for further development in April 2019. The case has now been returned to the Board for appellate review. Although the Veteran initially filed a claim for major depressive disorder, the Veteran has also been clinically diagnosed with adjustment disorder, mood disorder, and anxiety. To afford the Veteran the broadest possible scope for his claim of entitlement to a psychiatric disorder, the issue has been recharacterized accordingly to that of entitlement to service connection for an acquired psychiatric disorder. Clemons v. Shinseki, 23 Vet. App. 1,6 (2009). Lastly, the requests to reopen a claim of service connection for osteoarthritis of the bilateral knees have been recharacterized as the claims of service connection for osteoarthritis of the bilateral knees because there is no prior final decision on these claims for the following reasons. The Veteran's claim for service connection for osteoarthritis of bilateral knees was originally denied in a May 2012 rating decision because the Agency of Original Jurisdiction (AOJ) found no evidence of in-service incurrence of the disability. On July 6, 2012, VA received the Veteran's request to reopen the claim of service connection for bilateral knees. In August 2012, he reported that he was receiving treatment for the disability at VA medical center. His request to reopen the claim of service connection for bilateral knee disabilities was denied in an October 2013 rating decision because the AOJ found no new and material evidence was submitted. The Veteran filed a notice of disagreement (NOD) in July 2014, and the AOJ continued the denial in a February 2016 statement of the case (SOC). He perfected the appeal by submitting a VA Form 9 in February 2016, which led to the current appeal. The Board finds that the May 2012 rating decision never became final because new evidence was received within its appeal period. 38 C.F.R. § 3.156 (2012). The Veteran underwent a VA examination in September 2012, during which he was diagnosed with bilateral knee patellofemoral osteoarthritis, with date of diagnosis "1980's" and a comment that the Veteran reported "increasing problems with his knees while on active duty (1980s)." This raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The evidence is, therefore, new and material. In light of this, the Board finds that his claims for service connection for osteoarthritis of bilateral knees have been pending since the May 2012 rating decision. 38 C.F.R. § 3.156 (b). New and Material Evidence Generally, an Agency of Original Jurisdiction (AOJ) decision denying a claim which has become final may not thereafter be reopened and allowed. 38 U.S.C. § 7105 (d)(3). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to VA, and material evidence is defined as 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 (a). The newly presented evidence is presumed to be credible for purposes of determining whether it is new and material. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For the purpose of determining whether new and material evidence has been presented to reopen a claim, the evidence for consideration is that which has been presented or secured since the last time the claim was finally disallowed on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). 1. PTSD The Veteran's claim for service connection for PTSD was originally denied in a May 2006 rating decision because the AOJ found that there was no current diagnosis of PTSD. The Veteran filed an NOD in August 2006, and in a November 2007 SOC, the AOJ discussed the Veteran's report of in-service stressor of witnessing a fighter pilot roll off the side of the ship into the water and continued the denial because it found that no in-service incurrence of the disability or current diagnosis of PTSD was found in the evidence. This appeal was not perfected, and no new evidence was received before the expiration of the appeal period. Thus, the May 2006 rating decision became final. 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2005) On July 9, 2008, VA received the Veteran's application to reopen the claim of service connection for PTSD. In a December 2008 rating decision, the denial of the claim was continued, essentially for lack of new evidence. The Veteran's NOD was received in May 2009. The denial was continued in an October 2009 SOC. On February 25, 2010, VA received the Veteran's request to reopen the claim of service connection for PTSD. In March 2010, the Veteran submitted a VA Form 9. In March 2010, the AOJ notified the Veteran that this submission was rejected because it was received outside the appeal period of the October 2009 SOC. Following up with the Veteran's February 2010 request, the AOJ reopened the claim of PTSD, but continued to deny the claim in a September 2011 rating decision because it found that there was no current diagnosis based, in part, on an October 2010 VA examination. On November 21, 2011, VA received the Veteran's request to reopen the claim of service connection for PTSD. In April 2012, the Veteran requested to obtain all treatment records from VA medical center in response to a March 2012 DTA letter. The AOJ denied the claim in a May 2012 rating decision because it did not find any new and material evidence. On October 19, 2012, the AOJ received the Veteran's request to reopen the claim of service connection for PTSD. In an October 17, 2013 rating decision, the AOJ reopened the claim, but continued to deny it because it did not find an in-service incurrence of the disability. On October 23, 2013, the Veteran's request to reopen the claim of service connection for PTSD. In a May 2014 rating decision, the AOJ reopened the claim, but continued to deny it because it found none of the three requirements for service connection was met. In July 2014, the Veteran filed a NOD for both October 2013 and May 2014 rating decisions. In February 2016, the AOJ issued a SOC that continued the denial of the claim, which was followed by a timely submission of a VA Form 9 in February 2016. This led to the current appeal. Based on the above procedural history, the Board finds that the last prior final decision was the December 2008 rating decision followed by the October 2009 SOC because the September 2011 rating decision never became final for the following reason. A review of the evidence indicates that the AOJ obtained outstanding VA treatment records in March 2012. This set of treatment records contains an entry, dated February 8, 2012, by Nurse J.L., in which she stated that it was her medical opinion as the Veteran's treating provider that he was at least as likely as not suffering from PTSD and he was being treated for the disability. Since this evidence raises a possibility of existing current diagnosis of the disability, it is material, and it was received within one year of the September 2011 rating decision. As such, this rating decision never became final and the claim has been pending since then. 38 C.F.R. § 3.156 (2011). On the other hand, no new evidence was associated with the claims file within the appeal periods of December 2008 rating decision or October 2009 SOC, respectively. The December 2008 rating decision became final. 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2008). In summary, as the above discussion shows, the February 2012 VA treatment record by Nurse J.L. raises a possibility of the Veteran's current diagnosis of PTSD, new and material evidence has been received since the last prior final December 2008 rating decision. The request to reopen the claim of service connection for PTSD is granted. 2. Major depressive disorder The Veteran's claim for service connection for major depression was originally denied in a May 2012 rating decision because the AOJ found no evidence for a current diagnosis or for in-service incurrence. On October 23, 2013, VA received the Veteran's request to reopen the claim for depression due to head injury. In a May 2014 rating decision, the AOJ denied the claim because it found no evidence for in-service incurrence and current diagnosis in VA examinations. It further noted that it did not find nexus between the claimed disability and service-connected head injury. The Veteran filed an NOD in July 2014, and in a January 2016 SOC, the AOJ continued the denial. The Veteran perfected the appeal by submitting a VA Form 9 in February 2016, which led to the current appeal. The Board finds that the May 2012 rating decision became final because no NOD or pertinent new evidence that could substantiate his claim was filed within its appeal period. 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2011). Evidence received since the May 2012 rating decision includes an October 2013 letter by Nurse J.L. at VA, stating that the Veteran had symptoms of major depressive disorder. Overall, the additional evidence pertains to an element of the claim that was previously found to be lacking and raises a reasonable possibility of substantiating the claim by indicating that the Veteran has current symptoms of major depressive disorder. The evidence is new and material, and the claim of service connection for major depressive disorder is reopened. 3. Right eye disability other than blepharitis 4. Left eye disability other than blepharitis The Veteran's claim for service connection for a left eye injury was originally denied in a January 1994 rating decision. The rating decision noted that the Veteran had had a complaint of having a foreign body in the left eye and that he was assessed with corneal abrasion, but that a June 1993 VA examination did not show any residual from the corneal abrasion. The Veteran's request to reopen the claim of service connection for chronic residuals of left eye injury was denied in a May 2012 rating decision because the AOJ found that no new and material evidence was submitted. Moreover, the Veteran's claim for service connection for a right eye disability was originally denied in the May 2012 rating decision because the AOJ found no evidence for a current diagnosis or in-service incurrence. On August 21, 2012, VA received the Veteran's claim for "problems with [his] eyes" with a comment that he was being treated at VA medical center for all these conditions. Subsequently, in an October 2013 rating decision, the AOJ continued the denial because it did not find any new and material evidence for these disabilities. In July 2014, the Veteran's NOD was received, and in a February 2016 SOC, the Veteran's request to reopen the claims of service connection for bilateral eye disability was denied again because the AOJ found no new and material evidence. The Veteran perfected his appeal on these claims by submitting a VA Form 9 in February 2016, which led to the current appeal. The Board finds that for the left eye disability, the January 1994 and May 2012 rating decisions became final because no NOD or new evidence was submitted within the respective appeal period. 38 C.F.R. §§ 3.104, 20.302, 20.1103 (1994, 2011). As for the right eye disability, the May 2012 rating decision became final because no NOD or new evidence, to include pertinent VA treatment records, that could substantiate his claim was submitted or associated with the claims file within the appeal period. 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2011). Evidence submitted since these rating decisions includes an August 2019 VA examination, during which the Veteran was diagnosed with bilateral nuclear sclerotic cataracts, chalazion of the left lower lid, bilateral hypertensive retinopathy, and bilateral dry eye syndrome in addition to service-connected bilateral blepharitis. The additional evidence pertains to an element of the claims that were previously found to be lacking and raises a reasonable possibility of substantiating the claims by indicating that the Veteran has current bilateral eye disability. The evidence is, therefore, new and material, and the claims of service connection for left and right eye disability are reopened. Service Connection Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the current disability and an in-service precipitating disease, injury or event. 38 U.S.C. § 1110; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). This permits service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of aggravation by a service-connected disability, a veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Id.; see also 38 C.F.R. § 3.310 (b). In relevant part, 38 U.S.C. § 1154 (a) (2012) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Bilateral eye disability other than blepharitis The Veteran has a current diagnosis of bilateral nuclear sclerotic cataracts, chalazion of the left lower lid, bilateral hypertensive retinopathy, and bilateral dry eye syndrome, in addition to service-connected bilateral blepharitis. See August 2019 VA examination. As for chalazion and dry eye syndrome, the August 2019 VA examiner opined that both of these disabilities are related to his service-connected blepharitis. The examiner explained that chalazions form as a result of blepharitis, which commonly occurs when tiny oil glands located near the base of the eyelashes become clogged and inflamed. That dryness and irritation, as in dry eye syndrome, results when blepharitis causes oily secretions and flaking from the eyelid. On the other hand, the August 2019 VA examiner opined that the Veteran's cataracts and hypertensive retinopathy are not related to his blepharitis. The examiner explained that hypertensive retinopathy is caused by uncontrolled high blood pressure and nuclear sclerotic cataracts are age-related. Notably, a May 2020 addendum opinion states that the veteran's chalazion is not related to blepharitis, that dry eye syndrome is age-related, that hypertensive retinopathy is related to blood pressure, and that cataract is age-related. The May 2020 examiner further stated that chalazion is not related to blepharitis because it is an "acquired treatable condition." As for chalazion and dry eye syndrome, the Board finds that the August 2019 opinion is more probative because it provides sufficient explanation to understand the relationship between service-connected blepharitis and these disabilities. In this regard, the May 2020 addendum opinion affords less probative weight with respect to these disabilities for two reasons. First of all, the examiner opined that the Veteran's blepharitis was less likely than not incurred in or caused by the blepharitis in service, which is contrary to the fact found in the claims file. Moreover, the rationale provided for chalazion and dry eye syndrome is insufficient. Treatability does not conflict with the August 2019 examiner's positive nexus opinions in that treatability does not exclude the conclusion reached by the August 2019 examiner. Moreover, the May 2020 opinion that dry eye syndrome is caused by age requires more explanation in light of the fact that the Veteran also has an additional, pertinent factor the eyelid problems. The claim for service connection for bilateral dry eye syndrome and chalazion of the left lower lid is granted. As for hypertensive retinopathy and cataracts, the Board finds both medical opinions probative in that they have reached the same conclusion with the same reasoning. Importantly, there is no medical evidence in support of the Veteran for these disabilities. Moreover, service treatment records do not indicate that he had these disabilities while in service, and he is not service connected for hypertension. Service connection for hypertensive retinopathy and cataracts is not warranted. Increased Rating 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. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, as here, the Veteran is requesting a higher rating for an already established service-connected disability, the present disability level is the primary concern and past medical reports do not take precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, "staged" ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). 6. Blepharitis The Veteran's blepharitis is currently rated noncompensable under Diagnostic Code 6018. The Veteran's claim for an increased rating was received on July 6, 2012. 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. 15316 (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. Both the former and revised criteria under Diagnostic Code 6018 for chronic conjunctivitis (nontrachomatous) distinguished active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivitae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. For an inactive disease process, both the former and revised criteria instruct to evaluate based on residuals, such as visual impairment and disfigurement (DC 7800). With regard to visual impairment, the May 2018 amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. The General Rating Formal 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. For brevity, the Board will not recite the ratings for incapacitating episodes, but will note how an incapacitating episode is defined from May 2018 onward. 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, DCs 6061-6091. The Board finds the evidence is at least evenly balanced as to whether the Veteran has had active episodes of blepharitis in both eyes throughout the entire appeal period. Although the evidence indicates that on some occasions, the Veteran did not have active blepharitis, active episodes of blepharitis have been observed and documented on multiple occasions over the years during the appeal period. For instance, an August 2011 VA treatment record reflects a complaint of eyelid infection, which was confirmed to be blepharitis in both eyes on slip lamp examination. A May 2013 VA treatment record found no blepharitis. However, a September 2014 VA treatment record reports a possible occurrence of blepharitis, and an August 2019 VA examination again found active blepharitis in both eyes upon slit lamp external eye exam; the Veteran reported having current symptoms of constant irritation, foreign body sensation, and itching. Resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's blepharitis has been active with chronic recurrence. An evaluation of 10 percent is warranted under both versions of Diagnostic Code 6018. Under the revised Diagnostic Code 6018, the Veteran's disability must further be evaluated under the General Rating Formula for an evaluation in excess of 10 percent. As for incapacitating episodes, the evidence, to include VA examinations and treatment records, does not indicate that he has had incapacitating episodes requiring any types of the treatment provided under the rating criteria throughout the appeal period. An evaluation in excess of 10 percent is not warranted based on incapacitating episodes. As for visual impairment, the evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75 (a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. Id. § 4.75(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id. Here, the Veteran's corrected distance visual acuity has remained at 20/20 in each eye, with no evidence of diplopia or contraction of visual field during the entire appeal period. An evaluation in excess of 10 percent is not warranted for visual impairment. In sum, an evaluation of 10 percent, but no higher, for the Veteran's bilateral blepharitis is warranted. REASONS FOR REMAND 1. Service connection for osteoarthritis of left knee 2. Service connection for osteoarthritis of right knee The Veteran has a current diagnosis of osteoarthritis of bilateral knees. See, e.g., September 2012 VA examination. Moreover, multiple service treatment records document that he sought treatment for his left knee, including a notation of "arthritis" for left knee pain with running on the steel flight deck in a July 1987 entry. A May 1987 service treatment record indicates that he fell in the park and had abrasion in the right knee. Yet, no medical opinion addresses whether the Veteran's current disability is at least as likely as not related to in-service treatment and complaints pertaining to the knees. Upon remand, the AOJ must schedule a VA examination and obtain an etiology opinion. McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159 (c)(4). 3. Service connection for an acquired psychiatric disorder, to include major depressive disorder, adjustment disorder, mood disorder, and anxiety 4. Service connection for PTSD A review of the medical evidence of record indicates that the Veteran has been clinically diagnosed with PTSD and other various acquired psychiatric disorders. He has been treated with therapies and medications for his psychiatric disabilities. However, no VA examinations have diagnosed him with PTSD. Pertinent to in-service incurrence, the evidence of record suggests that he had adjustment difficulties with military life. For instance, in a December 2008 Social Security Administration (SSA) application, the Veteran reported that his commander forced him to move out of his home away from his children back into the base barracks and this impacted his marital and family life and indicated he encountered violence and racism while in service. He submitted a service record documenting that he violated an article in the Uniform Code of Military Justice in April 1982. Moreover, a July 2009 VA psychiatry outpatient note indicates that he divorced in 1988 prior to his separation in 1989. In addition to the above, the evidence of record also indicates that the Veteran's psychiatric symptoms are due to his TBI. In fact, his treating nurse at VA wrote in her October 2013 letter that the Veteran's acquired psychiatric disability and TBI are all interrelated. A May 2014 medical opinion states that the Veteran's TBI results in irritability, dislike of crowds, suspiciousness of others, and reduced tolerance of others. The Veteran also contends that his performance in the military deteriorated after the in-service head injury. No TBI VA examinations have provided a separate diagnosis of an acquired psychiatric disorder. In light of the above, the Board finds that additional development must be conducted in order to adjudicate the Veteran's claim. First, the AOJ must obtain all of his military personnel records since it does not appear that those records have been obtained from the service department. Only a one-page record submitted by the Veteran is associated with the claims file. Then, after the military personnel records are obtained, the AOJ must schedule a VA examination to ascertain if the Veteran has a current diagnosis of any acquired psychiatric disorder under DSM-5 and, if so, etiology of the diagnosed disability as to whether it is directly related to his service or if it is secondary to the service-connected TBI. See McClendon, 20 Vet. App. 79; 38 C.F.R. § 3.159(c)(4). 5. Evaluation in excess of 40 percent prior to March 8, 2014 and in excess of 70 percent thereafter, for TBI The Veteran has a current diagnosis of tension headaches, as reflected in an April 2012 VA examination. Moreover, as discussed above, it is possible that the Veteran has a comorbid, separately diagnosed psychiatric disability that is also service-connected as he claims. The AOJ must schedule a VA examination for TBI and headaches, after the development for the claim of service connection for acquired psychiatric disability and PTSD is complete. The examiner must provide an opinion as to whether each of the symptoms of TBI is clearly and separately attributable to TBI, headaches, or acquired psychiatric disability if diagnosed. 6. Evaluation in excess of 30 percent for rhinitis The Veteran underwent a rhinitis/sinusitis examination last time in September 2012, which is almost 10 years ago. As such, the evidence of record is clearly stale. The Veteran must be afforded a new VA examination in order to ascertain the current severity of the disability. See, e.g., Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Moreover, the evidence of record indicates that the Veteran has also been treated with sinusitis, the original condition for which he filed a claim. A new examination is also necessary to ascertain whether the Veteran's service connected disability pertains to both rhinitis and sinusitis. 7. TDIU prior to March 8, 2014 The issue of TDIU is inextricably intertwined with the claims of increased ratings as well as service connection. Therefore, the adjudication of the TDIU claim is deferred pending resolution of these claims. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain the Veteran's complete service personnel records. Document the process of obtaining the records. If the records cannot be obtained, notify the Veteran in writing as to the unavailability of his service personnel records. 2. Schedule the Veteran for a VA examination for his bilateral knees. The examiner must review the claims file. The examiner must opine (1) whether the Veteran's current knee disability is at least as likely as not related to service, including in-service treatment and complaint of left knee and right knee; (2) whether his current knee disability is at least as likely as not proximately due to or aggravated beyond natural progression by a service-connected disability; and (3) whether the Veteran's current osteoarthritis of bilateral knees are at least as likely as not that they (a) began during active service, (b) manifested within one year after discharge from service, or (c) was noted during service with continuity of the same symptomatology since service. All opinions must accompany sufficient rationale. 3. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder or PTSD. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a claimed in-service stressor. If any acquired psychiatric disorders other than PTSD are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease or it is at least as likely as not proximately due to or aggravated beyond natural progression by TBI. If any acquired psychiatric disorder is related to TBI, the examiner must opine whether each psychiatric symptom is clearly distinguishable from those of residuals of TBI. All opinions must accompany sufficient rationale. 4. Schedule the Veteran for an examination by an appropriate clinician for residuals of his service-connected TBI and headaches. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must review the result of the psychiatric examination obtained in the step 2 above if the psychiatric examination is conducted by a different examiner. All opinions must accompany sufficient rationale. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected rhinitis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must properly identify the condition or symptoms for which the Veteran is service-connected, i.e., rhinitis or sinusitis, or both. All opinions must accompany sufficient rationale. 6. After the development requested has been completed, the examination reports should be reviewed to ensure that they are in complete compliance with the directives of this REMAND. If any report is deficient in any manner, corrective procedures should be implemented. 7. Readjudicate the claims, to include the issue of TDIU prior to March 8, 2014. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Taylor 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.