Citation Nr: 22017537 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 18-44 005 DATE: March 25, 2022 ORDER Service connection for a traumatic brain injury (TBI) is denied. REMANDED Entitlement to service connection for bilateral glaucoma on a direct basis or secondary to service-connected closed fracture zygoma is remanded. FINDING OF FACT The Veteran does not have a current diagnosis of a TBI, or any residuals therefrom. CONCLUSION OF LAW The criteria for service connection for a TBI have not been met. 38 U.S.C. § 1131, 5107; 38 C.F.R. § 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1979 to February 1983. In December 2021, the Veteran testified at a virtual hearing before the undersigned. At the hearing, he requested, and was granted, a 60-day abeyance period to submit additional evidence. Additional medical evidence relevant to the service connection claim for bilateral glaucoma was received in January 2022. The appeals of entitlement to compensation under 38 U.S.C. § 1151 for a right eye injury and entitlement to service connection for glaucoma secondary to TBI have been assigned separate docket numbers and will be addressed in separate decisions consistent with the Appeals Modernization Act (AMA) framework. See September 2020 VA Form 10182. Service Connection for TBI Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection, there must be medical evidence of a (1) current disability; (2) medical, or in certain circumstances, lay evidence of 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 present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran essentially contends that service connection for a TBI is warranted based on injuries sustained when he was hit in the face in service. Even acknowledging in-service complaints and treatment for the Veteran's injury to the face in 1982, what is missing from the record in this claim is competent evidence demonstrating that the Veteran has a TBI or residuals of a TBI currently. The Veteran's post-service treatment records are silent for any findings related to a TBI. Moreover, the Veteran underwent a VA TBI examination in June 2016, wherein the examiner reviewed the claims file, examined the Veteran, and opined that there was no evidence of residuals of a head injury, to include TBI. See June 2016 Disability Benefits Questionnaire (DBQ) and August 2016 VA Addendum medical opinion. There is no medical evidence to the contrary. In December 2021, the Veteran also testified he had not been diagnosed with or treated for a TBI. See December 2021 Board hearing transcript. Thus, the Board concludes the Veteran has not been shown to have a TBI or current residuals of such disability from service. See Brammer v. Derwinski, supra. Consideration has been given to the Veteran's own statements that he has a TBI. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a TBI falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). A TBI is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that medical testing and other specific findings are needed to properly assess and diagnose the disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). That is, although the Board readily acknowledges that Veteran is competent to report his symptoms, there is no indication that the Veteran possesses the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, this lay evidence does not constitute competent or credible evidence and lacks probative value. The Board concludes that, as the evidence persuasively favors against service connection for TBI, it is not in approximate balance, and the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). REASONS FOR REMAND The Veteran seeks service connection for bilateral glaucoma on a direct basis or secondary to service-connected closed fracture zygoma. (As noted above, the separate issues of entitlement to service connection for bilateral glaucoma secondary to TBI and entitlement to compensation under 38 U.S.C. § 1151 for a right eye injury are not for consideration in this decision.) The VA medical opinions of record are not adequate to adjudicate this claim. In this regard, an August 2014 VA examiner opined that the Veteran's glaucoma of the left eye was not due to an inservice injury; however, the examiner did not address the right eye. Additionally, a December 2021 private medical opinion from Dr. PG was subsequently received. This opinion states the type of glaucoma in the left eye is "usually" secondary to trauma and does not offer an adequate rationale for that opinion. Finally, there is no opinion as to whether the bilateral glaucoma is secondary to service-connected closed fracture zygoma. Therefore, an addendum opinion is needed. The matter is REMANDED for the following action: Obtain an addendum medical opinion from an appropriate VA examiner regarding the Veteran's bilateral glaucoma. The entire claims file must be made available to and be reviewed by the examiner. An explanation for all opinions expressed must be provided. The examiner should also address and discuss the December 2021 opinion from Dr. PG. The examiner must provide the following opinions: a. Is it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral glaucoma had onset in or is otherwise caused by active service, to include a head injury sustained in 1982? b. Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's service-connected closed fracture zygoma caused the bilateral glaucoma or aggravated the bilateral glaucoma? For the purposes of secondary service connection, the examiner is advised that aggravation is defined as "any increase in disability." See Allen v. Brown, 7 Vet. App. 439, 448 (1995). The examiner must explain the rationale for any opinion given. If the examiner is unable to provide an opinion without resorting to speculation, he/she should so state and provide an explanation as to the reason(s) therefor. If the examiner determines that the requested opinion may not be provided without a physical examination of the Veteran, then such should be scheduled. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fletcher, Kathleen 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.