Citation Nr: 21008341 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 10-18 494 DATE: February 16, 2021 ORDER 1. As new and material evidence has been received, the request to reopen the claim for service connection for a lumbar spine (low back) disability, including degenerative arthritis, is granted. 2. As new and material evidence has been received, the request to reopen the claim for service connection for a right eye disability is granted. 3. The reopened claim of entitlement to service connection for a lumbar spine disability, including degenerative arthritis and degenerative disc disease, is denied. 4. Entitlement to service connection for a cervical spine (neck) disability, including degenerative arthritis, is denied. REMANDED 5. Whether new and material evidence has been received to reopen the claim for service connection for a right knee disability is remanded. 6. The reopened claim of entitlement to service connection for a right eye disability is remanded. FINDINGS OF FACT 1. The Veteran’s claim for service connection for a lumbar spine disability was last previously denied by a December 2009 decision. The Veteran was notified of his appellate rights, but he did not appeal or submit new and material evidence during the applicable one-year appellate period. 2. Subsequent to the December 2009 decision denying service connection for a lumbar spine disability, new and material evidence has been submitted, which, presuming the credibility of subsequent statements, presents a reasonable possibility of substantiating the claim on the merits. 3. The Veteran’s claim for service connection for a right eye disability was last previously denied by a July 2006 decision. The Veteran was notified of his appellate rights, but he did not appeal or submit new and material evidence during the applicable one-year appellate period. 4. Subsequent to the July 2006 decision denying service connection for a right eye disability, new and material evidence has been submitted, which, presuming the credibility of subsequent statements, presents a reasonable possibility of substantiating the claim on the merits. 5. A lumbar spine disability did not develop in service and was not causally related to service, and arthritis of the lumbar spine was not present within the first post-service year. 6. A cervical spine disability did not develop in service and was not causally related to service, and arthritis of the cervical spine was not present within the first post-service year. CONCLUSIONS OF LAW 1. The December 2009 rating decision that denied entitlement to service connection for a lumbar spine disability is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. The criteria to reopen the claim for service connection for a lumbar spine disability have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The July 2006 rating decision that denied entitlement to service connection for a right eye disability is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 4. The criteria to reopen the claim for service connection for a right eye disability have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The criteria for service connection for a lumbar spine disability, to include degenerative arthritis and degenerative disc disease, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309 6. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1974 to August 1976, and he had subsequent National Guard membership. The Department of Veterans Affairs (VA) is grateful for his service. The Veteran testified before the undersigned Veterans Law Judge at a hearing conducted in October 2020. A transcript is of record. The Veteran also has a clothing allowance claim on appeal, which was addressed at the October 2020 hearing. However, this is considered a specialty issue and will be addressed in a separate decision. Service Connection Requests to Reopen Generally, when a claim is disallowed, it may not be reopened and allowed, and a claim based on the same factual basis may not be considered. 38 U.S.C. § 7105(c). However, a claim on which there is a final decision may be reopened if new and material evidence is submitted. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to agency decisionmakers, while 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. 38 C.F.R. § 3.156(a). 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. Id. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. See Shade v. Shinseki, 24 Vet. App. 110 (2010). Moreover, in determining whether this low threshold is met, consideration need not be limited to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but also whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA's duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510 (1992). 1. Request to reopen the claim for service connection for lumbar spine disability The RO last previously denied service connection for a low back disability by a December 2009 decision, based on the Veteran not submitting new relevant evidence, since a current disability had already been established and new evidence of a onset in service or a link to service was not provided. The Veteran was provided appropriate notice of this decision and notice of his appellate rights, but he did not timely submit a notice of disagreement or relevant evidence, and hence the decision became final 38 C.F.R. § 20.302. At his October 2020 Board of Veterans’ Appeals (Board) hearing before the undersigned, the Veteran testified that his back had been symptomatic on a chronic basis since his injury while on active duty training with the National Guard in June 1984. The Board here reopens the Veteran’s lumbar spine disability claim based on new evidence consisting of the Veteran’s testimony concerning a symptomatic back condition persisting from the time of an injury in June 1984. Evidence received subsequent to a final decision is presumed credible for the purposes of reopening the veteran's claim unless it is inherently false or untrue, or it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216, 220 (1995); Justus, 3 Vet. App. at 513 (1992). In light of this presumption, the Veteran’s testimony of ongoing back symptoms is sufficient to reopen the claim. 2. Request to reopen the claim for service connection for a right eye disability The Veteran’s claim for service connection for an eye disability was last previously denied by a July 2006 decision the RO denied reopening of a claim for service connection for an organic eye disability. The RO then found that treatment records subsequent to the last prior denial in January 1985 did not bear “directly and substantially” on the claim for service connection for an eye disability. The Veteran was provided appropriate notice of this decision and notice of his appellate rights, but he did not timely appeal that decision or submit pertinent evidence within the appeal period, and accordingly the decision became final. 38 C.F.R. § 20.302. At his October 2020 hearing before the undersigned, the Veteran testified to fracturing his eye socket while playing football in service and being told at the time that the fracture would heal on its own but that “I would go blind later on in years.” (HT, pg. 7.) He then added that his eye condition continued from service and he suffered from “dry socket,” his “eye sticks a lot of times,” and he often has a lot of pain, which symptoms were not relieved by various treatments including ointment and eye drops. Id. He also reported that his eye doctor observed a lot of nerve damage in the eye. The Board here reopens the Veteran’s eye disability claim based on new evidence consisting of the Veteran’s testimony concerning ongoing eye disability following service. This testimony is presumed credible only for purposes of reopening the claim. Duran, 7 Vet. App. at 220; Justus, 3 Vet. App. at 513. The reopened eye disability claim is the subject of remand, below. 3. – 4. Claims of entitlement to service connection for a lumbar spine disability and cervical spine disability – adjudicated on the merits Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "Active military, naval, or air service" includes active duty and any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or an injury incurred or aggravated in the line of duty, or any period of inactive duty training (INACDUTRA) in which the individual concerned was disabled or died from an injury (not also a disease) that was incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Reserve and National Guard service generally means ACDUTRA and INACDUTRA. ACDUTRA is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). Basically, this refers to the two weeks of annual training that each Reservist or National Guardsman must perform each year. It can also refer to the Reservist's or Guardsman's initial period of training. In this case, an accident and acute injury in June 1984, which is a factual basis for the Veteran’s claims for service connection lumbar spine disability and cervical spine disability, is documented in the record, as discussed below. However, the Board herein denies the Veteran’s claims for service connection for lumbar and cervical spine disabilities, in pertinent part, because the weight of the evidence is against a current disability, or one present at any time during the claim period, originating from that June 1984 accident and injury or otherwise having onset in service or a causal link to service. The Board also finds that service connection on a presumptive basis is not warranted. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition, service connection may also be established under 38 C.F.R. § 3.303(b) if a chronic disease or injury is shown in service, and subsequent manifestations of the same chronic disease or injury at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. Arthritis is a chronic disease listed under 38 C.F.R. § 3.309(a); and thus, 38 C.F.R. § 3.303(b) is applicable. See 38 U.S.C. § 1101; see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established based upon a legal presumption by showing that a disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.307, 3.309(a). Moreover, presumptive service connection does not apply to claims predicated on ACDUTRA and INACDUTRA service, only instead active duty. See Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991); Smith v. Shinseki, 24 Vet. App. 40 (2010). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. In determining the weight to be assigned to evidence, credibility can be affected by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self- interest, malingering, desire for monetary gain, and witness demeanor. Caluza v. Brown, 7 Vet. App. 498, 511, 512 (1995), aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996). Service treatment records document a few limited complaints related to back strain and neck pain in addition to the Veteran’s documented fall in June 1984 when he was in the National Guard. The claims file contains an undated military facility treatment record when the Veteran was 26 (which would be in approximately 1982 based on the Veteran’s birth in 1956) reflecting the Veteran’s report of pulling a muscle in his back when running that morning. He then stated that it felt the same as it did years ago when he pulled a muscle in his back. Physical examination was within normal limits except for low back muscle tenderness. Low back strain was assessed. A September 1982 military facility treatment record for back strain reflects the Veteran’s report that his back had improved, though he requested refill of muscle relaxer. An August 1983 military facility treatment record documents the Veteran’s complaint of pain in the left upper shoulder and neck and stiffness in the neck. He reported slipping in the shower about three days earlier. He also then complained of a rash in his crotch and requested a shaving profile. The treating physician found mild tenderness to the left shoulder and directed that the Veteran return to normal duty. There is no military record of ongoing difficulties with the neck following this care visit. A June 13, 1984 treatment record informs that five days earlier the Veteran fell off a loading dock and hit his thigh, straining his back, with the result that he now had pain in both. Swelling was present in the thigh, and the low back was tender. The clinician assessed a contusion of the thigh and low back strain. X-rays were to be obtained and the condition treated conservatively. He was placed on a profile for 10 days. An incident statement by a fellow soldier dated June 13, 1984 provides: On Saturday 9 June 1984 I was helping the KPs get rations from our storage area/bldg. #2 on post and bring them to building #105 to put in the mess hall area for meal preparation. While we were putting the rations on our truck, [the Veteran] slipped and fell between the loading dock and the truck. I asked him if he was alright and he answered “yes.” We continued to work and [the Veteran] didn’t show any signs of injury or discomfort. We brought the rations back to the company area and continued our normal duty. An incident statement by a different soldier dated June 13, 1984 provides: [The Veteran] was on KP 9 Jun 84 and did slip and fall between the loading dock and vehicle. At this time he didn’t have any noticeable pain or stiffness or back problem. He begin to feel bad and have some discomfort while the company was in a tactical exercise starting 0001 Hrs on 10 Jun 84 and ending 1200 Hrs on 13 June 84. [The Veteran] performed all his duties while in the field to include helping load trucks, move equipment and other chores as needed. When [the Veteran] come to me and complained about his back hurting, I sent him to receive medical care as needed. A June 14, 1984 sick slip informs that the Veteran was placed on continued light duty due to back strain. At a July 19, 1984 treatment at a Naval hospital, the Veteran’s history was noted of a fall on active duty when he fell between a truck and a loading dock and injured his low back. The Veteran then reported no relief from his symptoms in the past six weeks since the accident on June 8. The Veteran reported that the pain was in the low back with occasional shooting pain to the right side and shooting pain up the left paravertebral muscles. Upon examination, a trigger point was identified in the left posterior iliac spine. Range of motion and neuromuscular examination of the lower extremities was normal. X-rays were “unremarkable.” The Veteran was provided a trigger point injection. An August 3, 1984 a military attending physician’s report informs of a diagnosis of lumbosacral strain with gradual healing, finding that the Veteran was currently fit to return to duty. Post service, November 1991 lumbar spine x-rays revealed disk spaces and alignment maintained, with no evidence of osteophytes, and no other abnormalities. A normal lumbar spine was assessed. A March 2000 VA treatment record notes the Veteran’s report of intermittent low back pain “when he does large amounts of heavy lifting,” with the pain resolving after a few days. The Veteran then reported having no current low back pain and having no history of injury. At his October 2020 Board of Veterans’ Appeals (Board) hearing before the undersigned, the Veteran testified that his back had been symptomatic on a chronic basis since his injury while on active duty training with the National Guard in June 1984. The Veteran also testified that he worsened his neck condition with a fall from a loader while on active duty with the National Guard in June 1984. He testified that his back had been symptomatic on a chronic basis since that injury. He then added that he had difficulties with his neck and his back on a continuous basis from service, stating, “I’ve always, like I said, I’ve always had that issue from my neck all the way down my back, all the way down my leg. Then they stopped talking about the lumbar issue and started saying it was sciatic, issue, you know. Like I say, I’m not a medical doctor, so all I know is that I’m hurting in these areas and it’s creating a problem, you know.” (Hearing transcript (HT), pg. 6.) He added that he had chronic neck symptoms since that time due to the fall, and that subsequently he obtained care intermittently at emergency rooms, and eventually he received care including referral to acupuncture. He additionally testified, “A lot of times I just reinjured it.” (HT, pg. 6.) Upon VA examination in March 2016 to address claimed back and neck disability, the examiner reviewed the record and the Veteran’s medical history, noting that the Veteran sustained a back strain during active duty for training (ACDUTRA) in with Army National Guard in June 1984. The examiner considered the Veteran’s contended theories of entitlement, of current back disability being causally related to a lumbar sprain when he fell from a loading dock in service, and of a neck disability being causally related to his injuring his neck during the same fall. Service treatment records were reviewed showing that the Veteran received therapy for the back strain with improvement, and that there was no evidence then of degenerative joint disease or degenerative disc disease. The examiner further noted that the Veteran was not diagnosed with degenerative disc disease of the lumbar spine until more than two decades after service. A comprehensive joints examination in November 2000 was noted to include a normal back examination with full range of motion and no pain, and neurological examination was also normal. For an orthopedic examination in October 2003 lumbar x-rays were reported as normal. In contrast, records after 2010 reflected chronic complaints for the cervical, thoracic, and lumbar spines. Imaging studies in November 2013 were noted to show degenerative disc disease and degenerative joint disease in the lumbar spine. Reviewed imaging studies of the lumbosacral spine from February 2015 showed degenerative disc disease at multiple levels as well as retrolisthesis. Reviewed February 2015 imaging studies of the cervical spine showed both retrolisthesis and anterolisthesis at multiple levels as well as degenerative changes. The March 2016 examiner opined that the Veteran had lumbar degenerative disc disease and degenerative joint disease, which were diagnosed many years after service and were not at least as likely as not related to service. The examiner supported this opinion with the following evidence: while the Veteran suffered a low back strain in service he received therapy for the condition with improvement; degenerative joint disease and degenerative disc disease were not shown in service; a period of many years following service reflected neither back complaints nor findings of degenerative disc disease or degenerative joint disease; and x-rays in 2000 and 2003 had normal findings, with degenerative joint disease and degenerative disc disease not diagnosed until over two decades following service. The examiner further explained that medical literature supported that natural aging combined with axial loading due to increased body mass index (BMI) leads to degenerative changes in the spine, and the Veteran was noted to have Class III obesity. Additionally, the examiner explained that while strain such as that which the Veteran suffered in November 1984 involved the muscles and ligaments of the spine, degenerative changes involved the vertebral bodies, and strain did not cause degenerative changes. Thus, while the examiner considered the Veteran’s self-reported history of back disability resulting from his fall in June 1984, the examiner concluded that the weight of the evidence of record and medical knowledge made that asserted history of current disability unlikely. The March 2016 examiner also opined that the Veteran had cervical degenerative disc disease and cervical degenerative joint disease, which were diagnosed many years after service and were not at least as likely as not related to service, explaining that service records showed no objective evidence of a neck disorder, and that even though the Veteran is documented to have complained on one occasion while in the National Guard that he had a pain in his neck, subsequent records did not support continuous complaints of a cervical condition. The examiner noted that while the Veteran claimed that he injured his neck from his fall from a loading dock in service, private records did not show neck problems until the 1990s, and degenerative disc disease and degenerative joint disease were not diagnosed until 2011-2013. The examiner added that medical literature supported natural aging when combined with axial loading due to increased BMI leading to degenerative changes in the spine, consistent with the examiner’s finding that the Veteran had Class III obesity. Thus, while the examiner considered the Veteran’s self-reported history of neck disability relating to his National Guard service, the examiner concluded that the weight of the evidence was against his current cervical disability being related to service. The Veteran’s current contentions, including in this hearing testimony, of his back disability being continuously present as a chronic condition since his injury in June 1984 are undermined by the March 2000 treatment record, which reflects the Veteran’s then report of intermittent low back pain when he performed large amounts of heavy lifting, which he reported would resolve after a few days. The examiner documented that the Veteran denied a history of an injury. The Veteran’s statement in March 2000 while seeking treatment is highly credible because he was then motivated to be factual in order to obtain correct treatment. Thus, what he reported in March 2000 refutes the Veteran’s allegation of chronic low back pain since the 1984 injury, and the Veteran’s allegation of chronic low back/lumbar spine pain since 1984 is not credible. Kahana, 24 Vet. App. at 433; Caluza, 7 Vet. App. at 511, 512. Based on this impaired credibility for statements of history in support of his claim back claim, the Board also finds little credibility in the Veteran’s statements of history in support of his cervical spine claim, as relating to symptoms due to the same in-service injury. There are multiple records surrounding the June 1984 injury, including statements from witnesses, and none of them document an injury to the neck or cervical spine. A July 1984 medical professional from the orthopedic department wrote that the Veteran was injured when he fell between a truck and a loading dock “sustaining a low back injury.” At this point, it had been a month since the injury, and the only injury documented was a low back injury. If the Veteran had sustained a neck injury, the Board finds that such would have been documented within the contemporaneous records. Instead, the Veteran did not report neck/cervical spine pain at the time of the 1984 injury, and there are no contemporaneous records documenting a neck/cervical spine injury, and the Board finds that no neck/cervical spine injury occurred at the time he injured his low back/lumbar spine. While the Veteran may sincerely believe that current cervical and lumbar spine disabilities are related to service including related to a fall in June 1984, these questions of etiology of conditions of the spine are medical questions beyond the ambit of lay knowledge, and hence the Veteran’s opinions are not competent evidence supporting the claims. The Veteran has not been shown to possess the requisite expertise or knowledge to address these questions. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. The Board finds the weight of competent and credible evidence of record to be consistent with and supportive of the March 2016 VA examiner’s findings and opinions to the effect that the Veteran’s current cervical and lumbar disabilities including degenerative disc disease and degenerative joint disease and other spinal changes were not incurred in service or otherwise causally related to service. The absence of service records supporting more than acute cervical pain and a lumbar sprain, which gradually resolved, without in-service onset of chronic disability, and the absence of post-service records supporting the development of degenerative disc disease, degenerative joint disease, or other chronic conditions of the cervical or lumbar spine until over a decade after service, as well as the medical knowledge that back sprains do not cause spinal degenerative changes and spinal degenerative changes are associated with age and axial loading associated with greater BMI, as reflected by the Veteran’s Class III obesity, all are supportive of the examiner’s conclusions. Contrary medical opinion evidence supporting a link between service and current cervical or lumbar disability has not been presented. Thus, the weight of the evidence of record including the examiner’s findings and conclusions is against the onset in service or a causal link to service for any cervical or lumbar disability present during the claim period, and against arthritis of the cervical or lumbar spine begin present within the first post-service year. The Board accordingly finds the preponderance of the evidence against service connection for cervical and lumbar disabilities on a direct basis or on a first-year-post-service presumptive basis. 38 C.F.R. §§ 3.303, 3.307, 3.309. Because the preponderance of the evidence is against the appealed claims denied herein, the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 5. Request to reopen claim for service connection for a right knee disability is remanded. As the undersigned observed at the Veteran’s October 2020 hearing, the VA Regional Office (RO) denied reopening a claim for service connection for a right knee disability in February 2017 and the Veteran submitted a timely notice of disagreement in September 2017, but the RO has yet to issue a responsive statement of the case (SOC). Where a notice of disagreement has been submitted, the veteran is entitled to an SOC. 38 C.F.R. § 19.26. The failure to issue an SOC is a procedural defect requiring a remand. Godfrey v. Brown, 7 Vet. App. 398 (1995) and Manlincon v. West, 12 Vet. App. 238 (1999). 6. Entitlement to service connection for a right eye disability is remanded. Service treatment records include a transcript of an April 30, 1976 x-ray examination report with the following impressions: “(1) Undisplaced zygomatic arch fracture. (2) Air fluid level and questionable irregularity in the inferolateral wall of the right antrum strongly suggestive of fracture at this site and re-evaluation suggested to determine exact extent of injury. (3) Free air in the right orbit indicative of fracture either of the ethmoid area or of the floor of the orbit, which is not displaced.” The service treatment records provide no indication that the re-evaluation recommended in this x-ray report was conducted. A May 6, 1976 service treatment record indicates that six days following the trauma the Veteran still had hypoesthesia of the upper lid and facial area. An August 1976 service separation examination report includes no mention of the Veteran’s right eye injury only months earlier. Upon careful review of the record, it does not appear that items (2) and (3) as listed in the April 30, 1976 x-ray report were ever adequately re-evaluated or addressed in furtherance of the Veteran’s claims since service for service connection for right eye disability. Upon a May 2014 VA examination addressing the Veteran’s in-service right zygomatic arch fracture and any residuals, the examiner found the extraocular muscles intact, the Veteran’s pupils equal and reactive to light and accommodation, and cranial nerves II to XII grossly intact. The examiner found no neurological impairment or loss of function associated with his history of right zygomatic arch fracture. Facial bones on x-ray revealed very mild deformities of the middle portions of the left and right zygomatic arch, “possibly representing bilateral old zygomatic arch fracture deformities.” However, the examiner found no acute abnormality, and no associated impairment in functioning. The focus of the examination was one of traumatic brain injury (TBI) associated with the zygomatic arch fracture, and the examiner found no evidence of TBI. Concurrently, VA examination to address any sinus residuals found no functional residuals associated with the Veteran’s old right zygomatic arch fracture. Regrettably, the examiner only addressed residuals of zygomatic arch fracture and failed to address any residuals of the possible fracture of the inferolateral wall of the right antrum and fracture of either the ethmoid area or the floor of the right orbit, as identified in the April 30, 1976 x-ray report. The May 2014 VA examination only reviewed residuals of right zygomatic arch fracture. Absent consideration of the other injury findings from April 30, 1976 x-ray report, the May 2014 VA examination cannot be complete or adequately probative. A medical opinion based on an inaccurate factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (per curiam). Remand for additional examination is accordingly warranted. The matters are REMANDED for the following action: 1. Readjudicate the request to reopen a claim for service connection for a right knee disability and furnish the Veteran and his authorized representative with a statement of the case (SOC) responsive to his September 2017 notice of disagreement, as appropriate. The issue should be returned to the Board for further review only if the appeal is perfected. 2. Obtain an examination by appropriate clinician to address any residuals of a right eye injury in service in April 1976. The examiner should carefully review the claims file and conduct any scans, tests, or examinations deemed necessary. A complete report of relevant findings should be provided. The examiner should specifically review the April 30, 1976 x-ray examination report, which provided the following assessments: “(1) Undisplaced zygomatic arch fracture. (2) Air fluid level and questionable irregularity in the inferolateral wall of the right antrum strongly suggestive of fracture at this site and re-evaluation suggested to determine exact extent of injury. (3) Free air in the right orbit indicative of fracture either of the ethmoid area or of the floor of the orbit, which is not displaced.” See VBMS entry with document type, “STR – Medical,” receipt date 08/25/2014, p. 12. The examiner should address each of these identified assessments and whether there are any current residuals. For each identified disability of the right eye or impairments of adjacent parts, the examiner should separately provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the impairment or disability is causally related to the right eye injury in service in April 1976 (including as reflected in the April 30, 1976 x-ray examination report) or is otherwise causally related to his period of active duty from August 1974 to August 1976. The examiner should provide a complete explanation for each opinion. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Schechter 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.