Citation Nr: 21022023 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 16-19 625 DATE: April 14, 2021 ORDER Service connection for a headache disorder is granted. Service connection for obstructive sleep apnea as secondary to service-connected respiratory disorder is granted. Service connection for generalized fatigue as secondary to service-connected obstructive sleep apnea is granted. Service connection for gastroesophageal reflux disease, to include as secondary to service-connected respiratory disorder is denied. Service connection for sinusitis, to include as secondary to service-connected respiratory disorder is denied. Service connection for rhinitis, to include as secondary to service-connected respiratory disorder is denied. Service connection for a reproductive organ disorder, to include voiding dysfunction, penis deformity and erectile dysfunction, to include as secondary to service-connected respiratory disorder is denied. Service connection for a right eye disorder, to include glaucoma suspect, pinguecula, myopia, astigmatism, presbyopia, to include as secondary to service-connected respiratory disorder is denied. Service connection for conjunctivitis, to include as secondary to service-connected respiratory disorder is denied. An increased 100 percent rating from October 10, 2013 to April 6, 2020 for the Veteran’s respiratory disorder is granted. REMANDED The issue of a total disability rating based on individual unemployability (TDIU) due to service-connected disorders is remanded. FINDINGS OF FACT 1. With resolution of the doubt in his favor, the Veteran’s headache disorder was incurred in-service. 2. With resolution of the doubt in his favor, the Veteran’s obstructive sleep apnea was aggravated by his service-connected respiratory disorder. 3. With resolution of the doubt in his favor, the Veteran’s generalized fatigue was caused by his service-connected obstructive sleep apnea. 4. The Veteran’s gastroesophageal reflux disease was not caused by service. 5. The Veteran’s gastroesophageal reflux disease was not caused or aggravated by his service-connected respiratory disorder. 6. The Veteran’s sinusitis was not caused by service. 7. The Veteran’s sinusitis was not caused or aggravated by his service-connected respiratory disorder. 8. The Veteran’s rhinitis was not caused by service. 9. The Veteran’s rhinitis was not caused or aggravated by his service-connected respiratory disorder. 10. The Veteran’s reproductive organ disorder was not caused by service. 11. The Veteran’s reproductive organ disorder was not caused or aggravated by his service-connected respiratory disorder. 12. The Veteran’s myopia, astigmatism and presbyopia constitute developmental errors of refraction and the Veteran has not been diagnosed with an additional disability on top of the underlying refractive errors. 13. The Veteran’s glaucoma suspect, cataracts and conjunctivitis were not caused by service. 14. The Veteran’s glaucoma suspect, cataracts and conjunctivitis were not caused or aggravated by his service-connected respiratory disorder. 15. With resolution of the doubt in his favor, for the entirety of the rating period on appeal, the Veteran’s respiratory disorder required daily use of immunosuppressive medications. CONCLUSIONS OF LAW 1. The criteria to establish service connection for a headache disorder have been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(b), (d), 3.309(a). 2. The criteria to establish service connection for obstructive sleep apnea have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.310. 3. The criteria to establish service connection for generalized fatigue have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.310. 4. The criteria to establish service connection for gastroesophageal reflux disease have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(d), 3.310. 5. The criteria to establish service connection for sinusitis have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(d), 3.310. 6. The criteria to establish service connection for rhinitis have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(d), 3.310. 7. The criteria to establish service connection for a reproductive organ disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(d), 3.310. 8. The criteria to establish service connection for a right eye disorder have not been. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(d), 3.310. 9. The criteria to establish service connection for conjunctivitis have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(d), 3.310. 10. The criteria to establish an increased 100 percent rating for the entirety of the rating period on appeal for the Veteran’s respiratory disorder have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.27, 4.97, Diagnostic Code (DC) 6600-6602. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from October 1975 to October 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the St. Paul, Minnesota Regional Office (RO). In November 2019, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge (VLJ). During the hearing, the VLJ engaged in a colloquy with the Veteran toward substantiation of the claims. Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A hearing transcript is in the record. In February 2020, the Board remanded the appeal to the RO for additional action. There was substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Service connection may 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). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection shall be granted on a secondary basis under 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder caused or aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Headache disorder Headaches, as an organic disease of the nervous system, is a “chronic disease” listed under 38 C.F.R. § 3.309(a). Therefore, the provisions of 38 C.F.R. § 3.303(b) apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such during active service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected unless they are clearly attributable to intercurrent causes. Generally, if a condition noted during active service is not shown to be chronic, then, a “continuity of symptoms” after service is required to establish service connection. 38 C.F.R. § 3.303(b). Additionally, as a chronic disease, headaches will be considered to have been incurred in or aggravated by service if the disease becomes manifest to a compensable degree within one year from the date of service separation. 38 C.F.R. § 3.307(a)(3). The Veteran asserts that his headache disorder was caused by the in-service medication used to treat his motion sickness, or alternatively, as secondary to his service-connected respiratory disorder. The claim will be granted on the theory of presumptive service connection based on continuity of symptomatology. In service treatment records (STRs) dated July 1977 and August 1977, the Veteran reported experiencing headaches. He was diagnosed with motion sickness and treated with Tylenol and Compazine. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered “no” to the question of whether he then had, or once had frequent or severe headaches. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no neurological abnormalities were noted. The STRs are highly probative because they were generated with the specific view of recording the events they describe. In this respect, they are akin to official records, which generally enjoy a high degree of probative value in the law. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board’s decision). In a November 2010 VA treatment record, the Veteran denied experiencing headaches. However, a June 2011 VA treatment record reflects the Veteran’s report of experiencing headaches. In an April 2012 VA treatment record, the Veteran reported experiencing headaches that began after the Veteran underwent dental treatment. He was diagnosed with headaches. A June 2013 VA treatment record reflects the Veteran’s report of experiencing headaches. In the March 2014 VA examination, the Veteran reported experiencing headaches during service. The examiner diagnosed the Veteran with headaches. The examiner opined, without any supporting rationale, that the Veteran’s headaches were not caused by the in-service medication used to treat his motion sickness and not caused and/or aggravated by his service-connected respiratory disorder. The VA medical opinion is of low probative value because it is conclusory and does not provide the Board with sufficient analysis to consider and weigh the opinion. Stefl v. Nicholson, 21 Vet. App. 120, 124-125 (2007) (holding that a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor’s opinion). In his November 2019 Board hearing, the Veteran reasserted that his headache disorder was secondary to his service-connected respiratory disorder and non-service connected sinusitis and rhinitis. The Veteran is not competent, as a lay-person, to provide a medical opinion as to the cause or aggravation of his headache disorder. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Veteran is competent to report symptoms which a layperson is competent to report. In a March 2020 statement, the Veteran reported experiencing headaches “regularly” during service. The Veteran is competent to report having experienced headaches because it is a symptom capable of lay observation. Pierce v. Principi, 18 Vet. App. 440 (2004); Jandreau, supra. However, as noted above, the Veteran denied experiencing frequent headaches in his service medical history reports. Curry v. Brown, 7 Vet. App. 59 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the veteran). In an April 2020 VA addendum, the examiner opined that the Veteran’s headache disorder was not caused by the in-service medication used to treat his motion sickness because the in-service headache was acute and transitory. The examiner also opined that the Veteran’s headache disorder was not caused or aggravated by his service-connected respiratory disorder because the Veteran has several non-service-connected medical conditions “that may cause headaches” and a headache is a ubiquitous symptom. Although the medical opinion is highly probative as to theories of direct and secondary service connection, the examiner did not provide an opinion as to continuity of symptomatology for presumptive service connection. The Board will grant the claim based on the benefit-of-the-doubt doctrine as to continuity of symptomatology. STRs reflect the Veteran having reported experiencing headaches during service. Although the Veteran denied experiencing severe or frequent headaches in his service medical history reports, the Veteran’s post-service medical records reflect the Veteran having experienced headaches as a continuous symptom. The Board will resolve all reasonable doubt in favor of the Veteran. Therefore, service connection is warranted and the claim is granted. Obstructive sleep apnea The Veteran asserts that his obstructive sleep apnea (OSA) was caused by the in-service medication used to treat his motion sickness, or alternatively, as secondary to his service-connected respiratory disorder. The claim will be granted as to secondary service connection based on aggravation. In STRs dated July 1977, August 1977 and November 1977, the Veteran was diagnosed with motion sickness and prescribe Compazine; however, there was no indication that the Veteran experienced trouble with sleeping. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered in the negative to the question of whether he then had, or once had frequent trouble sleeping. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no neurological or sleeping abnormalities were noted. In a November 2011 VA treatment record, the Veteran reported experiencing trouble sleeping and that his partner observed the Veteran experience apneas. The VA treating physician indicated that sleep apnea was possible due to the Veteran’s gender, age, asthma and crowded oropharynx. A December 2011 VA sleep study revealed a diagnosis of OSA. In an October 2013 statement, the Veteran reported experiencing trouble sleeping due to shortness of breath. In the September 2014 VA examination, the examiner opined, without supporting rationale, that the Veteran’s OSA was not caused by the in-service medication used to treat the Veteran’s motion sickness. The examiner opined that the Veteran’s OSA was not caused or aggravated by his service-connected respiratory disorder because the medical literature was silent as to such an indication. Both opinions were of low probative value. The examiner’s opinion as to direct service connection was conclusory and did not provide the Board with sufficient analysis to consider and weigh the opinion. Stefl, supra. The opinion as to secondary service connection was not supported by the Veteran’s pertinent medical history. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). In a December 2014 VA treatment record, the Veteran’s VA treating physician indicated that the Veteran had multiple risk factors for OSA, such as a deviated septum, allergic rhinitis and enlarged tonsils. The physician also indicated that the Veteran was on multiple medication for asthma, OSA and asthma were interlinked and that asthma “can exacerbate OSA.” The VA treating physician’s medical opinion is highly probative because the physician had an accurate and complete history of the Veteran’s medical history and provided a medical opinion with supporting rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In the April 2020 VA addendum, the examiner opined that the Veteran’s OSA was not caused by the Veteran’s in-service medication for motion sickness because motion sickness was a distinct symptom and not causative of OSA. The examiner also opined that the Veteran’s OSA was not caused or aggravated by his respiratory disorder because asthma resulted in airflow inflammation with bronchial hyper-responsiveness and airflow obstruction with associated dyspnea but the obstructive cause of OSA resulted from laxity of the soft tissue in the oropharyngeal airway. The VA addendum opinion is also highly probative. Nieves-Rodriguez, supra. The Board will grant the claim based on the benefit-of-the-doubt doctrine as to secondary service connection based on aggravation. The December 2014 VA treating physician opined that the Veteran’s respiratory disorder aggravated the Veteran’s OSA and the April 2020 VA examiner opined otherwise. As noted above, both opinions were highly probative. The Board will resolve all reasonable doubt in favor of the Veteran. Therefore, service connection is warranted and the claim is granted. Generalized fatigue The Veteran asserts that his generalized fatigue was caused by service, or alternatively, as secondary to service-connected respiratory disorder and/or obstructive sleep apnea. The claim will be granted. STRs are silent for complaints or contemporaneous reports concerning fatigue. In service medical history reports dated October 1986, June 1991 and May 1999 the Veteran did not report experiencing fatigue. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no neurological abnormalities were noted. In a May 2010 VA treatment record, the Veteran reported experiencing fatigue. It was noted that the Veteran’s asthma was not well-controlled and “may be the cause of his fatigue.” A December 2010 VA treatment record reflects the Veteran’s report of experiencing fatigue. The VA treating physician indicated that the Veteran’s respiratory disorder “may be the cause” of his fatigue since the Veteran’s asthma was not well controlled. The medical opinions in the VA treatment record are of low probative value because the opinions speculated on the issue of etiology. Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009) (a medical opinion is speculative when it uses equivocal language such as “may well be,” “could,” or “might”). In a January 2011 VA treatment record, it was noted that the Veteran’s respiratory disorder resulted in a lack of stamina, weakness and fatigue. A June 2011 VA treatment record reflects the Veteran’s report of experiencing daytime fatigue. The March 2014 VA examiner diagnosed the Veteran with generalized fatigue. In his November 2019 Board hearing, the Veteran reported experiencing fatigue as a result of his OSA. The April 2020 VA examiner opined that the Veteran’s generalized fatigue was not caused by service, or alternatively, not caused and/or aggravated by his respiratory disorder because there was no direct clinical correlation between such conditions. The examiner opined that the Veteran’s generalized fatigue was caused by obstructive sleep apnea because the Veteran had a history of fatigue from insomnia, sleep apnea, anxiety and other chronic conditions. The Board will grant the claim based on the benefit-of-the-doubt doctrine. As noted above, the Veteran has been granted service connection for obstructive sleep apnea and the Veteran has reported experiencing fatigue after having slept. Although the April 2020 VA examiner indicated that the Veteran had a history of fatigue from insomnia, anxiety and other chronic conditions, the examiner opined that the Veteran’s generalized fatigue was caused by obstructive sleep apnea. The Board will resolve all reasonable doubt in favor of the Veteran. Therefore, service connection is warranted and the claim is granted. Gastroesophageal reflux disease The Veteran asserts that his gastroesophageal reflux disease (GERD) was caused by service, or alternatively, as secondary to his service-connected respiratory disorder. The claim will be denied. A December 1978 STR reflects the Veteran’s report of experiencing stomach pain after having consumed eggs. He was diagnosed with mild gastroenteritis. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered in the negative to the question of whether he then had, or once had stomach trouble. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no abnormalities pertaining to GERD were noted. An April 2007 VA treatment record reflects the Veteran’s diagnosis of GERD. In a July 2011 VA treatment record, it was noted that the Veteran was prescribed Ranitidine and Omeprazole for GERD. A November 2011 VA treatment record reflects the Veteran’s diagnosis of GERD. In an October 2013 statement, the Veteran reported having been diagnosed with GERD in December 1978 during service. However, the December 1978 STR reflects a diagnosis of gastroenteritis, not GERD. The Veteran is not competent, as a lay-person, to provide a medical opinion as to the cause of his GERD. Jandreau, supra. In a July 2014 VA treatment record, the Veteran underwent an esophagogastro-duodenoscopy (EGD) and it was noted that the Veteran’s GERD had nearly resolved. The September 2014 VA examiner opined, without supporting rationale, that the Veteran’s GERD was not caused by service. The examiner also opined that the Veteran’s GERD was not caused or aggravated by his service-connected respiratory disorder, to include the medication used to treat the disorder because medical literature did not support such a conclusion. Both medical opinions were inadequate and therefore of low probative value. The opinion as to direct connection was conclusory and did not provide the Board with sufficient analysis to consider and weigh the opinion. Stefl, supra. The opinion as to secondary service connection was not supported by sufficient rationale. Nieves-Rodriguez, supra. In a March 2020 statement, the Veteran asserted that GERD was a “chronic disease” according to medical literature. The Veteran claimed that his in-service coughing and vomiting due to motion sickness were symptoms of GERD. The Veteran also asserted that his GERD was aggravated by his respiratory disorder because an April 2013 VA treatment record listed GERD as having been exacerbated by the Veteran’s asthma. However, GERD is not listed as a chronic disease under 38 C.F.R. § 3.309(a) and is therefore not subject to presumptive service connection. As noted above, the Veteran was diagnosed with gastroenteritis, not GERD, during service and the Veteran is not competent, as a lay-person, to attribute his in-service symptoms of coughing and vomiting to a diagnosis of GERD. Jandreau, supra. The April 2013 VA treatment record reflects that GERD can exacerbate asthma, not the other way as the Veteran claims: “Severe persistent asthma: not entirely well controlled. Exacerbating factors include … GERD.” In the April 2020 VA addendum, the examiner opined that the Veteran’s GERD was not caused by service, or alternatively, not caused and/or aggravated by his service-connected respiratory disorder because the Veteran’s GERD was a base symptom attributed to cigarette smoking and advanced age. The VA addendum is highly probative because the examiner had an accurate and complete history of the Veteran’s medical history and provided a medical opinion with supporting rationale. Nieves-Rodriguez, supra. A preponderance of the evidence is against a finding that the Veteran’s GERD was caused by service, or alternatively, as secondary to service-connected respiratory disorder. The Veteran is not competent to provide a medical opinion as to the cause or aggravation of his GERD. The April 2020 VA examiner opined that the Veteran’s GERD was not caused by service. The examiner also opined that the Veteran’s GERD was not caused or aggravated by his service-connected respiratory disorder. Significantly, no competent medical provider has opined otherwise. Therefore, service connection is not warranted and the claim is denied. Sinusitis The Veteran asserts that his sinusitis was caused by service, or alternatively, as secondary to his service-connected respiratory disorder. The claim will be denied. A November 1975 STR reflects the Veteran’s report of experiencing stuffy sinuses. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered in the negative to the question of whether he then had, or once had sinusitis. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no sinus abnormalities were noted. A May 2010 VA sinus radiograph revealed opacification of maxillary sinuses and ethmoid air cells consistent with sinusitis. The Veteran was diagnosed with sinusitis. VA treatment records dated April 2012 and June 2013 reflect a diagnosis of sinusitis. The March 2014 VA examiner opined, without any rationale, that the Veteran’s sinusitis was not caused or aggravated by his service-connected respiratory disorder. The September 2014 VA examiner opined, without any rationale, that the Veteran’s sinusitis was not caused by in-service nasal treatment. Both opinions were inadequate and therefore of low probative value because they were conclusory and did not provide the Board with sufficient analysis to consider and weigh the opinions. Stefl, supra. In a March 2020 statement, the Veteran claimed that the March 2014 VA examiner attributed the Veteran’s in-service sinus congestion to a diagnosis of sinusitis. Contrarily, the March 2014 VA examiner noted the symptom of sinus congestion in the Veteran’s STRs and attributed that symptom to the Veteran’s service-connected respiratory disorder. The Veteran is not competent to attribute his in-service sinus congestion to a diagnosis of sinusitis. Jandreau, supra. The April 2020 VA examiner opined that the Veteran’s sinusitis was not caused by service because the Veteran’s symptoms of cold and clogged (“stuffy”) sinuses during service were caused from a viral infection and that it was acute and transitory. The examiner also opined that the Veteran’s sinusitis was not caused or aggravated by his service-connected respiratory disorder as there was no evidence to indicate causation or aggravation. The VA addendum opinion is highly probative. Nieves-Rodriguez, supra. A preponderance of the evidence is against a finding that the Veteran’s sinusitis was caused by service, or alternatively, as secondary to his service-connected respiratory disorder. The Veteran is not competent to provide a medical opinion as to the cause or aggravation of his sinusitis. The April 2020 VA examiner opined that the Veteran’s sinusitis was not caused by service and not caused and/or aggravated by his service-connected respiratory disorder. Significantly, no competent medical provider has opined otherwise. Therefore, service connection is not warranted and the claim is denied. Rhinitis The Veteran asserts that his rhinitis was caused by service, or alternatively, as secondary to his service-connected respiratory disorder. The claim will be denied. In the Veteran’s October 1979 separation medical examination report, a history of frequent throat infections was noted. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered in the negative to the question of whether he then had, or once had ear, nose or throat trouble. In service medical examination reports dated October 1986, June 1991 and May 1999, no nose, mouth or throat abnormalities were noted. A November 2010 VA treatment record reflects the Veteran’s diagnosis of allergic rhinitis. In a January 2011 VA treatment record, the Veteran reported experiencing nasal stuffiness, sneezing, nasal dripping, facial pressure, eye twitching and eye redness. He was diagnosed rhinitis. The VA treating physician noted that the Veteran was probably allergic and that his symptoms had a “close correlation” with asthma control. A September 2012 VA treatment record reflects the Veteran’s report of experiencing nasal congestion. He was diagnosed with allergic rhinitis. In a March 2013 VA treatment record, it was noted that the triggers for the Veteran’s allergic rhinitis were dust, pollen and cat dander. A June 2013 VA treatment record reflects the Veteran’s diagnosis of perennial rhinitis. The September 2014 VA examiner opined, without supporting rationale, that the Veteran’s rhinitis was not caused by service, or alternatively, not caused and/or aggravated by the Veteran’s service-connected respiratory disorder. The VA medical opinion was inadequate because it was conclusory and did not provide the Board with sufficient analysis to consider and weigh the opinion. Stefl, supra. In a November 2014 VA treatment record, it was noted that the Veteran was allergic to dust mites, cats, dogs and aspergillus. The Veteran reported experiencing episodes of nasal congestion, sore throat, itchy throat, itchy nose and itchy eyes during service. The VA physician indicated that it “certainly sounds like he had an allergic component” during service that “could have played a role” in the development of allergic rhinitis. The VA physician’s opinion is of low probative value because it speculated on the issue of etiology. Polovick, supra. In a March 2020 statement, the Veteran claimed to have been exposed to dust, mites and mole during service and attributed his sinus-related symptoms to such exposure. The Veteran is competent to report having experienced his observable symptoms; however, he is not competent, as a lay-person, to attribute his symptoms to a diagnosis of rhinitis. Jandreau, supra. The April 2020 VA examiner opined that the Veteran’s rhinitis was not caused by service because the Veteran’s in-service cold and sinus symptoms resulted from a viral infection that was acute and transitory. The examiner also opined that the Veteran’s rhinitis was not caused or aggravated by his respiratory disorder because his rhinitis was caused by exposure to dust mites, cats, dogs and aspergillus which reflects a hypersensitivity to allergens and was anatomically distinct to asthma. The VA addendum opinion is highly probative. Nieves-Rodriguez, supra. A preponderance of the evidence is against a finding that the Veteran’s rhinitis was caused by service, or alternatively, as secondary to his service-connected respiratory disorder. The Veteran is not competent to provide a medical opinion as to the cause or aggravation of his rhinitis. The April 2020 VA examiner opined that the Veteran’s rhinitis was not caused by service, and not caused and/or aggravated by his service-connected respiratory disorder. Therefore, service connection is not warranted and the claim is denied. Reproductive organ disorder The Veteran asserts that his reproductive organ disorder was caused by service, or alternatively, as secondary to his service-connected respiratory disorder. The claim will be denied. In an April 1978 STR, the Veteran reported experiencing painful urination and blockage. He was diagnosed with a urinary tract infection and provisionally diagnosed with a urethral stricture. A January 1979 STR reflects the Veteran’s report of experiencing genital itching. He was diagnosed with a venereal disease. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered in the negative to the question of whether he then had, or once had frequent or painful urination. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no genitourinary system abnormalities were noted. A March 2013 VA treatment record reflects the Veteran’s report of experiencing urinary retention. The September 2014 VA examiner diagnosed the Veteran with voiding dysfunction, penis deformity and erectile dysfunction. In a January 2015 statement, the Veteran reported experiencing trouble urinating and having been diagnosed with a sexually transmitted disease during service and attributed it to his current reproductive organ disorder. The Veteran also claimed that his reproductive organ disorder was caused by the medication required to treat his respiratory disorder. The Veteran is not competent to provide a medical opinion as to the cause or aggravation of his reproductive organ disorder. Jandreau, supra. In his November 2019 Board hearing, the Veteran testified that he did not have a diagnosis of voiding dysfunction but did have erectile dysfunction. The April 2020 VA examiner opined that the Veteran’s reproductive organ disorder was not caused by service, or alternatively, not caused or aggravated by his respiratory disorder because it was a natural result of his age and cigarette smoking. The VA addendum opinion is highly probative. Nieves-Rodriguez, supra. A preponderance of the evidence is against a finding that the Veteran’s reproductive organ disorder was caused by service, or alternatively, as secondary to his respiratory disorder. The Veteran is not competent to provide a medical opinion as to the cause or aggravation of his reproductive organ disorder. The April 2020 VA examiner opined that the Veteran’s reproductive organ disorder was not caused by service, or alternatively, not caused or aggravated by his respiratory disorder. Significantly, no competent medical provider has opined otherwise. Therefore, service connection is not warranted and the claim is denied. Right eye disorder and conjunctivitis Refractive errors of the eye, such as astigmatism, myopia, hyperopia and presbyopia are not considered diseases or injuries for which service connection is available. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. Service connection may be granted for additional disability on top of underlying refractive error that results from a superimposed disease or injury during service. See VAOPGCPREC 82-90 (July 18, 1990). However, in the absence of a superimposed disease or injury, service connection may not be granted for refractive error of the eyes even if symptoms increased in severity in service, as refractive error is not a disease or injury eligible for service connection. The Board notes that the Veteran is service-connected for left eye pterygium. In a March 1979 STR, the Veteran reported having hit his left eye. He was treated with ice and an eye patch. In service medical history reports dated October 1986, June 1991 and May 1999, the Veteran answered in the negative to the question of whether he then had, or once had eye trouble. In service medical examination reports dated October 1979, October 1986, June 1991 and May 1999, no eye abnormalities were noted. An April 2007 VA treatment record reflects the Veteran’s diagnosis of conjunctivitis. A January 2011 VA treatment record reflects the Veteran’s report of experiencing eye itching, burning and redness. He was diagnosed with conjunctivitis. In a March 2013 VA treatment record, the Veteran reported experiencing itchy and dry eyes. He was diagnosed with conjunctivitis. The March 2014 VA examiner diagnosed the Veteran with bilateral eye conjunctivitis, glaucoma suspect, pinguecula, myopia, astigmatism, presbyopia and left eye pterygium. The October 2020 VA examiner indicated that the Veteran’s myopia, astigmatism and presbyopia were developmental errors of refraction. The examiner opined that the Veteran’s glaucoma suspect, cataracts and conjunctivitis were not caused by service and not caused and/or aggravated by his respiratory disorder; rather, glaucoma suspect was caused by hereditary or developmental causes and cataracts was caused by normal age progression. As noted above, the Veteran’s myopia, astigmatism and presbyopia constitute developmental errors of refraction and although the Veteran hit his left eye during service, the Veteran has not submitted competent evidence and the VA examiners had not diagnosed the Veteran with an additional disability on top of the underlying refractive errors. The October 2020 VA examiner opined that the Veteran’s glaucoma suspect, cataracts and conjunctivitis were not caused by service and not caused and/or aggravated by his service-connected respiratory disorder. Significantly, no competent medical provider has opined otherwise. A preponderance of the evidence is against claims. Therefore, service connection is not warranted and the claims are denied. Increased Rating Disability evaluations are determined by comparing the Veteran’s current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155. When there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Respiratory disorder Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. The additional code is shown after the hyphen. Id. Under DC 6602, a 60 percent rating is warranted for asthma manifested by forced expiratory volume in one second (FEV-1) of 40 to 55 percent predicted, or; FEV-1/forced vital capacity (FVC) of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. 38 C.F.R. § 4.97, DC 6602. A 100 percent rating is warranted for asthma manifested by FEV-1 less than 40 percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of system (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Id. Ratings under DCs 6600 through 6817 and 6822 through 6847 will not be combined with each other. Rather, a single rating will be assigned under the DC which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.96(a). Additionally, when evaluating a disability based on pulmonary function tests (PFTs), the post-bronchodilator results are to be used in applying the evaluation criteria in the rating schedule unless such are poorer than the pre-bronchodilator results. In such cases, the pre-bronchodilator values are to be used for rating purposes. 38 C.F.R. § 4.96(d)(5). The Veteran’s respiratory disorder is rated 30 percent disabling from August 28, 2006 to May 30, 2010; 60 percent disabling from May 31, 2010 to April 6, 2020 and 100 percent disabling from April 7, 2020 and continuing thereafter under DC 6600-6602. The appellate period is from October 10, 2013, the receipt date of the Veteran’s increased rating claim. In an October 2013 statement, the Veteran reported experiencing daily asthmatic symptoms and that he was required to see his allergist once every other month. The Veteran indicated that his level of treatment had increased. He reported experiencing asthmatic attacks once per month and sometimes two to three times per month. A January 2014 VA treatment reflects that the Veteran treated his respiratory disorder with montelukast, albuterol, spiriva and symbicort on a daily basis. The March 2014 VA examiner indicated that the Veteran required use of chronic low maintenance corticosteroids, daily inhalational bronchodilator therapy and daily inhalational anti-inflammatory medication. The Veteran did not require the use of oral bronchodilators, antibiotics or outpatient oxygen therapy. The examiner noted that the Veteran experienced an average of one asthma attack with episodes of respiratory failure per week in the past twelve months. The Veteran visited a physician “less frequently than monthly” for required care of exacerbations over the past twelve months. Pre-bronchodilator testing revealed FVC at 99 percent, FEV-1 at 78 percent, FEV-1/FVC at 78 percent and DLCO at 106 percent. Post-bronchodilator testing revealed FVC at 98 percent, FEV-1 at 85 percent and FEV-1/FVC at 86 percent. The examiner noted that FEV-1/FVC accurately reflected the Veteran’s then-current severity level of his respiratory disorder. VA treatment records dated April 2014 and June 2014 reflect the Veteran’s active respiratory medications: albuterol every six hours as needed, tiotropium for oral inhalation once daily and budesonide oral inhalation two times per day. A July 2014 VA treatment record reflects the Veteran’s report of experiencing shortness of breath one to two times per week. The Veteran treated with albuterol once on a daily basis. It was noted that the Veteran was highly adherent to his asthma medications: symbicort, montelukast, spiriva and albuterol. A November 2014 VA treatment record reflects that the Veteran used prednisone, symbicort, spiriva, montelukast and albuterol daily. An August 2015 VA treatment record reflects the Veteran’s then-current asthma medications for daily use: symbicort, montelukast, spiriva, albuterol and prednisone. In the February 2020 VA examination, the Veteran reported using albuterol two to three times per day, a nebulizer two to three times per week and prednisone one to two times per month. The examiner indicated that the Veteran required intermittent courses of corticosteroid bursts four times or more in the past twelve months and mepolizumab once per month. The Veteran required inhalational bronchodilator therapy intermittently, inhalational anti-inflammatory medication daily and other inhaled medications such as budesonide, albuterol, mometasone and olodaterol. The Veteran did not require use of antibiotics or outpatient oxygen therapy. The Veteran experienced four asthma attacks with episodes of respiratory failure per week in the past twelve months. Pre-bronchodilator testing revealed FVC at 76 percent, FEV-1 at 60 percent, FEV-1/FVC at 79 percent and DLCO at 106 percent. Post-bronchodilator testing revealed FVC at 76 percent, FEV-1 at 68 percent and FEV-1/FVC at 89 percent. The Board will grant an increased 100 percent rating for the entirety of the rating period on appeal based on the benefit-of-the-doubt doctrine. The evidence reflects the Veteran having been prescribed several medications for daily use for his respiratory disorder, to include albuterol – an immuno-suppressive medication. The March 2014 VA examiner indicated that the Veteran required daily inhalational bronchodilator therapy and daily inhalational anti-inflammatory medication. The February 2020 VA examiner indicated that the Veteran required inhalational bronchodilator therapy intermittently, inhalational anti-inflammatory medication daily and other inhaled medications such as budesonide, albuterol, mometasone and olodaterol. The Board will resolve all reasonable doubt in favor of the Veteran. Therefore, an increased rating is warranted and the claim is granted. REASONS FOR REMAND The remaining matter is remanded for the following actions: 1. BACKGROUND FOR THE RO ADUDICATOR The February 2020 VA examiner indicated that the Veteran’s service-connected respiratory disorder impacted the Veteran’s ability to work. The issue of entitlement to a TDIU has been raised. Rice v. Shinseki, 22 Vet. App. 447 (2009). Remand is warranted for due process development for the issue of a TDIU prior to appellate consideration, including adjudication by the RO. A December 2018 VA treatment record reflects the Veteran having been then-employed full time as a VA vocational rehabilitation counselor; however, the Veteran has not submitted a VA Form 21-8940, Application for Increased Compensation based on Unemployability and the most recent evidence is not clear as the Veteran’s current employment status. 2. Provide appropriate VCAA notice concerning the claim for a TDIU. 3. Ask the Veteran to complete and return a VA Form 21-8940, Application for Increased Compensation based on Unemployability, and/or other documents containing the necessary employment and education history. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Cohen, 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.