Citation Nr: 25014841 Decision Date: 12/12/25 Archive Date: 12/12/25 DOCKET NO. 20-04 731A DATE: December 12, 2025 ORDER Entitlement to service connection for bilateral eye disability is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT The Veteran's eye disability is not etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for an eye disability have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1966 to October 1968. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision by a Department of Veterans Affairs (VA) regional office, which is the agency of original jurisdiction (AOJ). The Board previously remanded this matter twice, in April 2024 and March 2025, for further development, including additional records development and an addendum medical opinion addressing the Veteran's lay statements regarding the etiology of his eye disabilities. The treatment records in question were submitted by the American Legion in October 2025. An addendum medical opinion was prepared and submitted, also in October 2025. As such, the Board finds that the March 2025 remand directives were complied with. Therefore, the issues can be adjudicated. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), provides that if a covered Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall provide a VA examination and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168. The medical opinion shall address the total potential exposure through all applicable military deployments; and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Id. Moreover, the Board is required to consider all potential theories of entitlement to service connection raised by the evidence. See Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of a matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Further, when the evidence persuasively favors one side or the other, the evidence is not in approximate balance and therefore the benefit-of-the-doubt rule does not apply. See Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). 1. Entitlement to service connection for a bilateral eye disability is denied. The Veteran asserts that service connection is warranted for a bilateral eye disability. Specifically, he asserted that he has macular degeneration due to exposure to ultraviolet (UV) rays from spending extended periods of time training in direct sunlight without any protective eyewear. See August 2018 VA Form 21-4138. In the alternative, he suggested that he had poor eyesight when he enlisted and that his service made his eye disability worse. See September 2023 VA Form 21-4138. As an initial matter, the Board recognizes that while the September 2018 rating decision on appeal does not make any explicit favorable findings regarding whether the Veteran has an eye disability, it refers to a diagnosis of neovascular age-related degeneration with inactive choroidal neovascular membrane left eye. This diagnosis is repeated in the October 2025 VA addendum opinion. In addition, the October 2025 VA addendum refers to a right eye total retinal detachment, which led to a right eye phthisis bulbi. As such, the Board finds that the first element of Shedden, a current disability, has been met. In addition, for the sake of consistency with previous rating decisions and Board decisions, the Board will refer to the Veteran's disability as a bilateral eye disability. With regard to the second and third Shedden elements, an in-service occurrence, and a nexus between active duty and current disability, the Veteran stated that his current bilateral eye disability is the result of his having been made to look at UV rays without adequate eye protection. The competent evidence fails to establish a nexus between active duty and his bilateral eye disability. In his August 1968 separation examination, the Veteran was noted to have eye trouble. The clinician clarified that this was referencing that the Veteran wore glasses to correct visual acuity. See July 2018 Service Treatment Record (STR). In addition, he was noted to wear glasses in what appears to be a handwritten medical review from the year 2000. See October 2025 STR. The Veteran was afforded VA eye conditions examinations and corresponding medical opinions in August 2018 and April 2024. Both of these medical opinions provided nexus statements against service connection. The Board notes that the August 2018 medical opinion was ruled to be inadequate in an April 2024 Board remand and that the April 2024 VA medical opinion was ruled inadequate in a March 2025 Board remand. However, even though the rationales used to formulate the nexus opinions were determined inadequate, it is still necessary to review the medical information discussed and recorded in the examination reports. In the August 2018 VA eye conditions examination, the Veteran was diagnosed with neovascular age-related degeneration with inactive choroidal neovascular membrane left eye, total retinal detachment right eye, and atrophy of globe (Phthisis Bulbi) right eye. With regard to medical history, the examiner clarified that both eye disabilities stem from, or are a form of, macular degeneration. The examiner continued that the date of onset was January 2016, and that the Veteran had a gradual decrease in vision secondary to age-related macular degeneration. The Veteran was suffering at that point from blindness/no light perception in his right eye and blindness in his left eye. As to an additional functional impact beyond the blindness already listed, the examiner stated that the eye disability had severe limitations to all activities even with assistive devices. With regard to relevant additional remarks, the examiner stated that the Veteran's previous eye records from that year showed no mention of degenerative myopia. In the April 2024 VA eye conditions examination, the Veteran was diagnosed with Phthisis Bulbi status-post retinal detachment right eye, legal blindness bilaterally, non-exudative, age-related macular degeneration, advanced atrophic stage left eye, bilateral dry eye syndrome, nuclear cataract left eye, and pseudophakia right eye. With regard to medical history, he states that in 2016 he suddenly lost vision out of his right eye due to retinal detachment, which was treated at that time with surgical repair, that he underwent cataract surgery after that time on the right eye, and that a second right eye retinal detachment then occurred which was again treated, however that the vision loss was permanent in nature. He reports being treated with steroid drops right eye since that time, as well as artificial tears daily for eye dryness and irritation of both eyes. The Veteran also reports that since the time of the second retinal detachment the right eye has become shrunken, but that the doctor is waiting to see if enucleation is needed in the future. He additionally reports macular degeneration has been diagnosed bilaterally in the past which has been treated with injections, although he could not specify the date of procedures and diagnosis. He stated that the injections failed to result in vision improvement, and therefore they were discontinued. He reported a history of high myopic refractive error (noted per service treatment records for each eye). He reported severe vision loss of the left eye over time and that he now can only see the broad movement of objects with his left eye and has no light perception with his right eye. He reports the need for constant mobility assistance and for activities of daily living. As to an additional functional impact beyond the blindness already listed, the examiner stated that the Veteran exhibits bilateral legal blindness and therefore would be unable to perform any visual tasks in any work setting. The Board notes that VA TERA opinions were also prepared for both eyes in January 2025. The January 2025 VA TERA opinion was determined to be inadequate with regard to the right eye in a March 2025 Board remand as overly conclusive. An addendum opinion was prepared in October 2025, pursuant to the March 2025 Board remand. The examiner noted that the Veteran had a bilateral eye disability with different etiologies. The right eye is blind due to a total retinal detachment, which was not noted to have incurred during service by any in-service medical records, and that he now had phthisis bulbi, which often occurs after blinding eye conditions such as total retinal detachment. The examiner continued that the left eye is blind due to neovascular age related macular degeneration with inactive choroidal neovascular membrane left eye. The examiner continued that excessive UV exposure is a risk factor for macular degeneration, but that there was no indication of any significant level of UV exposure during service beyond what an average outside worker would experience. Further, most individuals that work outdoors without protective sunglasses do not develop macular degeneration. The examiner continued that genetic predisposition is the strongest risk factor for age-related macular degeneration, and that it was more likely that this was what led to the Veteran's left eye disability, as opposed to UV exposure. The Board finds the October 2025 addendum opinion adequate and affords it high probative value as the examiner conducted a thorough review of the Veteran's medical records, considered his lay statements, and provided thorough and detailed alternative etiologies. Further, it considered all of the Board remand directives of both Board remands. In the alternative, the Veteran stated that his eyesight was poor upon entering service, and that various activities while on active duty made his eye disability worse. See September 2023 VA Form 21-4138. Every person employed in the active military, naval, air, or space service during peacetime for six months or more shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1132. However, the Veteran's March 1966 pre-induction examination noted that he had normal eyes, with regard to general eye health, ophthalmoscopic, pupil equality and reaction, and ocular motility. See July 2018 STR. As such, the Board finds that the presumption of soundness attaches, and the Veteran had sound eye health upon enlistment with the sole exception of refractive error that needed correction with eyeglasses. The Board recognizes the Veteran's own firmly held belief that his eye disability is related to service (both in cause and/or aggravation) but finds this to have limited to no probative value. While lay evidence may be competent on a variety of matters concerning the nature and cause of a disability, the etiology of such disorders as the one currently on appeal is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion. Therefore, the Board finds that the Veteran's eye disability is not etiologically related to service. Accordingly, as there is not an approximate balance of positive and negative evidence, the benefit of the doubt doctrine is not applicable, and service connection for his asserted left and right eye disability is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that he is entitled to service connection for bilateral hearing loss. Specifically, he asserts that he was exposed to excessive noise from tanks and other armored vehicles, heavy machine guns, and mortars, and that the excessive noise of these vehicles and weapons initiated his problems with hearing loss. See October 2018 VA Form 10182. The Veteran was afforded a VA hearing loss and tinnitus examination in August 2018. He reported difficulty at hearing without his hearing aids, stating that he cannot hear clearly without them. He also stated that he is blind, so he relies on his hearing to get around. The examiner stated that the Veteran's military occupational specialty (MOS) of Armor Senior Sergeant had a high probability of hazardous noise exposure. The VA examiner opined that the Veteran's bilateral hearing loss is less likely than not caused by or the result of service, noting that the March 1966 entrance examination reflected normal hearing and the August 1968 separation examination showed no significant threshold shift. Initially, the Board notes that the absence of in-service evidence of a hearing disability is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service as opposed to intercurrent causes. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). For these reasons, the Board finds the August 2018 VA examiner's rationale is inadequate, and therefore of no probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that most of the probative value of an opinion comes from its rationale or underlying reasoning). It is necessary to note that a VA TERA hearing loss opinion was prepared in January 2025. The examiner determined that it was less likely than not that the Veteran's bilateral hearing loss was due to his TERA exposures. The examiner stated that hearing loss related to chemicals and toxins exists but that the hearing loss in those cases would be immediate. Given that the Veteran's separation examination showed no shift in hearing for either ear during service, this is objective evidence that he did not have hearing loss as a result of TERA exposure. The Board finds that this opinion is adequate and probative. However, it does not completely answer the medical question before the Board, whether the bilateral hearing loss is at least as likely as not related to service. The Board further finds that the AOJ's reliance on the inadequate August 2018 opinion constituted a pre-decisional duty to assist error and that a remand is necessary for an addendum opinion to adequately determine if the Veteran's hearing loss is due to his military service. The matter is REMANDED for the following action: Obtain an addendum opinion for the Veteran's bilateral hearing loss. The need for an in-person examination of the Veteran is left to the discretion of the examiner. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran's bilateral hearing loss at least as likely as not related to service, to include hazardous noise exposure? The examiner should also address the Veteran's various lay statements regarding his in-service noise exposure and continuity since. Provide a rationale to support the opinion. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. T. V. Casey Veterans Law Judge Board of Veterans' Appeals Attorney for the Board McLaughlin, Paul J. Jr 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.