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Citation Nr: 1713743
Decision Date: 04/27/17    Archive Date: 05/05/17

DOCKET NO.  14-38 540A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. Petersburg, Florida

THE ISSUES

1.  Entitlement to service connection for left face nerve damage, to include as secondary to a service-connected traumatic brain injury (TBI) with a fracture of the left zygoma.

2.  Entitlement to service connection for a bilateral eye disability (claimed as "blurred vision"), to include as secondary to a service-connected TBI with a fracture of the left zygoma.

3.  Entitlement to service connection for left eye blindness with loss of visual acuity, to include as secondary to a service-connected TBI with a fracture of the left zygoma.

4.  Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) with depression and polysubstance abuse, based on an alleged personal assault.

REPRESENTATION

Veteran represented by:	The American Legion

WITNESS AT HEARING ON APPEAL

The Veteran

ATTORNEY FOR THE BOARD

P.S. Rubin, Counsel

INTRODUCTION

The Veteran had active duty service from May 1961 to April 1964 in the United States Army.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from November 2011 and September 2012 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida.

This appeal was processed using Virtual VA and the Veterans Benefits Management System (VBMS).  Accordingly, any future consideration of this Veteran's case should take into consideration the existence of this electronic record.

The Board observes that in the November 2011 rating decision on appeal, the RO also denied the Veteran's claims for service connection for bilateral trench foot and a dental disability.  However, a review of the record shows that the Veteran did not submit a Notice of Disagreement (NOD) or Substantive Appeal (e.g., VA Form 9 or equivalent statement) for these particular issues.  See 38 U.S.C.A. § 7105(a) (West 2014); 38 C.F.R. §§ 20.200, 20.201, 20.202, 20.300, 20.302 (2016).  In fact, in a January 2012 NOD pertaining to the issues currently on appeal, the Veteran explicitly stated that he did not wish to pursue the issues of service connection for bilateral trench foot and a dental disability.  Thus, these particular service connection issues are not on appeal before the Board.

In January 2017, the Veteran presented testimony at a Travel Board hearing at the RO before the undersigned Veterans Law Judge.  A transcript of that hearing is associated with VBMS.

Finally, the Veteran submitted additional VA treatment records and Vet Center records in January 2017, after certification of his appeal.  However, he waived his right to have the RO initially consider this evidence.  Therefore, the Board accepts this additional evidence for inclusion in the record and consideration by the Board at this time.  See 38 C.F.R. §§ 20.800, 20.1304 (2016).

This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2016).  38 U.S.C.A. § 7107(a)(2) (West 2014).

FINDINGS OF FACT

1.  The Veteran does not have a current left face nerve damage disability, that is separate and distinct from the symptoms of his TBI that have already been service-connected.

2.  The Veteran's current bilateral eye ocular hypertension, glaucoma, and cataracts are not causally or etiologically related to active service, to include any injury or event therein.  In addition, these disabilities did not develop post-service as secondary to the Veteran's service-connected TBI.

3.  The Veteran's current bilateral eye refractive error / presbyopia is not a "disease" or "injury" under the meaning of applicable law and regulation for VA purposes; in addition, his refractive error was not subject to a superimposed disease or injury during service, resulting in any additional disability.

4.  The Veteran has left eye blindness with loss of visual acuity proximately due to or the result of his service-connected TBI with a fracture of the left zygoma.

5.  There is credible supporting evidence (including in-service behavioral changes), confirming that the Veteran's alleged in-service physical assault occurred.

6.  The most probative evidence of record establishes that the Veteran has a current diagnosis of PTSD with depression and substance abuse due to an in-service physical assault and TBI, in accordance within the applicable VA regulation.

CONCLUSIONS OF LAW

1.  A left face nerve damage disability was not incurred in or aggravated during active service, and is not secondary to his service-connected TBI.  38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 4.14 (2016).

2.  A bilateral eye and/or vision disorder, to include ocular hypertension, glaucoma, and cataracts were not incurred in or aggravated by active service, and are not secondary to the Veteran's service-connected TBI.  38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2016).

3.  Bilateral eye refractive error / presbyopia was not incurred in or aggravated by service and was not subject to a superimposed disease or injury in service that resulted in additional disability.  38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 4.9, 4.127 (2016); VAOPGCPREC 82-90 (July 18, 1990); VAOPGCPREC 67-90 (July 18, 1990).

4.  Resolving all reasonable doubt in his favor, the Veteran left eye blindness with loss of visual acuity is secondary to his service-connected TBI with a fracture of the left zygoma.  38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.310(a), (d).

5.  Resolving all reasonable doubt in his favor, the Veteran has PTSD with depression and polysubstance abuse that was incurred in active military service.  38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304(f)(5), 3.310, 4.125(a) (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

I.  VA's Duty to Notify and Assist

The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits.  38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2014); Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2016).

The VCAA applies to the instant claims for service connection and secondary service connection for left eye blindness with loss of visual acuity and PTSD with depression and polysubstance abuse.  However, the Veteran was provided adequate VCAA notice for these issues in October 2010, November 2010, September 2011, November 2011, and July 2012 letters.

Moreover, if any defect in VCAA notice or assistance is found, such defect is not prejudicial to the Veteran, given the completely favorable disposition of the left eye blindness and PTSD with depression and polysubstance abuse issues on appeal.  Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993).

With regard to the left face nerve damage and bilateral eye disability issues being denied in the present decision, VA's duty to notify was satisfied by VCAA letters dated in October 2010, November 2010, September 2011, and November 2011.  See 38 U.S.C.A. §§ 5102, 5103, 5103A (West 2014); 38 C.F.R. § 3.159 (2016); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015).

Accordingly, the Veteran has received all required notice in this case for these particular service connection issues on appeal for left face nerve damage and a bilateral eye disability (claimed as "blurred vision"), such that there is no prejudicial error in the content or timing of VCAA notice.  See also Shinseki v. Sanders, 556 U.S. 396 (2009) (an error in VCAA notice should not be presumed prejudicial and the burden of showing harmful error rests with the party raising the issue, to be determined on a case-by-case basis).  There has been no allegation of any error in the VCAA notice provided to the Veteran for these particular issues.

With respect to the duty to assist, the RO has obtained the Veteran's service treatment records (STRs), service personnel records (SPRs), VA outpatient treatment records, private medical evidence as authorized by the Veteran, and VA examinations.  For his part, the Veteran has submitted personal statements, hearing testimony, argument from his representative, and additional VA and Vet Center evidence.  The Veteran has not identified any additional, outstanding evidence that is relevant to his service connection claims being denied herein for left face nerve damage and a bilateral eye disability.

The Veteran was also afforded VA examinations and opinions in October 2011 and February 2017 to determine the etiology of his left face nerve damage and bilateral eye disability, to include as secondary to a service-connected TBI.  See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4).  As will be discussed below, these VA examinations were thorough, supported by explanations, based on a review of the claims folder, and supported by clinical evidence of record.  These VA examinations also considered the Veteran's reported lay history.  As such, there is no basis for any further VA examination or opinion as to the left face nerve damage and bilateral eye disability issues on appeal.

According to a March 2017 letter to the Veteran from the Social Security Administration (SSA), the SSA indicated they paid disability benefits to the Veteran from 1993 to 2004.  However, these disability benefits were converted to retirement benefits in November 2004 because of the Veteran's advanced age.  In any event, a copy of the September 1994 SSA disability determination submitted by the Veteran concluded that he was disabled due to nonservice-connected lumbar spine, urinary dysfunction, and lower extremity disabilities.  The Veteran was considered to be disabled by the SSA post-service since 1992, after the Veteran injured himself hauling furniture, according to a June 2012 VA psychological examination. Complete SSA disability records are not present in the claims folder.

But most significantly, it is apparent that these SSA disability benefits were only awarded in the context of his nonservice-connected lumbar spine, urinary dysfunction, and lower extremity disabilities.  As there was no reason to suspect the SSA records would change the outcome of the service connection claims being denied in the present case, VA is not obligated to invest further time and resources to obtain them.  See Golz v. Shinseki, 590 F.3d 1317, 1323 (2010) ("It is not the case that the government must obtain records in every case in order to rule out their relevance.  Such a decision would be akin to a determination that all medical records must be obtained.")  In essence, efforts to obtain these SSA records are clearly not warranted, as they are not relevant to the claims being denied and would provide no reasonable possibility of substantiating the claims on appeal.  38 U.S.C.A. § 5103A(a)(2).

Moreover, for both the left face nerve damage and bilateral eye issues on appeal, neither the Veteran nor his representative has advanced any procedural arguments in relation to VA's duties to notify and assist.  See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015) (holding that "absent extraordinary circumstances . . . we think it is appropriate for the Board and the Veterans Court to address only those procedural arguments specifically raised by the veteran . . .").   For instance, the Veteran has not alleged any deficiency with his January 2017 Travel Board hearing testimony as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010).  In this regard, the Federal Circuit recently ruled in Dickens v. McDonald, 814 F.3d 1359 (Fed. Cir. 2016) that a Bryant hearing deficiency was subject to the doctrine of issue exhaustion as laid out in the Scott case, cited to above.  Thus, the Board need not discuss any potential Bryant problem because the Veteran has not raised that issue before the Board.

Accordingly, the Board is satisfied that the RO has provided all assistance required by the VCAA.  38 U.S.C.A. § 5103A (West 2014).  Hence, there is no error or issue that precludes the Board from addressing the merits of the service connection issues on appeal for left face nerve damage and a bilateral eye disability.

II.  Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service.  38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Under 38 C.F.R. § 3.303(a), service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  The Federal Circuit Court recently held that diseases that would be considered "chronic" in a medical sense, but which are not listed in 38 C.F.R. § 3.309(a) as an enumerated "chronic disease," may still qualify for service connection under the three-element test for disability compensation described in § 3.303(a).  Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013).

But under 38 C.F.R. § 3.303(b), where the evidence shows an enumerated "chronic disease" in service (or within the presumptive period under § 3.307), or "continuity of symptoms" of such a disease after service, the disease shall be presumed to have been incurred in service.  Walker, 708 F.3d at 1335-37.  Initially, certain bilateral eye disorders and left face nerve damage the Veteran has been diagnosed with are not an enumerated "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions based on "chronic" symptoms in service and "continuous" symptoms since service at 38§C.F.R. § 3.303(b) do not apply for these disorders.  Walker, 708 F.3d at 1338-39.

However, the Veteran's glaucoma of the eyes is an enumerated "chronic disease" listed under 38 C.F.R. § 3.309(a) (other organic disease of the nervous system); therefore, 38 C.F.R. § 3.303(b) does apply to that disorder.  Id.  Service connection for an enumerated "chronic disease" listed under 38 C.F.R. § 3.309(a) such as glaucoma can also be also be established on a presumptive basis by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service.  38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).

That is, under 38 C.F.R. § 3.303(b), with an enumerated "chronic disease" such as glaucoma shown in service (or within the presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes.  See also Groves v. Peake, 524 F.3d 1306, 1309 (2008).  This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clear cut clinical entity, at some later date.  For the showing of chronic disease such as glaucoma in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic."  When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity of symptomatology.  38 C.F.R. § 3.303(b).

In addition, for chronic diseases listed in 38 C.F.R. § 3.309(a) - such as glaucoma - service connection may be established by showing continuity of symptoms, which requires a claimant to demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of symptoms; and (3) medical or, in certain circumstances, lay evidence of a link between the present disability and the post-service symptoms.  38 C.F.R. § 3.303(b) (2016); see Walker, 708 F.3d at 1340 (Fed. Cir. 2013) (holding that only those chronic diseases listed in 38 C.F.R. § 3.309 are subject to service connection by continuity of symptoms described in § 3.303(b).  The correct understanding of the "condition noted during service" is that the condition is one that is indicative of but not dispositive of a chronic disease.  Walker, 708 F.3d at 1339.  Stated another way, continuity of symptomatology after discharge is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned, i.e., "when the fact of chronicity in service is not adequately supported."  38 C.F.R. § 3.303(b).  See also Walker, 708 F.3d at 1339-40.

Under 38 C.F.R. § 3.303(d), disorders diagnosed after discharge may also still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service.  See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

A disability can also be service connected on a secondary basis if it is proximately due to or the result of a service-connected condition.  38 C.F.R. § 3.310(a).  Moreover, secondary service connection may be established, as well, by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition.  38 C.F.R. § 3.310(b), effective October 10, 2006.  See 71 Fed. Reg. 52,744-52,747 (September 7, 2006).  See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991).  Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.  Allen, 7 Vet. App. at 448.

In short, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability.  Wallin v. West, 11 Vet. App. 509, 512 (1998).

VA is to give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability benefits.  38 U.S.C.A. § 1154(a) (West 2014).  The Federal Circuit has held that medical evidence is not always or categorically required in every instance to establish a medical diagnosis or the required nexus between the claimed disability and the Veteran's military service.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).

That is, lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson, 581 F.3d at 1316.  See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  In short, when considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent on the issues of diagnosis and medical causation.  Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011).  "The question of whether a particular medical issue is beyond the competence of a layperson-including both claimants and [VA adjudicators] must be determined on a case-by-case basis.  Id.

For instance, a layperson is competent to identify such disorders as varicose veins, tinnitus, and flat feet.  38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303, 310 (2007); Charles v. Principi, 16 Vet. App. 370, 374 (2002); Falzone v. Brown, 8 Vet. App. 398, 405 (1995).  In contrast, a layperson is not competent to identify medical conditions that require scientific, technical, or other specialized knowledge, such as in identifying bronchial asthma.  38 C.F.R. § 3.159(a)(1); Layno v. Brown, 6 Vet. App. 465, 469 (1994).

Therefore, the Board must assess the competence and credibility of lay statements.  Barr, 21 Vet. App. at 308.

The Federal Circuit has held that the Board can favor competent medical evidence over lay statements offered by the Veteran, as long as the Board neither deems lay evidence categorically incompetent nor improperly requires a medical opinion as the sole way to prove causation.  King v. Shinseki, 700 F.3d 1339, 1344 (2012).

In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine.  38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991).

	A.  Preliminary Discussion of Already Service-Connected TBI Injury

Initially, in a very recent February 2017 rating decision, the Board sees the Veteran was service-connected for an underlying TBI that occurred in June 1963 during active duty while stationed with the Army in Korea.  The precise circumstances of how the TBI occurred are somewhat unclear.  The Veteran has reported that in May or June of 1963 near Camp Casey in Korea, he was attacked by two Korean civilians.  During the attack, the Veteran was struck on the left side of his head and face with an unknown object, but described at times as a brick.  He was knocked unconscious for an unknown period of time, but he does remember waking up in an Army medical facility.  He has inconsistently reported that the attack occurred while he was on guard duty, or in the alternative, while he was at a nightclub.  He was transported to MEDEVAC hospital in Camp Casey, and then placed in another Army Hospital in Korea.  STRs only document a fracture of his left zygoma, something (illegible) with his left eye, and a fracture of his left maxilla.  At that time, STRs relate that the Veteran had sustained this injury while playing baseball. However the Veteran has explained that he falsely reported the baseball injury to his commanding officer because he thought he would look bad, after he had been in a civilian village, which was an off-limit place.  So he admits he told an incorrect story to his commanding officer about how his TBI was sustained.  See November 2010 stressor statement for PTSD (VA Form 21-0781); August 2012 stressor statement for PTSD based on assault (VA Form 21-0781a); September 2011 VA psychiatry note; June 2012 VA psychological examination; January 2014 VA History and Physical; January 2017 Travel Board hearing testimony; February 2017 VA TBI examination.

In any event, the RO has already service-connected the Veteran for the underlying TBI with various residuals to include a fracture of the left zygoma, a left cheek scar, and tension headaches with loss of balance, dizziness, and fatigue, among other TBI residuals.  In addition, a February 2017 photo of the Veteran's face clearly shows significant indentation and injury to the left side of face, which is grossly distorted with elevation and depression.  The undersigned Veterans Law Judge also remarked upon this fact during the Veteran's January 2017 hearing testimony.  Thus, the Veteran has already been service-connected by VA for the in-service TBI with various residuals.  This fact is not in dispute.

Therefore, due to the verified and service-connected underlying TBI, the Board has specifically considered the presumptive provisions 38 C.F.R. § 3.310(d).  Under 38 C.F.R. § 3.310(d), in a veteran who has a service-connected TBI, the following shall be held to be the proximate result of the service-connected TBI, in the absence of clear evidence to the contrary: (i) Parkinsonism, including Parkinson's disease, following moderate or severe TBI; (ii) Unprovoked seizures following moderate or severe TBI; (iii) Dementias of the following types: presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, if manifest within 15 years following moderate or severe TBI; (iv) Depression if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI; or (v) Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifest within 12 months of moderate or severe TBI.  Thus 38 C.F.R. § 3.310(d)(1) entails presumptive service connection for the above disabilities.

In the present case, there is no evidence of record showing that the Veteran's current depression was manifested within 3 years of moderate or severe TBI, or within 12 months of mild TBI.  38 C.F.R. § 3.310(d)(1)(iv).  In addition, the Veteran's currently diagnosed eye disorders, PTSD, substance abuse disorder, and left face apraxia, are not listed under 38 C.F.R. § 3.310(d)(1) as one of the presumptive conditions associated with a TBI injury.

However, secondary service connection may also be awarded under 38 C.F.R. § 3.310(d)(2) for any condition not meeting the above criteria, under the generally applicable provisions of service connection.  This would entail consideration of non-presumptive service connection, established by the evidence of record.  Therefore, the Board will consider all of these disorders on a non-presumptive basis as well.

The determination of the severity level (mild, moderate, or severe) of the underlying TBI is based on the TBI symptoms at the time of the injury or shortly thereafter. The TBI does not have to meet all the criteria listed under a certain severity level in order to classify the TBI at that severity level.  If a TBI meets the criteria in more than one category of severity, then the TBI should be ranked at the highest level in which a criterion is met, except where the qualifying criterion is the same at both levels.  38 C.F.R. § 3.310(d)(3).

A TBI is mild in severity if there is normal structural imaging, loss of consciousness for up to 30 minutes, alteration of consciousness or mental statement for a moment to up to 24 hours, post-traumatic amnesia for up to a day, and a Glasgow Coma Scale ranging from 13 to 15.  A TBI is moderate in severity if there is normal or abnormal structural imaging, loss of consciousness from 30 minutes to less than 24 hours, alteration of consciousness or mental state for more than 24 hours, post-traumatic amnesia from one to 7 days, or Glasgow Coma Scale from 9-12.  A TBI is severe if there is normal or abnormal structural imaging, loss of consciousness for more than 24 hours, alteration of consciousness or mental state for more than 24 hours, post-traumatic amnesia for more than 7 days or a Glasgow Coma Scale of 3-8.  See 38 C.F.R. § 3.310(d)(3).

The resultant disabling effects of a TBI event beyond those that follow immediately from the acute injury to the brain are known as TBI residuals or TBI sequelae.  The signs and symptoms of TBI residuals can be organized into the three main categories of physical, cognitive, and behavioral / emotional residuals for evaluation purposes.  TBI residuals can resolve in a short period of time, persist chronically or permanently, or may also have a delayed onset.  See M21-1, Live Manual, Part III, Subpart iv, Chapter 4, Section G, Topic 2, Block d (change date September 29, 2016).

With regard to the in-service TBI, after review of the medical and lay evidence of record (see e.g., October 2011 VA TBI examination), it appears the Veteran's in-service June 1963 TBI injury was "moderate" to "severe" due to loss of consciousness for around 24 hours or alteration of consciousness or mental state for more than 24 hours.  See 38 C.F.R. § 3.310(d)(3).

The Board will now turn to consideration of service connection and secondary service connection for the specfic disabilities on appeal.

	B.  Left Face Nerve Damage

The Veteran contends that he has nerve damage or neurological damage to the left side of his face as a residual of his already service-connected TBI.  He says he developed nerve damage related to his in-service facial trauma in 1963.  Post-service, he says he did not have health insurance, so he simply lived with the pain until 2010.  The Veteran currently reports numbness in the left cheek.  See August 2010 formal claim for TBI; January 2014 DRO conference; January 2017 hearing testimony at pages 7-8; February 2017 VA skin / scar examination report.

Upon review of the evidence of record, the Board concludes that the Veteran is not entitled to service connection or secondary service connection for left face nerve damage.

Importantly, the Veteran is already service-connected for a broad array of residuals of his in-service TBI.  Specifically, he has been assigned a 70 percent rating for residuals of a TBI under 38 C.F.R. § 4.124a, Diagnostic Code 8045.  Also, he has been assigned a 30 percent rating for residuals of fracture of the left zygoma, with residual left cheek scar, under 38 C.F.R. § 4.118, Diagnostic Code 7800 (scars of the head, face, or neck).  In addition, he has been assigned a 10 percent rating for a painful left cheek scar under 38 C.F.R. § 4.118, Diagnostic Code 7804.  Finally, he has been assigned a 0 percent rating for tension headaches with loss of balance, dizziness, and fatigue, under 38 C.F.R. § 4.124a, Diagnostic Code 8100.

According to the February 2017 rating decision, the 70 percent rating for the Veteran's TBI already considered neurological residuals of his TBI.  This was based on the findings of a February 2017 VA TBI examiner.  Specifically, a level of severity of "2" has been assigned for the Veteran's motor activity (with intact motor and sensory system) facet based on motor activity mildly decreased or with moderate slowing due to "apraxia."  Apraxia is defined as the loss of ability to carry out familiar, purposeful movements in the absence of paralysis or other motor sensory impairment.  See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 120 (30TH Ed. 2003).

The evaluation of the same disability or the same manifestations of disability under multiple diagnoses is to be avoided.  38 C.F.R. § 4.14.  A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity."  Brady v. Brown, 4 Vet. App. 203, 206 (1993).  This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14.  See also Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009) ("two defined diagnoses constitute the same disability for purposes of section 4.14 if they have overlapping symptomatology").

However, when a veteran has separate and distinct manifestations attributable to the same injury, he should be compensated under different diagnostic codes with different ratings.  Esteban v. Brown, 6 Vet. App. 259, 262 (1994).  See also Fanning v. Brown, 4 Vet. App. 225 (1993).  The critical inquiry in making such a determination is whether any of the disabling symptomatology is duplicative or overlapping.  The Veteran is entitled to a combined rating only where the symptomatology is distinct and separate.  Id.

The existence of a current disability is the cornerstone of a claim for VA disability compensation.  38 U.S.C.A. § 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.  In the absence of proof of a present, separate disability from nerve damage to the left side of his face, there can be no valid claim for direct service connection.  38 U.S.C.A. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary).

In order for a Veteran to qualify for basic entitlement to compensation under 38 U.S.C.A. § 1110 or § 1131, the Veteran must prove existence of a disability, and one that has resulted from a disease or injury that occurred in the line of duty.  See Sanchez-Benitez v. Principi, 259 F.3d 1356, 1361 (2001).  The mere fact of a veteran reporting subjective symptoms, whether pain or otherwise, does not necessarily warrant a finding that he has met the current disability due to disease or injury requirement.  Rather, an underlying disease or injury is required, with current impairment of some sort.

On this issue, there is no probative evidence of any current, distinct neurological symptomatology from the Veteran's service-connected TBI that would permit a separate rating for any facial nerve disorder, other than what he already has.  Accordingly, as evaluation of the same disability or the same manifestations of disability under multiple diagnoses (i.e., pyramiding) is to be avoided, service connection or secondary service connection for separate nerve damage to the face is not warranted.  Simply stated, the Veteran is already service connected by the RO for whatever neurological symptoms to the face he has, as a residual of his TBI.  See 38 C.F.R. § 4.14.

On this issue, the Board acknowledges that the Veteran reported numbness of the face to the February 2017 VA TBI examiner.  But this is the only time the Veteran reported this specific symptom in the record, including in VA and private treatment records.  Moreover, in contrast, the medical evidence of record outweighs the Veteran's subjective complaint.  No medical professional of record has assessed additional neurological impairment to the face as a residual of the Veteran's TBI, aside from the motor activity mildly decreased or with moderate slowing due to "apraxia."  For example, at an August 2010 VA History and Physical, the Veteran's neurological examination was normal.  An October 2011 VA eye examination assessed no optic nerve pallor in both eyes from the in-service trauma.  A January 2013 VA eye note showed no retinal nerve fiber thinning.  The ocular nerve examination was normal.  Finally, the February 2017 VA TBI examiner found no evidence of cranial nerve dysfunction.  In addition, the same VA TBI examiner did not identify any specific sensory dysfunction impairment due to the TBI and did not check the sensory dysfunction impairment box for any residuals.  The VA TBI examiner also did not find it necessary to order a separate cranial or peripheral nerve questionnaire.  In summary, no clinical evidence of record reveals any distinct neurological symptomatology to the face other than the Veteran's already service-connected apraxia.  FILE

Once again, the existence of a current disability is the cornerstone of a claim for VA disability compensation.  38 U.S.C.A. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328 (1997).  Absent probative or reliable evidence of any current, distinct neurological symptomatology to the face other than the Veteran's already service-connected apraxia, service connection cannot be granted in the present case.  Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225.

Accordingly, the preponderance of the evidence is against the Veteran's service connection claim for left face nerve damage.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

      C.  Bilateral Eye Disability

The Veteran contends that he has "blurred vision" in both eyes that began in service, or developed over time secondary to his service-connected TBI.  The Veteran says he did not receive any medical treatment for the blurred vision until VA treatment in 2010.  Glasses did not help him clear up the blurriness either.  See August 2010 formal claim for TBI; December 2010 Veteran's statement; September 2010 VA eye consult.

At the outset, the Board emphasizes that in the present decision it is service-connecting the Veteran for left eye blindness with loss of visual acuity as secondary to the service-connected TBI with a fracture of the left zygoma.  The analysis of this secondary service connection grant will be discussed in further detail below.  However, what is at issue in this section of the decision is whether service connection or secondary service connection is warranted for a separate bilateral eye blurred vision or other bilateral eye disability, as distinct from left eye blindness.

In this vein, VA must fully and sympathetically develop a veteran's claim to its optimum, and that requires VA to determine all potential claims raised by the evidence, applying all relevant laws and regulations.  Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004).  The Court has held that a claimant's identification of the benefit sought does not require technical precision.  See Ingram v. Nicholson, 21 Vet. App. 232, 256-57 (2007).  The Court has further held that a claimant may satisfy this requirement by referring to a body part or system that is disabled or by describing symptoms of the disability.  Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (stating that, when determining the scope of a claim, the Board must consider the claimant's description of the claim; the symptoms the claimant describes; and the information the claimant submits or that the Secretary obtains in support of that claim).  Thus, the Board in the present decision has considered whether service connection is warranted for all of the Veteran's eye diagnoses identified in the record.

Upon review of the evidence of record, the Board concludes that the Veteran is not entitled to service connection or secondary service connection for a bilateral eye disability to include "blurred vision" in both eyes.

The existence of a current disability is the cornerstone of a claim for VA disability compensation.  38 U.S.C.A. § 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary).  In the present case, there is sufficient evidence that the Veteran meets the threshold criterion for service connection of a current bilateral eye disability.  Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225.  Here, VA eye clinic notes and examinations dated from 2010 to 2016 reveal various diagnoses of ocular hypertension, glaucoma, cataracts, and refractive error / presbyopia.  The Veteran also has been prescribed various prescriptions to treat these eye disorders.  Thus, the evidence clearly reveals current bilateral eye disabilities for the Veteran as assessed by VA eye physicians.  Thus, the first element of service connection is met.

However, the remaining two elements of service connection are not met for these particular eye disorders.  STRs dated from 1961 to 1964 are negative for any complaints, treatment, or diagnosis of ocular hypertension, glaucoma, cataracts, or other vision abnormalities.  His uncorrected visual acuity was recorded as 20/20 in both eyes at separation in May 1964.  No eye disability was objectively observed at separation.  He also denied any eye problems at separation.  There is no evidence of an enumerated "chronic" disease such as glaucoma shown during service or within one year of service.  See 38 C.F.R. § 3.309(a); Walker, 708 F.3d at 1339.

Post-service, the Veteran did not receive any treatment for his eyes until 2010 according to the Veteran, aside from getting glasses.  Post-service, with regard to a nexus, there is probative medical evidence of record that clearly weighs against a relationship between the Veteran's present bilateral eye disabilities listed above and his period of military service.  Holton, 557 F.3d at 1366.  See also 38 C.F.R. § 3.303(a), (d).  Specifically, after an examination and review of the claims folder, an October 2011 VA eye examiner opined that the Veteran's bilateral cataracts are not caused by his left side head and face trauma. The rationale was that "traumatic" cataracts would have a stellate appearance, but in contrast the Veteran has nuclear and cortical cataracts which are usually caused by aging.  In formulating this opinion, the VA eye examiner cited his review of medical literature, medical records, and his clinical experience.  The VA eye examiner also opined that the Veteran's glaucoma suspect was less likely as not (less than 50/50 probability) caused by the in-service left side head and face trauma.  In formulating this opinion, the VA eye examiner cited his review of medical literature, medical records, and his clinical experience.  This VA eye examiner did not diagnose the Veteran with ocular hypertension.  Overall, this VA eye examination and opinion was thorough, supported by an explanation, based on a review of the claims folder, and supported by the probative evidence of record.  Importantly, the Veteran has not submitted any contrary medical nexus opinion of record with regard to his bilateral eye blurred vision.  Furthermore, an October 2013 VA eye note indicated that Veteran's failure to take his medications and keep his appointments was causing his blurred vision, and that his blurred vision does not appear to be due to any injury or nerve damage.

The Board acknowledges that blurred vision is listed in a VA Live Manual table as one of the potential physical residuals or sequelae of a TBI.  TBI residuals can resolve in a short period of time, persist chronically or permanently, or may also have a delayed onset.  See M21-1, Live Manual, Part III, Subpart iv, Chapter 4, Section G, Topic 2, Block d (change date September 29, 2016).  However, the VA Live Manual also states that VA should not automatically concede that a new sign, symptom or diagnosis is a residual of a TBI simply because it is listed in the table or evaluation criteria.  See Id. at Block j.

In any event, service connection for residuals of a TBI can be either on a direct or secondary basis.  In this regard, secondary service connection may be awarded under 38 C.F.R. § 3.310(d)(2) for any condition under the generally applicable provisions of service connection.  See also M21-1, Live Manual, Part III, Subpart iv, Chapter 4, Section G, Topic 3, Blocks a to i (change date May 9, 2016).  The October 2011 VA eye examination provides strong evidence against any secondary relationship for blurred vision to the Veteran's service-connected TBI.

With regard to the Veteran's lay assertions, the Veteran is indeed competent to report purported symptoms of bilateral eye blurriness during and after service.  See 38 C.F.R. § 3.159(a)(2); Barr, 21 Vet. App. at 307-09.  But the Veteran's lay assertions in the present case are outweighed by the clinical findings of the October 2011 VA eye examiner, who determined that the Veteran's current bilateral eye disabilities did not originate during service or as the result of the Veteran's TBI.  The Federal Circuit has held that the Board can favor competent medical evidence over lay statements offered by the Veteran, as long as the Board neither deems lay evidence categorically incompetent nor improperly requires a medical opinion as the sole way to prove causation.  King v. Shinseki, 700 F.3d 1339, 1344 (2012).  In this case, the VA eye examiner reviewed and considered the evidence of record, including the Veteran's statements, and provided a medical opinion with a supporting rationale relying on medical training, knowledge, and expertise.

Accordingly, the preponderance of the evidence is against the Veteran's service connection claim and secondary service connection claim of bilateral eye blurriness from ocular hypertension, glaucoma, or cataracts. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

The Board now turns to the Veteran's diagnosis of refractive error (RE) in the record.  In this regard, the Veteran has been diagnosed with refractive error and presbyopia in both eyes in post-service VA treatment records.  See June 2013 October 2013, October 2014, and April 2015 VA eye notes and VA eye examinations.

Defects are defined as "structural or inherent abnormalities or conditions which are more or less stationary in nature."  VAOPGCPREC 82-90 (July 18, 1990); VAOPGCPREC 67-90 (July 18, 1990).  Congenital or developmental "defects," such as refractive error, automatically rebut the presumption of soundness and are therefore considered to have preexisted service.  38 U.S.C.A. §§ 1111; 38 C.F.R. §§ 3.303(c), 4.9.  In this regard, the courts have held that the presumption of soundness does not apply to congenital defects, such as refractive error.  Terry v. Principi, 340 F.3d 1378, 1383-84 (Fed. Cir. 2003); Winn v. Brown, 8 Vet. App. 510, 516 (1996) (holding that a non-disease or non-injury entity such as a congenital defect is "not the type of disease- or injury-related defect to which the presumption of soundness can apply").

In addition, service connection is generally precluded by VA regulation for congenital or developmental "defects" such as refractive error because they are not "diseases" or "injuries" within the meaning of applicable legislation.  38 C.F.R. §§ 3.303(c), 4.9, 4.127; Palczewski v. Nicholson, 21 Vet. App. 174, 179 (2007).  However, a congenital defect such as refractive error can still be subject to superimposed disease or injury during active service.  VAOPGCPREC 82-90.  If such superimposed disease or injury does occur, service connection may be warranted for the resulting disability.  Id.

In contrast, VA's Office of General Counsel has distinguished between congenital or developmental defects, such as refractive error, for which service connection is precluded by regulation, and congenital or hereditary diseases, for which service connection may be granted, if initially manifested in or aggravated by service.  See VAOPGCPREC 82-90, VAOPGCPREC 67-90.  The General Counsel draws on medical authorities and case law from other federal jurisdictions and concludes that a defect differs from a disease in that a defect is "more or less stationary in nature", while a disease is "capable of improving or deteriorating."  See VAOPGCPREC 82-90 at para. 2.

The VA Live Manual further instructs that defects of form or structure of the eye that are of congenital or developmental origin may not be considered as disabilities or service-connected on the basis of incurrence or aggravation beyond natural progress during service.  Rather, actual pathology, other than refractive error, is required to support impairment of visual acuity.  The fact that a Veteran was supplied with glasses for correcting refractive error is not, in itself, considered indicative of aggravation by service that would warrant compensation.  See M21-1, Part III, Subpart iv, Chapter 4, Section B, Topic 1, Blocks b, c, and e (May 7, 2015).  The Veteran's presbyopia, as diagnosed by the VA eye examiners in the present case, is considered to be a form of refractive error.  See Id. at Block d.  In adults, refractive errors are generally stationary or change slowly until the stage of presbyopia.  See Id. at Block e.  Thus, as mentioned, service connection for refractive error in most circumstances is precluded by VA regulation and by the opinions of VA's Office of General Counsel and by VA's Live Manual.

However, a congenital defect, such as refractive error, can still be subject to superimposed disease or injury during active service.  VAOPGCPREC 82-90.  If such superimposed disease or injury does occur, service connection may be warranted for the resulting disability.  Id.  In the present case, although the Veteran sustained a TBI during service, no probative evidence of record establishes that his refractive error resulted in additional disability from the TBI.  Absent any probative evidence that his current refractive error is due to in-service trauma or was subject to a superimposed disease or injury during service resulting in additional disability, the refractive error is not a disability for purposes of VA disability compensation as it is congenital in nature.  38 C.F.R. § 3.303(c).  See, e.g., Browder v. Derwinski, 1 Vet. App. 204 (1991) (pertaining to refractive error).  Thus, service connection for refractive error and presbyopia is denied.

Accordingly, the preponderance of the evidence is against service connection for bilateral eye refractive error / presbyopia.  See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).

      D.  Left Eye Blindness with Loss of Visual Acuity

However, with regard to secondary service connection, there is some probative medical and lay evidence of record that demonstrates that the Veteran's current left eye blindness with loss of visual acuity is proximately due to or the result of his service-connected TBI with a fracture of the left zygoma.  38 C.F.R. § 3.310(a), (d)(2); Velez v. West, 11 Vet. App. 148, 158 (1998).  Initially, it is noted the Veteran's in-service June 1963 TBI injury was "moderate" to "severe" due to loss of consciousness for around 24 hours or alteration of consciousness or mental state for more than 24 hours.  See 38 C.F.R. § 3.310(d)(3).  As to evidence of a secondary nexus to service-connected TBI with a fracture of the left zygoma, a June 7, 1963 STR documenting a fracture of the left zygoma also mentions something about the left eye, but the writing explaining the notation is illegible.  However, November 2010, January 2011, May 2011, and August 2011 VA eye notes opined there was visual loss of the left eye of +2' due to trauma from the 1963 service-connected TBI.  Current visual acuity in the left eye was 20/400, while in the right eye it was much better at 20/30+.  These VA eye notes and examinations provide strong evidence in support of the left eye claim.  In addition, VA eye notes dated in October 2013 and August 2014 reflected that visual acuity in the left eye was reduced, but the etiology was unclear.  A VA eye note dated in April 2015 observed that the Veteran's left eye acuity was reduced, but again the etiology was unclear.  VA optometrists added that although the Veteran's left eye cataract was consistent  with reduced vision, the loss of visual acuity still appears to VA medical professionals to be worse than expected with a cataract alone.

Accordingly, secondary service connection for left eye blindness with loss of visual acuity is warranted.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.  The Board emphasizes that it is granting secondary service connection left eye blindness with loss of visual acuity on the basis that it is the direct result of a service-connected TBI disability, as opposed to aggravation.

	E.  PTSD with Depression and Polysubstance Abuse

Service connection for PTSD has unique evidentiary requirements.  It generally requires:  (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor.  38 C.F.R. § 3.304(f).  See also Cohen v. Brown, 10 Vet. App. 128 (1997).

Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the recently updated Diagnostic and Statistical Manual (Fifth Edition) (the DSM-5).  See 79 Fed. Reg. 45,094 (August 4, 2014).  VA adopted as final, without change, this interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board on or before August 4, 2014.  See Schedule for Rating Disabilities - Mental Disorders and Definition of Psychosis for Certain VA Purposes, 80 Fed. Reg. 14,308 (March 19, 2015).

In the present case, the RO certified the Veteran's PTSD appeal to the Board in March 2015, which is after August 4, 2014.  Thus, the amended 38 C.F.R. § 4.125(a) conforming to the DSM-5 is applicable in the present case.  In any event, the Board will still consider any private or VA examiner's discussion of both the DSM-IV and DSM-5 in adjudicating the current Veteran's PTSD claim, in order to provide the Veteran with every benefit of the doubt.

If VA determines either that the veteran did not engage in combat with the enemy or that the veteran did engage in combat, but that the alleged stressor is not combat related, the veteran's lay testimony, by itself, is not sufficient to establish the occurrence of the alleged stressor.  Instead, the record must contain credible supporting evidence that corroborates the veteran's testimony or statements.  38 C.F.R. § 3.304(f); Stone v. Nicholson, 480 F.3d 1111 (Fed. Cir. 2007); Cohen v. Brown, 10 Vet. App. 128, 147 (1997); Moreau v. Brown, 9 Vet. App. 389, 395 (1996).

With regard to an actual diagnosis of PTSD, lay persons are not categorically incompetent to speak on matters of medical diagnosis or etiology.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).  The Board must consider the type of condition specifically claimed and whether it is readily amenable to lay diagnosis or probative comment on etiology.  See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).  In this regard, the Federal Circuit recently held that "PTSD is not the type of medical condition that lay evidence . . . is competent and sufficient to identify."  Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014).  Regardless, the Board acknowledges the Veteran is competent to report psychiatric symptoms both during and after service.  See 38 C.F.R. § 3.159(a)(2); Jandreau, 492 F.3d at 1377 (discussing that Veteran is competent to report a contemporaneous medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (discussing general competency of a Veteran to report psychiatric symptoms).

That is, lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson, 581 F.3d at 1316.  See also Jandreau, 492 F.3d at 1376-77.

In this case, the Veteran does not allege that he was in combat.  Instead, the Veteran contends that he has PTSD attributable to his in-service physical assault by two Korean civilians in June 1963 outside of Camp Casey, Korea.  During the attack, the Veteran was struck on the left side of his head and face with an unknown object, but described at times as a brick.  He was knocked unconscious for an unknown period of time, but he does remember waking up in an Army medical facility.  He has inconsistently reported that the attack occurred while he was on guard duty, or in the alternative, while he was at a nightclub.  He was transported to MEDEVAC hospital in Camp Casey, and then placed in another Army Hospital in Korea.  STRs only document a fracture of his left zygoma, something (illegible) with his left eye, and a fracture of his left maxilla.  He says he engaged in alcohol and drug abuse while in service, subsequent to the assault.  He also contends that behavioral issues began to arise, such that he was eventually reduced in rank and had a change of assignment.  Post-service, he became depressed and treated himself by way of drugs and alcohol.  As a result of this traumatic in-service assault, the Veteran has claimed that he developed PTSD with depression and polysubstance abuse, and at times has been homeless.  See November 2010 stressor statement for PTSD (VA Form 21-0781); August 2012 stressor statement for PTSD based on assault (VA Form 21-0781a); September 2011 VA psychiatry note; June 2012 VA psychological examination; January 2014 VA History and Physical; January 2017 Travel Board hearing testimony; February 2017 VA TBI examination.

The Veteran's PTSD claim is predicated on an allegation of a physical assault while he was in the military.  Because personal trauma is an extremely personal and sensitive issue, many incidents are not officially reported, which creates a proof problem with respect to the occurrence of the claimed stressor.  In such situations, it is not unusual for there to be an absence of service records documenting the events the veteran has alleged.  The victims of such trauma may not necessarily report the full circumstances of the trauma for many years after the trauma.  See VA Live Manual M21-1, III.iv.4.H.4.b. (Change date March 31, 2017).

Therefore, VA cannot use the absence of service record documentation or lack of report of in-service sexual assault or physical assault to military authorities as evidence to conclude that an assault did not occur.  AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013).

Thus, when a PTSD claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident.  38 C.F.R. § 3.304(f)(5).  See also Patton v. West, 12 Vet. App. 272, 277 (1999).  It is often necessary to seek alternative evidence that may demonstrate the presence of markers.  The term marker refers to evidentiary signs, events, or circumstances indicating a possibility that the claimed stressor occurred, such as reports, lay statements, or behavioral changes that may be associated with the approximate timeframe of the claimed stressor.  See VA Live Manual M21-1, IV.ii.1.D.5.m. (Change date March 31, 2017).

Examples of such evidence include, but are not limited to: records from law enforcement authorities; rape crisis centers; mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy.  38 C.F.R. § 3.304(f)(5).

Evidence of behavior changes following the claimed assault is another type of relevant evidence that may be found in these sources.  That is, if STRs and SPRs contain no explicit documentation that personal trauma occurred, and alternative sources of evidence do not provide credible supporting evidence of personal trauma, VA should consider secondary evidence including evidence of behavioral changes around the time of, and after, the incident(s).  See VA Live Manual M21-1, III.iv.4.H.4.d. (Change date March 16, 2017).

Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes.  38 C.F.R. § 3.304(f)(5).

Furthermore, corroboration of every detail of a claimed stressor, including the veteran's personal participation, is not required; rather, a veteran only needs to offer independent evidence of a stressful event that is sufficient to imply his or her personal exposure.  See Pentecost v. Principi, 16 Vet. App. 124, 128 (2002) (quoting Suozzi v. Brown, 10 Vet. App. 307 (1997)).

The Court has set a relatively low bar for interpreting a claim for PTSD as one involving a personal assault stressor for which the provisions of 38 C.F.R. § 3.304(f)(5) are applicable.  See, e.g., Bradford v. Nicholson, 20 Vet. App. 200 (2006) (veteran alleged that his sergeant kicked him down a set of stairs).  VA itself has defined personal trauma very broadly.  Personal trauma for the purpose of VA disability compensation claims based on PTSD refers broadly to stressor events involving harm perpetrated by a person who is not considered part of an enemy force.  Examples include assault, battery, robbery, mugging, stalking, and harassment.  Military sexual trauma is a subset of personal trauma and refers to sexual harassment, sexual assault, or rape that occurs in a military setting.  See VA Live Manual M21-1, IV.ii.1.D.5.a. (Change date March 31, 2017).

For a PTSD claim based on personal assault, an after-the-fact medical opinion can serve as the credible supporting evidence of the stressor.  That is, VA examiners can interpret the evidence of record to confirm the occurrence of in-service physical assault, sexual assault, or harassment.  38 C.F.R. § 3.304(f)(5); Menegassi v. Shinseki, 638 F.3d 1379, 1383 (Fed. Cir. 2011); Bradford v. Nicholson, 20 Vet. App. 200, 207 (2006); Patton v. West, 12 Vet. App. 272, 280 (1999).  In fact, secondary evidence or behavior change evidence typically needs interpretation by a clinician in personal trauma claims.  The VA examiner should determine whether credible factual evidence of behavior changes demonstrated by the Veteran is consistent with the expected reaction or adjustment of a person who has been subjected to an assault.  See VA Live Manual M21-1, III.iv.4.H.4.f. (Change date March 16, 2017); IV.ii.1.D.5.r. (Change date March 31, 2017).

Upon review of the evidence of record, the Board concludes that the Veteran is entitled to service connection for PTSD with depression and polysubstance abuse.

STRs dated from 1961 to 1964 are negative for any complaint, treatment, or diagnosis of PTSD or other acquired psychiatric disorder.  In addition, no psychiatric disorder was objectively found at the Veteran's May 1964 separation examination, and the Veteran denied a history of insomnia, depression, excessive worry, or nervous trouble.  In any event, as to PTSD, an in-service diagnosis is not required.  See 38 C.F.R. § 3.304(f).

SPRs document that the Veteran's military occupational specialty (MOS) was a physical activities specialist.  He served in Korea from August 1962 to September 1963.  A June 18, 1963 SPR personnel action - reclassification board, several weeks after his June 7, 1963 TBI occurred, noted that the Veteran had been counseled for the past three months on his completely disinterested attitude towards his military duties.  The counseling had a completely negative result.  He was noted to be three months behind in filing and posting of orders and correspondence to the personnel records.  He was recommended for reduction in rank for inefficiency.  He had the lowest academic standing of all 65 students.  He was separated from service in April 1964.

Upon review, there is evidence of record corroborating that the early June 1963 in-service physical assault and TBI occurred.  38 C.F.R. § 3.304(f)(5); Cohen, 10 Vet. App. at 147; Moreau, 9 Vet. App. at 395.  Specifically, the RO has already service-connected the Veteran for the underling TBI with various residuals to include a fracture of the left zygoma, a left cheek scar, and tension headaches with loss of balance, dizziness, and fatigue, among other TBI residuals.  In addition, a February 2017 photo of the Veteran's face clearly shows significant indentation and injury to the left side of face, which is grossly distorted with elevation and depression.  The undersigned Veterans Law Judge also remarked upon this fact during the Veteran's January 2017 hearing testimony.  Thus, the Veteran has already been service-connected by VA for the in-service TBI with various residuals.  The evidence of deterioration in work performance is not fully clear because it appears his work performance problems preceded his in-service TBI by several months.  In any event, for corroboration in assault cases, what is required is that sufficient circumstantial evidence exists that the alleged assault may have a basis in fact.  The Board emphasizes that a stressor need not be corroborated in every detail. Pentecost, 16 Vet. App. at 128.  In the present case corroborative evidence of the alleged in-service physical assault in June 1963 is circumstantial in nature, not definitive in nature.  However, again, the in-service TBI was service-connected by the RO in a recent February 2017 rating decision.  In addition, as discussed below, multiple VA psychiatrists have concluded that the Veteran's in-service assault did occur.

With respect to the criteria of a current diagnosis of PTSD, the threshold consideration for any service connection claim is the existence of a current disability.  38 U.S.C.A. § 1131; 38 C.F.R. § 3.303; Boyer, 210 F.3d at 1353; Brammer, 3 Vet. App. at 225.  In particular, aside from corroboration of an in-service stressor, current medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-5) is required, as well as competent evidence of a nexus between current PTSD symptomatology and his verified in-service stressor.  38 C.F.R. § 3.304(f).  See also Cohen v. Brown, 10 Vet. App. 128 (1997).

However, again, medical opinions in cases of personal assault for PTSD are exceptions to the general rule - as, for example, announced in Moreau v. Brown, 9 Vet. App. 389, 396 (1996), that an opinion by a medical professional based on a post-service examination cannot be used to establish the occurrence of a stressor. 38 C.F.R. § 3.304(f)(3); Patton v. West, 12 Vet. App. 272, 280 (1999).  For assault stressors, the examiner can interpret the meaning of behavioral changes during service to determine if an assault stressor did occur.  Id.

In the present case, VA psychiatric treatment records dated from 2010 to 2016 have rendered a current diagnosis of PTSD.  This is not in dispute.

But more importantly, with regard to a nexus, VA medical opinions of record assessed that a personal assault accompanied by a TBI did occur in June 1963, in addition to concluding that a diagnosis of PTSD due to the credible June 1963 personal assault was proper.  38 C.F.R. § 3.304(f)(5).

In particular, the record reflects several favorable VA medical opinions and treatment records from VA psychiatrists dated from 2010 to 2016.  The Board has reviewed VA psychiatry notes and VA history and physicals dated in September 2011, January 2014, December 2015, and August 2016 from the same VA psychiatrist who was familiar with the Veteran due to repeated treatment.  This VA psychiatrist opined that the Veteran had PTSD more likely than not to be the direct result of the attack on him during service in Korea.  Several of the latter opinions considered the DSM-5.  This VA psychiatrist repeatedly discussed details of the TBI incident in Korea, and repeatedly discussed the Veteran's PTSD symptoms.  In a January 2014 opinion, the same VA psychiatrist, when advised by VA of inconsistent descriptions of the in-service TBI by the Veteran, nonetheless opined that she was "convinced that the injury was done by a brick thrown at him, was done by a Korean and that everything is as I had opined in all my documentation on this patient."  The VA examiner also described the Veteran as "highly credible."  In addition, a different May 2011 VA psychiatrist came to the same favorable conclusion as to PTSD.  Also, the Veteran underwent positive PTSD screens in August 2010, November 2010, December 2010, September 2011, July 2013, October 2014, and October 2015.  These PTSD screens revealed positive symptomatology such as nightmares, avoidance, numbness, detachment, and hypervigilance.  They were also often accompanied by positive depression screens.  Moreover, in July 2012, a VA nurse practitioner opinion stated that both VA primary care and VA psychiatry suggest that the Veteran's PTSD "could" be related to the head trauma he received while in the Army in Korea.  Finally, VA Vet Center counseling records dated from 2014 to 2016 assessed the Veteran with multiple symptoms consistent with the diagnosis of PTSD based on the in-service assault in Korea.

Pursuant to 38 C.F.R. § 4.125(a), if the diagnosis of a mental disorder does not conform to DSM-IV / DSM-5 or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis.  Mental health professionals are experts and are presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis.  As such, the Court has held that a PTSD diagnosis provided by a mental-health professional must be presumed to have been made in accordance with the applicable DSM-IV (or DSM-5) criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor, unless there is evidence to the contrary.  Cohen v. Brown, 10 Vet. App. 128, 140 (1997).  The DSM-IV (or DSM-5) cannot be used "as a basis for rejecting the Veteran's favorable medical evidence as to the sufficiency of a stressor or the adequacy of the Veteran's symptomatology."  Id.  As such, in order to make a finding that the Veteran in this case did not have a valid PTSD diagnosis, the Board must clearly articulate its reasons for finding that the PTSD diagnosis was not made in accordance with the DSM-IV or DSM-5 requirements.  If the Board cannot support a conclusion that the diagnosis was not made in accordance with DSM-IV or DSM-5 requirements, it must accept the diagnosis as valid.

In the present case, the Board will therefore accept the above PTSD diagnoses rendered by VA medical professionals as valid and in accordance with the DSM-IV and DSM-5.  In any event, the VA psychiatrists of record described the reasons for their conclusions and also discussed the Veteran's underlying PTSD symptomatology.

Overall, the above VA psychiatry notes and opinions were thorough, supported by explanations, and considered the Veteran's history and relevant longitudinal complaints.  In short, there is probative evidence in support of the PTSD claim.   The Board emphasizes that VA may not order additional development for the sole purpose of obtaining evidence unfavorable to a claimant.  Mariano v. Principi, 17 Vet. App. 305, 312 (2003).

The Board acknowledges that some unfavorable evidence of record with respect to the Veteran's PTSD exists.  Specifically, a VA psychological examiner in July 2012 and August 2012 (the same VA examiner), after a mental health examination of the Veteran and a review of the evidence of record, opined that the Veteran did not meet any of the DSM-IV criteria for PTSD.  However, the underlying premise of this opinion is flawed.  The VA examiner determined that the in-service June 1963 TBI never took place.  But subsequently, the RO determined that it did in fact take place based on the findings of a later February 2017 VA TBI examiner.  At that point, the RO in a February 2017 rating decision service-connected the Veteran for the underlying incident in question, and awarded the Veteran service-connected compensation for various residuals of his in-service TBI from the assault.  The Court has held on a number of occasions that a medical opinion premised upon an inaccurate factual premise is of no probative value.  See Sklar v. Brown, 5 Vet. App. 140 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993); Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); Swann v. Brown, 5 Vet. App. 229, 232 (1993).  Thus, the unfavorable VA psychological examination reports dated in July 2012 and August 2012 are entitled to only limited probative value against the claim.

Given the law and the medical evidence of record, the Board is compelled to grant the Veteran the benefit of the doubt and allow service connection for PTSD.  See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102.

In addition, the Board has also considered whether the Veteran's PTSD claim raised the issue of whether service connection is warranted for any other acquired psychiatric disorder in addition to PTSD.  See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record).  In this regard, the record also shows the Veteran has depression, NOS, and polysubstance abuse disorder as secondary to his service-connected PTSD and his service-connected TBI.  See 38 C.F.R. § 3.310(a).  Specifically, in August 2010 and May 2011 VA psychiatric notes, it was mentioned that the Veteran began to use alcohol and drugs to deal with his physical TBI pain after he left service.  The Board has also reviewed VA psychiatry notes and history and physicals dated in September 2011, January 2014, December 2015, and August 2016 from the same VA psychiatrist who was familiar with the Veteran due to repeated treatment. Psychiatric testing revealed "moderate depression."  This VA psychiatrist opined that the Veteran had a TBI-based pain disorder "with psychological factors" and that his drug and alcohol addiction was the result of his in-service TBI.  In September 2011 the VA psychiatrist remarked that "chemical dependency was his way of self-medicating for the pain and PTSD."

In any event, the present decision is considered a full grant of the benefits sought by the Veteran for his acquired psychiatric disorder claim to include PTSD.  In granting service connection for PTSD with depression and polysubstance abuse, the RO should assign a disability rating or ratings that encompass the symptoms of these disorders.  See Amberman v. Shinseki, 570 F.3d 1377, 1381 (2009) (two defined diagnoses constitute the same disability for purposes of 38 C.F.R. § 4.14 if they have overlapping symptomatology, but bipolar disorder and PTSD could have different symptoms and it could therefore be improper in some circumstances for VA to treat these separately diagnosed conditions as producing only the same disability).

ORDER

Service connection for left face nerve damage, to include as secondary to a service-connected TBI with a fracture of the left zygoma, is denied.

Service connection for a bilateral eye disability (claimed as "blurred vision"), to include as secondary to a service-connected TBI with a fracture of the left zygoma, is denied.

Subject to the provisions governing the award of monetary benefits, service connection for left eye blindness with loss of visual acuity as secondary to a service-connected TBI with a fracture of the left zygoma, is granted.

Subject to the provisions governing the award of monetary benefits, service connection for PTSD with depression and polysubstance abuse is granted.

____________________________________________
DAVID L. WIGHT
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

text: Citation

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text: On

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text: Department

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text: Veterans

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text: Regional

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text: Petersburg

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text: THE

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text: left

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text: left

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text: American

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text: United

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text: Veterans

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text: processed

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text: service

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text: disability

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text: Veteran

text: has

text: left

text: eye

text: blindness

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text: loss

text: of

text: visual

text: acuity

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text: due

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text: result

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text: service

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text: TBI

text: with

text: a

text: fracture

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text: the

text: left

text: zygoma

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text: is

text: credible

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text: Veteran

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text: that

text: the

text: Veteran

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text: current

text: diagnosis

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text: PTSD

text: with

text: depression

text: and

text: substance

text: abuse

text: due

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text: service

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text: loss

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text: PTSD

text: with

text: depression

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text: polysubstance

text: abuse

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text: was

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text: active

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text: service

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text: part

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text: s

text: duties

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text: loss

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text: PTSD

text: with

text: depression

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text: polysubstance

text: abuse

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text: the

text: Veteran

text: was

text: provided

text: adequate

text: VCAA

text: notice

text: for

text: these

text: issues

text: in

text: October

text: November

text: September

text: November

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text: July

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text: if

text: any

text: defect

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text: VCAA

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text: or

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text: found

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text: defect

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text: not

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text: to

text: the

text: Veteran

text: given

text: the

text: completely

text: favorable

text: disposition

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text: the

text: left

text: eye

text: blindness

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text: PTSD

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text: depression

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text: decision

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text: duty

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text: satisfied

text: by

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text: dated

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text: these

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text: left

text: face

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text: a

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text: blurred

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text: that

text: there

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text: with

text: the

text: party

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text: issue

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text: be

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text: case

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text: has

text: been

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text: any

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text: RO

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text: Veteran

text: s

text: service

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text: STRs

text: service

text: personnel

text: records

text: SPRs

text: VA

text: outpatient

text: treatment

text: records

text: private

text: medical

text: evidence

text: as

text: authorized

text: by

text: the

text: Veteran

text: and

text: VA

text: examinations

text: For

text: his

text: part

text: the

text: Veteran

text: has

text: submitted

text: personal

text: statements

text: hearing

text: testimony

text: argument

text: from

text: his

text: representative

text: and

text: additional

text: VA

text: and

text: Vet

text: Center

text: evidence

text: The

text: Veteran

text: has

text: not

text: identified

text: any

text: additional

text: outstanding

text: evidence

text: that

text: is

text: relevant

text: to

text: his

text: service

text: connection

text: claims

text: being

text: denied

text: herein

text: for

text: left

text: face

text: nerve

text: damage

text: and

text: a

text: bilateral

text: eye

text: disability

text: The

text: Veteran

text: was

text: also

text: afforded

text: VA

text: examinations

text: and

text: opinions

text: in

text: October

text: and

text: February

text: to

text: determine

text: the

text: etiology

text: of

text: his

text: left

text: face

text: nerve

text: damage

text: and

text: bilateral

text: eye

text: disability

text: to

text: include

text: as

text: secondary

text: to

text: a

text: service

text: connected

text: TBI

text: See

text: McLendon

text: v

text: Nicholson

text: Vet

text: App

text: see

text: also

text: U

text: S

text: C

text: A

text: A

text: d

text: C

text: F

text: R

text: c

text: As

text: will

text: be

text: discussed

text: below

text: these

text: VA

text: examinations

text: were

text: thorough

text: supported

text: by

text: explanations

text: based

text: on

text: a

text: review

text: of

text: the

text: claims

text: folder

text: and

text: supported

text: by

text: clinical

text: evidence

text: of

text: record

text: These

text: VA

text: examinations

text: also

text: considered

text: the

text: Veteran

text: s

text: reported

text: lay

text: history

text: As

text: such

text: there

text: is

text: no

text: basis

text: for

text: any

text: further

text: VA

text: examination

text: or

text: opinion

text: as

text: to

text: the

text: left

text: face

text: nerve

text: damage

text: and

text: bilateral

text: eye

text: disability

text: issues

text: on

text: appeal

text: According

text: to

text: a

text: March

text: letter

text: to

text: the

text: Veteran

text: from

text: the

text: Social

text: Security

text: Administration

text: SSA

text: the

text: SSA

text: indicated

text: they

text: paid

text: disability

text: benefits

text: to

text: the

text: Veteran

text: from

text: to

text: However

text: these

text: disability

text: benefits

text: were

text: converted

text: to

text: retirement

text: benefits

text: in

text: November

text: because

text: of

text: the

text: Veteran

text: s

text: advanced

text: age

text: In

text: any

text: event

text: a

text: copy

text: of

text: the

text: September

text: SSA

text: disability

text: determination

text: submitted

text: by

text: the

text: Veteran

text: concluded

text: that

text: he

text: was

text: disabled

text: due

text: to

text: nonservice

text: connected

text: lumbar

text: spine

text: urinary

text: dysfunction

text: and

text: lower

text: extremity

text: disabilities

text: The

text: Veteran

text: was

text: considered

text: to

text: be

text: disabled

text: by

text: the

text: SSA

text: post

text: service

text: since

text: after

text: the

text: Veteran

text: injured

text: himself

text: hauling

text: furniture

text: according

text: to

text: a

text: June

text: VA

text: psychological

text: examination

text: Complete

text: SSA

text: disability

text: records

text: are

text: not

text: present

text: in

text: the

text: claims

text: folder

text: But

text: most

text: significantly

text: it

text: is

text: apparent

text: that

text: these

text: SSA

text: disability

text: benefits

text: were

text: only

text: awarded

text: in

text: the

text: context

text: of

text: his

text: nonservice

text: connected

text: lumbar

text: spine

text: urinary

text: dysfunction

text: and

text: lower

text: extremity

text: disabilities

text: As

text: there

text: was

text: no

text: reason

text: to

text: suspect

text: the

text: SSA

text: records

text: would

text: change

text: the

text: outcome

text: of

text: the

text: service

text: connection

text: claims

text: being

text: denied

text: in

text: the

text: present

text: case

text: VA

text: is

text: not

text: obligated

text: to

text: invest

text: further

text: time

text: and

text: resources

text: to

text: obtain

text: them

text: See

text: Golz

text: v

text: Shinseki

text: F

text: d

text: It

text: is

text: not

text: the

text: case

text: that

text: the

text: government

text: must

text: obtain

text: records

text: in

text: every

text: case

text: in

text: order

text: to

text: rule

text: out

text: their

text: relevance

text: Such

text: a

text: decision

text: would

text: be

text: akin

text: to

text: a

text: determination

text: that

text: all

text: medical

text: records

text: must

text: be

text: obtained

text: In

text: essence

text: efforts

text: to

text: obtain

text: these

text: SSA

text: records

text: are

text: clearly

text: not

text: warranted

text: as

text: they

text: are

text: not

text: relevant

text: to

text: the

text: claims

text: being

text: denied

text: and

text: would

text: provide

text: no

text: reasonable

text: possibility

text: of

text: substantiating

text: the

text: claims

text: on

text: appeal

text: U

text: S

text: C

text: A

text: A

text: a

text: Moreover

text: for

text: both

text: the

text: left

text: face

text: nerve

text: damage

text: and

text: bilateral

text: eye

text: issues

text: on

text: appeal

text: neither

text: the

text: Veteran

text: nor

text: his

text: representative

text: has

text: advanced

text: any

text: procedural

text: arguments

text: in

text: relation

text: to

text: VA

text: s

text: duties

text: to

text: notify

text: and

text: assist

text: See

text: Scott

text: v

text: McDonald

text: F

text: d

text: Fed

text: Cir

text: holding

text: that

text: absent

text: extraordinary

text: circumstances

text: we

text: think

text: it

text: is

text: appropriate

text: for

text: the

text: Board

text: and

text: the

text: Veterans

text: Court

text: to

text: address

text: only

text: those

text: procedural

text: arguments

text: specifically

text: raised

text: by

text: the

text: veteran

text: For

text: instance

text: the

text: Veteran

text: has

text: not

text: alleged

text: any

text: deficiency

text: with

text: his

text: January

text: Travel

text: Board

text: hearing

text: testimony

text: as

text: to

text: the

text: duties

text: discussed

text: in

text: Bryant

text: v

text: Shinseki

text: Vet

text: App

text: In

text: this

text: regard

text: the

text: Federal

text: Circuit

text: recently

text: ruled

text: in

text: Dickens

text: v

text: McDonald

text: F

text: d

text: Fed

text: Cir

text: that

text: a

text: Bryant

text: hearing

text: deficiency

text: was

text: subject

text: to

text: the

text: doctrine

text: of

text: issue

text: exhaustion

text: as

text: laid

text: out

text: in

text: the

text: Scott

text: case

text: cited

text: to

text: above

text: Thus

text: the

text: Board

text: need

text: not

text: discuss

text: any

text: potential

text: Bryant

text: problem

text: because

text: the

text: Veteran

text: has

text: not

text: raised

text: that

text: issue

text: before

text: the

text: Board

text: Accordingly

text: the

text: Board

text: is

text: satisfied

text: that

text: the

text: RO

text: has

text: provided

text: all

text: assistance

text: required

text: by

text: the

text: VCAA

text: U

text: S

text: C

text: A

text: A

text: West

text: Hence

text: there

text: is

text: no

text: error

text: or

text: issue

text: that

text: precludes

text: the

text: Board

text: from

text: addressing

text: the

text: merits

text: of

text: the

text: service

text: connection

text: issues

text: on

text: appeal

text: for

text: left

text: face

text: nerve

text: damage

text: and

text: a

text: bilateral

text: eye

text: disability

text: II

text: Service

text: Connection

text: Service

text: connection

text: may

text: be

text: granted

text: for

text: a

text: disability

text: resulting

text: from

text: disease

text: or

text: injury

text: incurred

text: in

text: or

text: aggravated

text: by

text: active

text: military

text: naval

text: or

text: air

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: Under

text: C

text: F

text: R

text: a

text: service

text: connection

text: requires

text: competent

text: evidence

text: showing

text: the

text: existence

text: of

text: a

text: present

text: disability

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: a

text: disease

text: or

text: injury

text: and

text: a

text: causal

text: relationship

text: between

text: the

text: present

text: disability

text: and

text: the

text: disease

text: or

text: injury

text: incurred

text: or

text: aggravated

text: during

text: service

text: the

text: so

text: called

text: nexus

text: requirement

text: Holton

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: quoting

text: Shedden

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: The

text: Federal

text: Circuit

text: Court

text: recently

text: held

text: that

text: diseases

text: that

text: would

text: be

text: considered

text: chronic

text: in

text: a

text: medical

text: sense

text: but

text: which

text: are

text: not

text: listed

text: in

text: C

text: F

text: R

text: a

text: as

text: an

text: enumerated

text: chronic

text: disease

text: may

text: still

text: qualify

text: for

text: service

text: connection

text: under

text: the

text: three

text: element

text: test

text: for

text: disability

text: compensation

text: described

text: in

text: a

text: Walker

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: But

text: under

text: C

text: F

text: R

text: b

text: where

text: the

text: evidence

text: shows

text: an

text: enumerated

text: chronic

text: disease

text: in

text: service

text: or

text: within

text: the

text: presumptive

text: period

text: under

text: or

text: continuity

text: of

text: symptoms

text: of

text: such

text: a

text: disease

text: after

text: service

text: the

text: disease

text: shall

text: be

text: presumed

text: to

text: have

text: been

text: incurred

text: in

text: service

text: Walker

text: F

text: d

text: at

text: Initially

text: certain

text: bilateral

text: eye

text: disorders

text: and

text: left

text: face

text: nerve

text: damage

text: the

text: Veteran

text: has

text: been

text: diagnosed

text: with

text: are

text: not

text: an

text: enumerated

text: chronic

text: disease

text: listed

text: under

text: C

text: F

text: R

text: a

text: therefore

text: the

text: presumptive

text: provisions

text: based

text: on

text: chronic

text: symptoms

text: in

text: service

text: and

text: continuous

text: symptoms

text: since

text: service

text: at

text: C

text: F

text: R

text: b

text: do

text: not

text: apply

text: for

text: these

text: disorders

text: Walker

text: F

text: d

text: at

text: However

text: the

text: Veteran

text: s

text: glaucoma

text: of

text: the

text: eyes

text: is

text: an

text: enumerated

text: chronic

text: disease

text: listed

text: under

text: C

text: F

text: R

text: a

text: other

text: organic

text: disease

text: of

text: the

text: nervous

text: system

text: therefore

text: C

text: F

text: R

text: b

text: does

text: apply

text: to

text: that

text: disorder

text: Id

text: Service

text: connection

text: for

text: an

text: enumerated

text: chronic

text: disease

text: listed

text: under

text: C

text: F

text: R

text: a

text: such

text: as

text: glaucoma

text: can

text: also

text: be

text: also

text: be

text: established

text: on

text: a

text: presumptive

text: basis

text: by

text: showing

text: that

text: it

text: manifested

text: itself

text: to

text: a

text: degree

text: of

text: percent

text: or

text: more

text: within

text: one

text: year

text: from

text: the

text: date

text: of

text: separation

text: from

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: a

text: That

text: is

text: under

text: C

text: F

text: R

text: b

text: with

text: an

text: enumerated

text: chronic

text: disease

text: such

text: as

text: glaucoma

text: shown

text: in

text: service

text: or

text: within

text: the

text: presumptive

text: period

text: under

text: subsequent

text: manifestations

text: of

text: the

text: same

text: chronic

text: disease

text: at

text: any

text: later

text: date

text: however

text: remote

text: are

text: service

text: connected

text: unless

text: clearly

text: attributable

text: to

text: intercurrent

text: causes

text: See

text: also

text: Groves

text: v

text: Peake

text: F

text: d

text: This

text: rule

text: does

text: not

text: mean

text: that

text: any

text: manifestation

text: of

text: joint

text: pain

text: any

text: abnormality

text: of

text: heart

text: action

text: or

text: heart

text: sounds

text: any

text: urinary

text: findings

text: of

text: casts

text: or

text: any

text: cough

text: in

text: service

text: will

text: permit

text: service

text: connection

text: of

text: arthritis

text: disease

text: of

text: the

text: heart

text: nephritis

text: or

text: pulmonary

text: disease

text: first

text: shown

text: as

text: a

text: clear

text: cut

text: clinical

text: entity

text: at

text: some

text: later

text: date

text: For

text: the

text: showing

text: of

text: chronic

text: disease

text: such

text: as

text: glaucoma

text: in

text: service

text: there

text: is

text: required

text: a

text: combination

text: of

text: manifestations

text: sufficient

text: to

text: identify

text: the

text: disease

text: entity

text: and

text: sufficient

text: observation

text: to

text: establish

text: chronicity

text: at

text: the

text: time

text: as

text: distinguished

text: from

text: merely

text: isolated

text: findings

text: or

text: a

text: diagnosis

text: including

text: the

text: word

text: chronic

text: When

text: the

text: disease

text: identity

text: is

text: established

text: leprosy

text: tuberculosis

text: multiple

text: sclerosis

text: etc

text: there

text: is

text: no

text: requirement

text: of

text: evidentiary

text: showing

text: of

text: continuity

text: of

text: symptomatology

text: C

text: F

text: R

text: b

text: In

text: addition

text: for

text: chronic

text: diseases

text: listed

text: in

text: C

text: F

text: R

text: a

text: such

text: as

text: glaucoma

text: service

text: connection

text: may

text: be

text: established

text: by

text: showing

text: continuity

text: of

text: symptoms

text: which

text: requires

text: a

text: claimant

text: to

text: demonstrate

text: that

text: a

text: condition

text: was

text: noted

text: during

text: service

text: evidence

text: of

text: post

text: service

text: continuity

text: of

text: symptoms

text: and

text: medical

text: or

text: in

text: certain

text: circumstances

text: lay

text: evidence

text: of

text: a

text: link

text: between

text: the

text: present

text: disability

text: and

text: the

text: post

text: service

text: symptoms

text: C

text: F

text: R

text: b

text: see

text: Walker

text: F

text: d

text: at

text: Fed

text: Cir

text: holding

text: that

text: only

text: those

text: chronic

text: diseases

text: listed

text: in

text: C

text: F

text: R

text: are

text: subject

text: to

text: service

text: connection

text: by

text: continuity

text: of

text: symptoms

text: described

text: in

text: b

text: The

text: correct

text: understanding

text: of

text: the

text: condition

text: noted

text: during

text: service

text: is

text: that

text: the

text: condition

text: is

text: one

text: that

text: is

text: indicative

text: of

text: but

text: not

text: dispositive

text: of

text: a

text: chronic

text: disease

text: Walker

text: F

text: d

text: at

text: Stated

text: another

text: way

text: continuity

text: of

text: symptomatology

text: after

text: discharge

text: is

text: required

text: only

text: where

text: the

text: condition

text: noted

text: during

text: service

text: or

text: in

text: the

text: presumptive

text: period

text: is

text: not

text: in

text: fact

text: shown

text: to

text: be

text: chronic

text: or

text: where

text: the

text: diagnosis

text: of

text: chronicity

text: may

text: be

text: legitimately

text: questioned

text: i

text: e

text: when

text: the

text: fact

text: of

text: chronicity

text: in

text: service

text: is

text: not

text: adequately

text: supported

text: C

text: F

text: R

text: b

text: See

text: also

text: Walker

text: F

text: d

text: at

text: Under

text: C

text: F

text: R

text: d

text: disorders

text: diagnosed

text: after

text: discharge

text: may

text: also

text: still

text: be

text: service

text: connected

text: if

text: all

text: the

text: evidence

text: including

text: pertinent

text: service

text: records

text: establishes

text: the

text: disorder

text: was

text: incurred

text: in

text: service

text: See

text: Combee

text: v

text: Brown

text: F

text: d

text: Fed

text: Cir

text: A

text: disability

text: can

text: also

text: be

text: service

text: connected

text: on

text: a

text: secondary

text: basis

text: if

text: it

text: is

text: proximately

text: due

text: to

text: or

text: the

text: result

text: of

text: a

text: service

text: connected

text: condition

text: C

text: F

text: R

text: a

text: Moreover

text: secondary

text: service

text: connection

text: may

text: be

text: established

text: as

text: well

text: by

text: any

text: increase

text: in

text: severity

text: i

text: e

text: aggravation

text: of

text: a

text: nonservice

text: connected

text: condition

text: that

text: is

text: proximately

text: due

text: to

text: or

text: the

text: result

text: of

text: a

text: service

text: connected

text: condition

text: C

text: F

text: R

text: b

text: effective

text: October

text: See

text: Fed

text: Reg

text: September

text: See

text: also

text: Allen

text: v

text: Brown

text: Vet

text: App

text: Tobin

text: v

text: Derwinski

text: Vet

text: App

text: Where

text: a

text: service

text: connected

text: disability

text: aggravates

text: a

text: nonservice

text: connected

text: condition

text: a

text: veteran

text: may

text: be

text: compensated

text: for

text: the

text: degree

text: of

text: disability

text: but

text: only

text: that

text: degree

text: over

text: and

text: above

text: the

text: degree

text: of

text: disability

text: existing

text: prior

text: to

text: the

text: aggravation

text: Allen

text: Vet

text: App

text: at

text: In

text: short

text: in

text: order

text: to

text: establish

text: entitlement

text: to

text: service

text: connection

text: on

text: this

text: secondary

text: basis

text: there

text: must

text: be

text: evidence

text: of

text: a

text: current

text: disability

text: evidence

text: of

text: a

text: service

text: connected

text: disability

text: and

text: probative

text: evidence

text: establishing

text: a

text: nexus

text: i

text: e

text: link

text: between

text: the

text: service

text: connected

text: disability

text: and

text: the

text: current

text: disability

text: Wallin

text: v

text: West

text: Vet

text: App

text: VA

text: is

text: to

text: give

text: due

text: consideration

text: to

text: all

text: pertinent

text: medical

text: and

text: lay

text: evidence

text: in

text: evaluating

text: a

text: claim

text: for

text: disability

text: benefits

text: U

text: S

text: C

text: A

text: a

text: West

text: The

text: Federal

text: Circuit

text: has

text: held

text: that

text: medical

text: evidence

text: is

text: not

text: always

text: or

text: categorically

text: required

text: in

text: every

text: instance

text: to

text: establish

text: a

text: medical

text: diagnosis

text: or

text: the

text: required

text: nexus

text: between

text: the

text: claimed

text: disability

text: and

text: the

text: Veteran

text: s

text: military

text: service

text: Davidson

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: That

text: is

text: lay

text: evidence

text: can

text: also

text: be

text: competent

text: and

text: sufficient

text: evidence

text: of

text: a

text: diagnosis

text: or

text: to

text: establish

text: etiology

text: if

text: the

text: layperson

text: is

text: competent

text: to

text: identify

text: the

text: medical

text: condition

text: the

text: layperson

text: is

text: reporting

text: a

text: contemporaneous

text: medical

text: diagnosis

text: or

text: lay

text: testimony

text: describing

text: symptoms

text: at

text: the

text: time

text: supports

text: a

text: later

text: diagnosis

text: by

text: a

text: medical

text: professional

text: Davidson

text: F

text: d

text: at

text: See

text: also

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: In

text: short

text: when

text: considering

text: whether

text: lay

text: evidence

text: is

text: competent

text: the

text: Board

text: must

text: determine

text: on

text: a

text: case

text: by

text: case

text: basis

text: whether

text: the

text: Veteran

text: s

text: particular

text: disability

text: is

text: the

text: type

text: of

text: disability

text: for

text: which

text: lay

text: evidence

text: may

text: be

text: competent

text: on

text: the

text: issues

text: of

text: diagnosis

text: and

text: medical

text: causation

text: Kahana

text: v

text: Shinseki

text: Vet

text: App

text: The

text: question

text: of

text: whether

text: a

text: particular

text: medical

text: issue

text: is

text: beyond

text: the

text: competence

text: of

text: a

text: layperson

text: including

text: both

text: claimants

text: and

text: VA

text: adjudicators

text: must

text: be

text: determined

text: on

text: a

text: case

text: by

text: case

text: basis

text: Id

text: For

text: instance

text: a

text: layperson

text: is

text: competent

text: to

text: identify

text: such

text: disorders

text: as

text: varicose

text: veins

text: tinnitus

text: and

text: flat

text: feet

text: C

text: F

text: R

text: a

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: Charles

text: v

text: Principi

text: Vet

text: App

text: Falzone

text: v

text: Brown

text: Vet

text: App

text: In

text: contrast

text: a

text: layperson

text: is

text: not

text: competent

text: to

text: identify

text: medical

text: conditions

text: that

text: require

text: scientific

text: technical

text: or

text: other

text: specialized

text: knowledge

text: such

text: as

text: in

text: identifying

text: bronchial

text: asthma

text: C

text: F

text: R

text: a

text: Layno

text: v

text: Brown

text: Vet

text: App

text: Therefore

text: the

text: Board

text: must

text: assess

text: the

text: competence

text: and

text: credibility

text: of

text: lay

text: statements

text: Barr

text: Vet

text: App

text: at

text: The

text: Federal

text: Circuit

text: has

text: held

text: that

text: the

text: Board

text: can

text: favor

text: competent

text: medical

text: evidence

text: over

text: lay

text: statements

text: offered

text: by

text: the

text: Veteran

text: as

text: long

text: as

text: the

text: Board

text: neither

text: deems

text: lay

text: evidence

text: categorically

text: incompetent

text: nor

text: improperly

text: requires

text: a

text: medical

text: opinion

text: as

text: the

text: sole

text: way

text: to

text: prove

text: causation

text: King

text: v

text: Shinseki

text: F

text: d

text: In

text: determining

text: whether

text: service

text: connection

text: is

text: warranted

text: the

text: Board

text: shall

text: consider

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: Alemany

text: v

text: Brown

text: Vet

text: App

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: A

text: Preliminary

text: Discussion

text: of

text: Already

text: Service

text: Connected

text: TBI

text: Injury

text: Initially

text: in

text: a

text: very

text: recent

text: February

text: rating

text: decision

text: the

text: Board

text: sees

text: the

text: Veteran

text: was

text: service

text: connected

text: for

text: an

text: underlying

text: TBI

text: that

text: occurred

text: in

text: June

text: during

text: active

text: duty

text: while

text: stationed

text: with

text: the

text: Army

text: in

text: Korea

text: The

text: precise

text: circumstances

text: of

text: how

text: the

text: TBI

text: occurred

text: are

text: somewhat

text: unclear

text: The

text: Veteran

text: has

text: reported

text: that

text: in

text: May

text: or

text: June

text: of

text: near

text: Camp

text: Casey

text: in

text: Korea

text: he

text: was

text: attacked

text: by

text: two

text: Korean

text: civilians

text: During

text: the

text: attack

text: the

text: Veteran

text: was

text: struck

text: on

text: the

text: left

text: side

text: of

text: his

text: head

text: and

text: face

text: with

text: an

text: unknown

text: object

text: but

text: described

text: at

text: times

text: as

text: a

text: brick

text: He

text: was

text: knocked

text: unconscious

text: for

text: an

text: unknown

text: period

text: of

text: time

text: but

text: he

text: does

text: remember

text: waking

text: up

text: in

text: an

text: Army

text: medical

text: facility

text: He

text: has

text: inconsistently

text: reported

text: that

text: the

text: attack

text: occurred

text: while

text: he

text: was

text: on

text: guard

text: duty

text: or

text: in

text: the

text: alternative

text: while

text: he

text: was

text: at

text: a

text: nightclub

text: He

text: was

text: transported

text: to

text: MEDEVAC

text: hospital

text: in

text: Camp

text: Casey

text: and

text: then

text: placed

text: in

text: another

text: Army

text: Hospital

text: in

text: Korea

text: STRs

text: only

text: document

text: a

text: fracture

text: of

text: his

text: left

text: zygoma

text: something

text: illegible

text: with

text: his

text: left

text: eye

text: and

text: a

text: fracture

text: of

text: his

text: left

text: maxilla

text: At

text: that

text: time

text: STRs

text: relate

text: that

text: the

text: Veteran

text: had

text: sustained

text: this

text: injury

text: while

text: playing

text: baseball

text: However

text: the

text: Veteran

text: has

text: explained

text: that

text: he

text: falsely

text: reported

text: the

text: baseball

text: injury

text: to

text: his

text: commanding

text: officer

text: because

text: he

text: thought

text: he

text: would

text: look

text: bad

text: after

text: he

text: had

text: been

text: in

text: a

text: civilian

text: village

text: which

text: was

text: an

text: off

text: limit

text: place

text: So

text: he

text: admits

text: he

text: told

text: an

text: incorrect

text: story

text: to

text: his

text: commanding

text: officer

text: about

text: how

text: his

text: TBI

text: was

text: sustained

text: See

text: November

text: stressor

text: statement

text: for

text: PTSD

text: VA

text: Form

text: August

text: stressor

text: statement

text: for

text: PTSD

text: based

text: on

text: assault

text: VA

text: Form

text: a

text: September

text: VA

text: psychiatry

text: note

text: June

text: VA

text: psychological

text: examination

text: January

text: VA

text: History

text: and

text: Physical

text: January

text: Travel

text: Board

text: hearing

text: testimony

text: February

text: VA

text: TBI

text: examination

text: In

text: any

text: event

text: the

text: RO

text: has

text: already

text: service

text: connected

text: the

text: Veteran

text: for

text: the

text: underlying

text: TBI

text: with

text: various

text: residuals

text: to

text: include

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: a

text: left

text: cheek

text: scar

text: and

text: tension

text: headaches

text: with

text: loss

text: of

text: balance

text: dizziness

text: and

text: fatigue

text: among

text: other

text: TBI

text: residuals

text: In

text: addition

text: a

text: February

text: photo

text: of

text: the

text: Veteran

text: s

text: face

text: clearly

text: shows

text: significant

text: indentation

text: and

text: injury

text: to

text: the

text: left

text: side

text: of

text: face

text: which

text: is

text: grossly

text: distorted

text: with

text: elevation

text: and

text: depression

text: The

text: undersigned

text: Veterans

text: Law

text: Judge

text: also

text: remarked

text: upon

text: this

text: fact

text: during

text: the

text: Veteran

text: s

text: January

text: hearing

text: testimony

text: Thus

text: the

text: Veteran

text: has

text: already

text: been

text: service

text: connected

text: by

text: VA

text: for

text: the

text: in

text: service

text: TBI

text: with

text: various

text: residuals

text: This

text: fact

text: is

text: not

text: in

text: dispute

text: Therefore

text: due

text: to

text: the

text: verified

text: and

text: service

text: connected

text: underlying

text: TBI

text: the

text: Board

text: has

text: specifically

text: considered

text: the

text: presumptive

text: provisions

text: C

text: F

text: R

text: d

text: Under

text: C

text: F

text: R

text: d

text: in

text: a

text: veteran

text: who

text: has

text: a

text: service

text: connected

text: TBI

text: the

text: following

text: shall

text: be

text: held

text: to

text: be

text: the

text: proximate

text: result

text: of

text: the

text: service

text: connected

text: TBI

text: in

text: the

text: absence

text: of

text: clear

text: evidence

text: to

text: the

text: contrary

text: i

text: Parkinsonism

text: including

text: Parkinson

text: s

text: disease

text: following

text: moderate

text: or

text: severe

text: TBI

text: ii

text: Unprovoked

text: seizures

text: following

text: moderate

text: or

text: severe

text: TBI

text: iii

text: Dementias

text: of

text: the

text: following

text: types

text: presenile

text: dementia

text: of

text: the

text: Alzheimer

text: type

text: frontotemporal

text: dementia

text: and

text: dementia

text: with

text: Lewy

text: bodies

text: if

text: manifest

text: within

text: years

text: following

text: moderate

text: or

text: severe

text: TBI

text: iv

text: Depression

text: if

text: manifest

text: within

text: years

text: of

text: moderate

text: or

text: severe

text: TBI

text: or

text: within

text: months

text: of

text: mild

text: TBI

text: or

text: v

text: Diseases

text: of

text: hormone

text: deficiency

text: that

text: result

text: from

text: hypothalamo

text: pituitary

text: changes

text: if

text: manifest

text: within

text: months

text: of

text: moderate

text: or

text: severe

text: TBI

text: Thus

text: C

text: F

text: R

text: d

text: entails

text: presumptive

text: service

text: connection

text: for

text: the

text: above

text: disabilities

text: In

text: the

text: present

text: case

text: there

text: is

text: no

text: evidence

text: of

text: record

text: showing

text: that

text: the

text: Veteran

text: s

text: current

text: depression

text: was

text: manifested

text: within

text: years

text: of

text: moderate

text: or

text: severe

text: TBI

text: or

text: within

text: months

text: of

text: mild

text: TBI

text: C

text: F

text: R

text: d

text: iv

text: In

text: addition

text: the

text: Veteran

text: s

text: currently

text: diagnosed

text: eye

text: disorders

text: PTSD

text: substance

text: abuse

text: disorder

text: and

text: left

text: face

text: apraxia

text: are

text: not

text: listed

text: under

text: C

text: F

text: R

text: d

text: as

text: one

text: of

text: the

text: presumptive

text: conditions

text: associated

text: with

text: a

text: TBI

text: injury

text: However

text: secondary

text: service

text: connection

text: may

text: also

text: be

text: awarded

text: under

text: C

text: F

text: R

text: d

text: for

text: any

text: condition

text: not

text: meeting

text: the

text: above

text: criteria

text: under

text: the

text: generally

text: applicable

text: provisions

text: of

text: service

text: connection

text: This

text: would

text: entail

text: consideration

text: of

text: non

text: presumptive

text: service

text: connection

text: established

text: by

text: the

text: evidence

text: of

text: record

text: Therefore

text: the

text: Board

text: will

text: consider

text: all

text: of

text: these

text: disorders

text: on

text: a

text: non

text: presumptive

text: basis

text: as

text: well

text: The

text: determination

text: of

text: the

text: severity

text: level

text: mild

text: moderate

text: or

text: severe

text: of

text: the

text: underlying

text: TBI

text: is

text: based

text: on

text: the

text: TBI

text: symptoms

text: at

text: the

text: time

text: of

text: the

text: injury

text: or

text: shortly

text: thereafter

text: The

text: TBI

text: does

text: not

text: have

text: to

text: meet

text: all

text: the

text: criteria

text: listed

text: under

text: a

text: certain

text: severity

text: level

text: in

text: order

text: to

text: classify

text: the

text: TBI

text: at

text: that

text: severity

text: level

text: If

text: a

text: TBI

text: meets

text: the

text: criteria

text: in

text: more

text: than

text: one

text: category

text: of

text: severity

text: then

text: the

text: TBI

text: should

text: be

text: ranked

text: at

text: the

text: highest

text: level

text: in

text: which

text: a

text: criterion

text: is

text: met

text: except

text: where

text: the

text: qualifying

text: criterion

text: is

text: the

text: same

text: at

text: both

text: levels

text: C

text: F

text: R

text: d

text: A

text: TBI

text: is

text: mild

text: in

text: severity

text: if

text: there

text: is

text: normal

text: structural

text: imaging

text: loss

text: of

text: consciousness

text: for

text: up

text: to

text: minutes

text: alteration

text: of

text: consciousness

text: or

text: mental

text: statement

text: for

text: a

text: moment

text: to

text: up

text: to

text: hours

text: post

text: traumatic

text: amnesia

text: for

text: up

text: to

text: a

text: day

text: and

text: a

text: Glasgow

text: Coma

text: Scale

text: ranging

text: from

text: to

text: A

text: TBI

text: is

text: moderate

text: in

text: severity

text: if

text: there

text: is

text: normal

text: or

text: abnormal

text: structural

text: imaging

text: loss

text: of

text: consciousness

text: from

text: minutes

text: to

text: less

text: than

text: hours

text: alteration

text: of

text: consciousness

text: or

text: mental

text: state

text: for

text: more

text: than

text: hours

text: post

text: traumatic

text: amnesia

text: from

text: one

text: to

text: days

text: or

text: Glasgow

text: Coma

text: Scale

text: from

text: A

text: TBI

text: is

text: severe

text: if

text: there

text: is

text: normal

text: or

text: abnormal

text: structural

text: imaging

text: loss

text: of

text: consciousness

text: for

text: more

text: than

text: hours

text: alteration

text: of

text: consciousness

text: or

text: mental

text: state

text: for

text: more

text: than

text: hours

text: post

text: traumatic

text: amnesia

text: for

text: more

text: than

text: days

text: or

text: a

text: Glasgow

text: Coma

text: Scale

text: of

text: See

text: C

text: F

text: R

text: d

text: The

text: resultant

text: disabling

text: effects

text: of

text: a

text: TBI

text: event

text: beyond

text: those

text: that

text: follow

text: immediately

text: from

text: the

text: acute

text: injury

text: to

text: the

text: brain

text: are

text: known

text: as

text: TBI

text: residuals

text: or

text: TBI

text: sequelae

text: The

text: signs

text: and

text: symptoms

text: of

text: TBI

text: residuals

text: can

text: be

text: organized

text: into

text: the

text: three

text: main

text: categories

text: of

text: physical

text: cognitive

text: and

text: behavioral

text: emotional

text: residuals

text: for

text: evaluation

text: purposes

text: TBI

text: residuals

text: can

text: resolve

text: in

text: a

text: short

text: period

text: of

text: time

text: persist

text: chronically

text: or

text: permanently

text: or

text: may

text: also

text: have

text: a

text: delayed

text: onset

text: See

text: M

text: Live

text: Manual

text: Part

text: III

text: Subpart

text: iv

text: Chapter

text: Section

text: G

text: Topic

text: Block

text: d

text: change

text: date

text: September

text: With

text: regard

text: to

text: the

text: in

text: service

text: TBI

text: after

text: review

text: of

text: the

text: medical

text: and

text: lay

text: evidence

text: of

text: record

text: see

text: e

text: g

text: October

text: VA

text: TBI

text: examination

text: it

text: appears

text: the

text: Veteran

text: s

text: in

text: service

text: June

text: TBI

text: injury

text: was

text: moderate

text: to

text: severe

text: due

text: to

text: loss

text: of

text: consciousness

text: for

text: around

text: hours

text: or

text: alteration

text: of

text: consciousness

text: or

text: mental

text: state

text: for

text: more

text: than

text: hours

text: See

text: C

text: F

text: R

text: d

text: The

text: Board

text: will

text: now

text: turn

text: to

text: consideration

text: of

text: service

text: connection

text: and

text: secondary

text: service

text: connection

text: for

text: the

text: specfic

text: disabilities

text: on

text: appeal

text: B

text: Left

text: Face

text: Nerve

text: Damage

text: The

text: Veteran

text: contends

text: that

text: he

text: has

text: nerve

text: damage

text: or

text: neurological

text: damage

text: to

text: the

text: left

text: side

text: of

text: his

text: face

text: as

text: a

text: residual

text: of

text: his

text: already

text: service

text: connected

text: TBI

text: He

text: says

text: he

text: developed

text: nerve

text: damage

text: related

text: to

text: his

text: in

text: service

text: facial

text: trauma

text: in

text: Post

text: service

text: he

text: says

text: he

text: did

text: not

text: have

text: health

text: insurance

text: so

text: he

text: simply

text: lived

text: with

text: the

text: pain

text: until

text: The

text: Veteran

text: currently

text: reports

text: numbness

text: in

text: the

text: left

text: cheek

text: See

text: August

text: formal

text: claim

text: for

text: TBI

text: January

text: DRO

text: conference

text: January

text: hearing

text: testimony

text: at

text: pages

text: February

text: VA

text: skin

text: scar

text: examination

text: report

text: Upon

text: review

text: of

text: the

text: evidence

text: of

text: record

text: the

text: Board

text: concludes

text: that

text: the

text: Veteran

text: is

text: not

text: entitled

text: to

text: service

text: connection

text: or

text: secondary

text: service

text: connection

text: for

text: left

text: face

text: nerve

text: damage

text: Importantly

text: the

text: Veteran

text: is

text: already

text: service

text: connected

text: for

text: a

text: broad

text: array

text: of

text: residuals

text: of

text: his

text: in

text: service

text: TBI

text: Specifically

text: he

text: has

text: been

text: assigned

text: a

text: percent

text: rating

text: for

text: residuals

text: of

text: a

text: TBI

text: under

text: C

text: F

text: R

text: a

text: Diagnostic

text: Code

text: Also

text: he

text: has

text: been

text: assigned

text: a

text: percent

text: rating

text: for

text: residuals

text: of

text: fracture

text: of

text: the

text: left

text: zygoma

text: with

text: residual

text: left

text: cheek

text: scar

text: under

text: C

text: F

text: R

text: Diagnostic

text: Code

text: scars

text: of

text: the

text: head

text: face

text: or

text: neck

text: In

text: addition

text: he

text: has

text: been

text: assigned

text: a

text: percent

text: rating

text: for

text: a

text: painful

text: left

text: cheek

text: scar

text: under

text: C

text: F

text: R

text: Diagnostic

text: Code

text: Finally

text: he

text: has

text: been

text: assigned

text: a

text: percent

text: rating

text: for

text: tension

text: headaches

text: with

text: loss

text: of

text: balance

text: dizziness

text: and

text: fatigue

text: under

text: C

text: F

text: R

text: a

text: Diagnostic

text: Code

text: According

text: to

text: the

text: February

text: rating

text: decision

text: the

text: percent

text: rating

text: for

text: the

text: Veteran

text: s

text: TBI

text: already

text: considered

text: neurological

text: residuals

text: of

text: his

text: TBI

text: This

text: was

text: based

text: on

text: the

text: findings

text: of

text: a

text: February

text: VA

text: TBI

text: examiner

text: Specifically

text: a

text: level

text: of

text: severity

text: of

text: has

text: been

text: assigned

text: for

text: the

text: Veteran

text: s

text: motor

text: activity

text: with

text: intact

text: motor

text: and

text: sensory

text: system

text: facet

text: based

text: on

text: motor

text: activity

text: mildly

text: decreased

text: or

text: with

text: moderate

text: slowing

text: due

text: to

text: apraxia

text: Apraxia

text: is

text: defined

text: as

text: the

text: loss

text: of

text: ability

text: to

text: carry

text: out

text: familiar

text: purposeful

text: movements

text: in

text: the

text: absence

text: of

text: paralysis

text: or

text: other

text: motor

text: sensory

text: impairment

text: See

text: DORLAND

text: S

text: ILLUSTRATED

text: MEDICAL

text: DICTIONARY

text: TH

text: Ed

text: The

text: evaluation

text: of

text: the

text: same

text: disability

text: or

text: the

text: same

text: manifestations

text: of

text: disability

text: under

text: multiple

text: diagnoses

text: is

text: to

text: be

text: avoided

text: C

text: F

text: R

text: A

text: claimant

text: may

text: not

text: be

text: compensated

text: twice

text: for

text: the

text: same

text: symptomatology

text: as

text: such

text: a

text: result

text: would

text: overcompensate

text: the

text: claimant

text: for

text: the

text: actual

text: impairment

text: of

text: his

text: earning

text: capacity

text: Brady

text: v

text: Brown

text: Vet

text: App

text: This

text: would

text: result

text: in

text: pyramiding

text: contrary

text: to

text: the

text: provisions

text: of

text: C

text: F

text: R

text: See

text: also

text: Amberman

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: two

text: defined

text: diagnoses

text: constitute

text: the

text: same

text: disability

text: for

text: purposes

text: of

text: section

text: if

text: they

text: have

text: overlapping

text: symptomatology

text: However

text: when

text: a

text: veteran

text: has

text: separate

text: and

text: distinct

text: manifestations

text: attributable

text: to

text: the

text: same

text: injury

text: he

text: should

text: be

text: compensated

text: under

text: different

text: diagnostic

text: codes

text: with

text: different

text: ratings

text: Esteban

text: v

text: Brown

text: Vet

text: App

text: See

text: also

text: Fanning

text: v

text: Brown

text: Vet

text: App

text: The

text: critical

text: inquiry

text: in

text: making

text: such

text: a

text: determination

text: is

text: whether

text: any

text: of

text: the

text: disabling

text: symptomatology

text: is

text: duplicative

text: or

text: overlapping

text: The

text: Veteran

text: is

text: entitled

text: to

text: a

text: combined

text: rating

text: only

text: where

text: the

text: symptomatology

text: is

text: distinct

text: and

text: separate

text: Id

text: The

text: existence

text: of

text: a

text: current

text: disability

text: is

text: the

text: cornerstone

text: of

text: a

text: claim

text: for

text: VA

text: disability

text: compensation

text: U

text: S

text: C

text: A

text: Boyer

text: v

text: West

text: F

text: d

text: Fed

text: Cir

text: Brammer

text: v

text: Derwinski

text: Vet

text: App

text: Congress

text: specifically

text: limits

text: entitlement

text: for

text: service

text: connected

text: disease

text: or

text: injury

text: to

text: cases

text: where

text: such

text: incidents

text: have

text: resulted

text: in

text: a

text: disability

text: In

text: the

text: absence

text: of

text: proof

text: of

text: a

text: present

text: separate

text: disability

text: from

text: nerve

text: damage

text: to

text: the

text: left

text: side

text: of

text: his

text: face

text: there

text: can

text: be

text: no

text: valid

text: claim

text: for

text: direct

text: service

text: connection

text: U

text: S

text: C

text: A

text: see

text: Degmetich

text: v

text: Brown

text: F

text: d

text: holding

text: that

text: interpretation

text: of

text: sections

text: and

text: of

text: the

text: statute

text: as

text: requiring

text: the

text: existence

text: of

text: a

text: present

text: disability

text: for

text: VA

text: compensation

text: purposes

text: cannot

text: be

text: considered

text: arbitrary

text: In

text: order

text: for

text: a

text: Veteran

text: to

text: qualify

text: for

text: basic

text: entitlement

text: to

text: compensation

text: under

text: U

text: S

text: C

text: A

text: or

text: the

text: Veteran

text: must

text: prove

text: existence

text: of

text: a

text: disability

text: and

text: one

text: that

text: has

text: resulted

text: from

text: a

text: disease

text: or

text: injury

text: that

text: occurred

text: in

text: the

text: line

text: of

text: duty

text: See

text: Sanchez

text: Benitez

text: v

text: Principi

text: F

text: d

text: The

text: mere

text: fact

text: of

text: a

text: veteran

text: reporting

text: subjective

text: symptoms

text: whether

text: pain

text: or

text: otherwise

text: does

text: not

text: necessarily

text: warrant

text: a

text: finding

text: that

text: he

text: has

text: met

text: the

text: current

text: disability

text: due

text: to

text: disease

text: or

text: injury

text: requirement

text: Rather

text: an

text: underlying

text: disease

text: or

text: injury

text: is

text: required

text: with

text: current

text: impairment

text: of

text: some

text: sort

text: On

text: this

text: issue

text: there

text: is

text: no

text: probative

text: evidence

text: of

text: any

text: current

text: distinct

text: neurological

text: symptomatology

text: from

text: the

text: Veteran

text: s

text: service

text: connected

text: TBI

text: that

text: would

text: permit

text: a

text: separate

text: rating

text: for

text: any

text: facial

text: nerve

text: disorder

text: other

text: than

text: what

text: he

text: already

text: has

text: Accordingly

text: as

text: evaluation

text: of

text: the

text: same

text: disability

text: or

text: the

text: same

text: manifestations

text: of

text: disability

text: under

text: multiple

text: diagnoses

text: i

text: e

text: pyramiding

text: is

text: to

text: be

text: avoided

text: service

text: connection

text: or

text: secondary

text: service

text: connection

text: for

text: separate

text: nerve

text: damage

text: to

text: the

text: face

text: is

text: not

text: warranted

text: Simply

text: stated

text: the

text: Veteran

text: is

text: already

text: service

text: connected

text: by

text: the

text: RO

text: for

text: whatever

text: neurological

text: symptoms

text: to

text: the

text: face

text: he

text: has

text: as

text: a

text: residual

text: of

text: his

text: TBI

text: See

text: C

text: F

text: R

text: On

text: this

text: issue

text: the

text: Board

text: acknowledges

text: that

text: the

text: Veteran

text: reported

text: numbness

text: of

text: the

text: face

text: to

text: the

text: February

text: VA

text: TBI

text: examiner

text: But

text: this

text: is

text: the

text: only

text: time

text: the

text: Veteran

text: reported

text: this

text: specific

text: symptom

text: in

text: the

text: record

text: including

text: in

text: VA

text: and

text: private

text: treatment

text: records

text: Moreover

text: in

text: contrast

text: the

text: medical

text: evidence

text: of

text: record

text: outweighs

text: the

text: Veteran

text: s

text: subjective

text: complaint

text: No

text: medical

text: professional

text: of

text: record

text: has

text: assessed

text: additional

text: neurological

text: impairment

text: to

text: the

text: face

text: as

text: a

text: residual

text: of

text: the

text: Veteran

text: s

text: TBI

text: aside

text: from

text: the

text: motor

text: activity

text: mildly

text: decreased

text: or

text: with

text: moderate

text: slowing

text: due

text: to

text: apraxia

text: For

text: example

text: at

text: an

text: August

text: VA

text: History

text: and

text: Physical

text: the

text: Veteran

text: s

text: neurological

text: examination

text: was

text: normal

text: An

text: October

text: VA

text: eye

text: examination

text: assessed

text: no

text: optic

text: nerve

text: pallor

text: in

text: both

text: eyes

text: from

text: the

text: in

text: service

text: trauma

text: A

text: January

text: VA

text: eye

text: note

text: showed

text: no

text: retinal

text: nerve

text: fiber

text: thinning

text: The

text: ocular

text: nerve

text: examination

text: was

text: normal

text: Finally

text: the

text: February

text: VA

text: TBI

text: examiner

text: found

text: no

text: evidence

text: of

text: cranial

text: nerve

text: dysfunction

text: In

text: addition

text: the

text: same

text: VA

text: TBI

text: examiner

text: did

text: not

text: identify

text: any

text: specific

text: sensory

text: dysfunction

text: impairment

text: due

text: to

text: the

text: TBI

text: and

text: did

text: not

text: check

text: the

text: sensory

text: dysfunction

text: impairment

text: box

text: for

text: any

text: residuals

text: The

text: VA

text: TBI

text: examiner

text: also

text: did

text: not

text: find

text: it

text: necessary

text: to

text: order

text: a

text: separate

text: cranial

text: or

text: peripheral

text: nerve

text: questionnaire

text: In

text: summary

text: no

text: clinical

text: evidence

text: of

text: record

text: reveals

text: any

text: distinct

text: neurological

text: symptomatology

text: to

text: the

text: face

text: other

text: than

text: the

text: Veteran

text: s

text: already

text: service

text: connected

text: apraxia

text: FILE

text: Once

text: again

text: the

text: existence

text: of

text: a

text: current

text: disability

text: is

text: the

text: cornerstone

text: of

text: a

text: claim

text: for

text: VA

text: disability

text: compensation

text: U

text: S

text: C

text: A

text: see

text: Degmetich

text: v

text: Brown

text: F

text: d

text: Absent

text: probative

text: or

text: reliable

text: evidence

text: of

text: any

text: current

text: distinct

text: neurological

text: symptomatology

text: to

text: the

text: face

text: other

text: than

text: the

text: Veteran

text: s

text: already

text: service

text: connected

text: apraxia

text: service

text: connection

text: cannot

text: be

text: granted

text: in

text: the

text: present

text: case

text: Boyer

text: F

text: d

text: at

text: Brammer

text: Vet

text: App

text: at

text: Accordingly

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: Veteran

text: s

text: service

text: connection

text: claim

text: for

text: left

text: face

text: nerve

text: damage

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: C

text: Bilateral

text: Eye

text: Disability

text: The

text: Veteran

text: contends

text: that

text: he

text: has

text: blurred

text: vision

text: in

text: both

text: eyes

text: that

text: began

text: in

text: service

text: or

text: developed

text: over

text: time

text: secondary

text: to

text: his

text: service

text: connected

text: TBI

text: The

text: Veteran

text: says

text: he

text: did

text: not

text: receive

text: any

text: medical

text: treatment

text: for

text: the

text: blurred

text: vision

text: until

text: VA

text: treatment

text: in

text: Glasses

text: did

text: not

text: help

text: him

text: clear

text: up

text: the

text: blurriness

text: either

text: See

text: August

text: formal

text: claim

text: for

text: TBI

text: December

text: Veteran

text: s

text: statement

text: September

text: VA

text: eye

text: consult

text: At

text: the

text: outset

text: the

text: Board

text: emphasizes

text: that

text: in

text: the

text: present

text: decision

text: it

text: is

text: service

text: connecting

text: the

text: Veteran

text: for

text: left

text: eye

text: blindness

text: with

text: loss

text: of

text: visual

text: acuity

text: as

text: secondary

text: to

text: the

text: service

text: connected

text: TBI

text: with

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: The

text: analysis

text: of

text: this

text: secondary

text: service

text: connection

text: grant

text: will

text: be

text: discussed

text: in

text: further

text: detail

text: below

text: However

text: what

text: is

text: at

text: issue

text: in

text: this

text: section

text: of

text: the

text: decision

text: is

text: whether

text: service

text: connection

text: or

text: secondary

text: service

text: connection

text: is

text: warranted

text: for

text: a

text: separate

text: bilateral

text: eye

text: blurred

text: vision

text: or

text: other

text: bilateral

text: eye

text: disability

text: as

text: distinct

text: from

text: left

text: eye

text: blindness

text: In

text: this

text: vein

text: VA

text: must

text: fully

text: and

text: sympathetically

text: develop

text: a

text: veteran

text: s

text: claim

text: to

text: its

text: optimum

text: and

text: that

text: requires

text: VA

text: to

text: determine

text: all

text: potential

text: claims

text: raised

text: by

text: the

text: evidence

text: applying

text: all

text: relevant

text: laws

text: and

text: regulations

text: Moody

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: Szemraj

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: The

text: Court

text: has

text: held

text: that

text: a

text: claimant

text: s

text: identification

text: of

text: the

text: benefit

text: sought

text: does

text: not

text: require

text: technical

text: precision

text: See

text: Ingram

text: v

text: Nicholson

text: Vet

text: App

text: The

text: Court

text: has

text: further

text: held

text: that

text: a

text: claimant

text: may

text: satisfy

text: this

text: requirement

text: by

text: referring

text: to

text: a

text: body

text: part

text: or

text: system

text: that

text: is

text: disabled

text: or

text: by

text: describing

text: symptoms

text: of

text: the

text: disability

text: Brokowski

text: v

text: Shinseki

text: Vet

text: App

text: see

text: also

text: Clemons

text: v

text: Shinseki

text: Vet

text: App

text: stating

text: that

text: when

text: determining

text: the

text: scope

text: of

text: a

text: claim

text: the

text: Board

text: must

text: consider

text: the

text: claimant

text: s

text: description

text: of

text: the

text: claim

text: the

text: symptoms

text: the

text: claimant

text: describes

text: and

text: the

text: information

text: the

text: claimant

text: submits

text: or

text: that

text: the

text: Secretary

text: obtains

text: in

text: support

text: of

text: that

text: claim

text: Thus

text: the

text: Board

text: in

text: the

text: present

text: decision

text: has

text: considered

text: whether

text: service

text: connection

text: is

text: warranted

text: for

text: all

text: of

text: the

text: Veteran

text: s

text: eye

text: diagnoses

text: identified

text: in

text: the

text: record

text: Upon

text: review

text: of

text: the

text: evidence

text: of

text: record

text: the

text: Board

text: concludes

text: that

text: the

text: Veteran

text: is

text: not

text: entitled

text: to

text: service

text: connection

text: or

text: secondary

text: service

text: connection

text: for

text: a

text: bilateral

text: eye

text: disability

text: to

text: include

text: blurred

text: vision

text: in

text: both

text: eyes

text: The

text: existence

text: of

text: a

text: current

text: disability

text: is

text: the

text: cornerstone

text: of

text: a

text: claim

text: for

text: VA

text: disability

text: compensation

text: U

text: S

text: C

text: A

text: see

text: Degmetich

text: v

text: Brown

text: F

text: d

text: holding

text: that

text: interpretation

text: of

text: sections

text: and

text: of

text: the

text: statute

text: as

text: requiring

text: the

text: existence

text: of

text: a

text: present

text: disability

text: for

text: VA

text: compensation

text: purposes

text: cannot

text: be

text: considered

text: arbitrary

text: In

text: the

text: present

text: case

text: there

text: is

text: sufficient

text: evidence

text: that

text: the

text: Veteran

text: meets

text: the

text: threshold

text: criterion

text: for

text: service

text: connection

text: of

text: a

text: current

text: bilateral

text: eye

text: disability

text: Boyer

text: F

text: d

text: at

text: Brammer

text: Vet

text: App

text: at

text: Here

text: VA

text: eye

text: clinic

text: notes

text: and

text: examinations

text: dated

text: from

text: to

text: reveal

text: various

text: diagnoses

text: of

text: ocular

text: hypertension

text: glaucoma

text: cataracts

text: and

text: refractive

text: error

text: presbyopia

text: The

text: Veteran

text: also

text: has

text: been

text: prescribed

text: various

text: prescriptions

text: to

text: treat

text: these

text: eye

text: disorders

text: Thus

text: the

text: evidence

text: clearly

text: reveals

text: current

text: bilateral

text: eye

text: disabilities

text: for

text: the

text: Veteran

text: as

text: assessed

text: by

text: VA

text: eye

text: physicians

text: Thus

text: the

text: first

text: element

text: of

text: service

text: connection

text: is

text: met

text: However

text: the

text: remaining

text: two

text: elements

text: of

text: service

text: connection

text: are

text: not

text: met

text: for

text: these

text: particular

text: eye

text: disorders

text: STRs

text: dated

text: from

text: to

text: are

text: negative

text: for

text: any

text: complaints

text: treatment

text: or

text: diagnosis

text: of

text: ocular

text: hypertension

text: glaucoma

text: cataracts

text: or

text: other

text: vision

text: abnormalities

text: His

text: uncorrected

text: visual

text: acuity

text: was

text: recorded

text: as

text: in

text: both

text: eyes

text: at

text: separation

text: in

text: May

text: No

text: eye

text: disability

text: was

text: objectively

text: observed

text: at

text: separation

text: He

text: also

text: denied

text: any

text: eye

text: problems

text: at

text: separation

text: There

text: is

text: no

text: evidence

text: of

text: an

text: enumerated

text: chronic

text: disease

text: such

text: as

text: glaucoma

text: shown

text: during

text: service

text: or

text: within

text: one

text: year

text: of

text: service

text: See

text: C

text: F

text: R

text: a

text: Walker

text: F

text: d

text: at

text: Post

text: service

text: the

text: Veteran

text: did

text: not

text: receive

text: any

text: treatment

text: for

text: his

text: eyes

text: until

text: according

text: to

text: the

text: Veteran

text: aside

text: from

text: getting

text: glasses

text: Post

text: service

text: with

text: regard

text: to

text: a

text: nexus

text: there

text: is

text: probative

text: medical

text: evidence

text: of

text: record

text: that

text: clearly

text: weighs

text: against

text: a

text: relationship

text: between

text: the

text: Veteran

text: s

text: present

text: bilateral

text: eye

text: disabilities

text: listed

text: above

text: and

text: his

text: period

text: of

text: military

text: service

text: Holton

text: F

text: d

text: at

text: See

text: also

text: C

text: F

text: R

text: a

text: d

text: Specifically

text: after

text: an

text: examination

text: and

text: review

text: of

text: the

text: claims

text: folder

text: an

text: October

text: VA

text: eye

text: examiner

text: opined

text: that

text: the

text: Veteran

text: s

text: bilateral

text: cataracts

text: are

text: not

text: caused

text: by

text: his

text: left

text: side

text: head

text: and

text: face

text: trauma

text: The

text: rationale

text: was

text: that

text: traumatic

text: cataracts

text: would

text: have

text: a

text: stellate

text: appearance

text: but

text: in

text: contrast

text: the

text: Veteran

text: has

text: nuclear

text: and

text: cortical

text: cataracts

text: which

text: are

text: usually

text: caused

text: by

text: aging

text: In

text: formulating

text: this

text: opinion

text: the

text: VA

text: eye

text: examiner

text: cited

text: his

text: review

text: of

text: medical

text: literature

text: medical

text: records

text: and

text: his

text: clinical

text: experience

text: The

text: VA

text: eye

text: examiner

text: also

text: opined

text: that

text: the

text: Veteran

text: s

text: glaucoma

text: suspect

text: was

text: less

text: likely

text: as

text: not

text: less

text: than

text: probability

text: caused

text: by

text: the

text: in

text: service

text: left

text: side

text: head

text: and

text: face

text: trauma

text: In

text: formulating

text: this

text: opinion

text: the

text: VA

text: eye

text: examiner

text: cited

text: his

text: review

text: of

text: medical

text: literature

text: medical

text: records

text: and

text: his

text: clinical

text: experience

text: This

text: VA

text: eye

text: examiner

text: did

text: not

text: diagnose

text: the

text: Veteran

text: with

text: ocular

text: hypertension

text: Overall

text: this

text: VA

text: eye

text: examination

text: and

text: opinion

text: was

text: thorough

text: supported

text: by

text: an

text: explanation

text: based

text: on

text: a

text: review

text: of

text: the

text: claims

text: folder

text: and

text: supported

text: by

text: the

text: probative

text: evidence

text: of

text: record

text: Importantly

text: the

text: Veteran

text: has

text: not

text: submitted

text: any

text: contrary

text: medical

text: nexus

text: opinion

text: of

text: record

text: with

text: regard

text: to

text: his

text: bilateral

text: eye

text: blurred

text: vision

text: Furthermore

text: an

text: October

text: VA

text: eye

text: note

text: indicated

text: that

text: Veteran

text: s

text: failure

text: to

text: take

text: his

text: medications

text: and

text: keep

text: his

text: appointments

text: was

text: causing

text: his

text: blurred

text: vision

text: and

text: that

text: his

text: blurred

text: vision

text: does

text: not

text: appear

text: to

text: be

text: due

text: to

text: any

text: injury

text: or

text: nerve

text: damage

text: The

text: Board

text: acknowledges

text: that

text: blurred

text: vision

text: is

text: listed

text: in

text: a

text: VA

text: Live

text: Manual

text: table

text: as

text: one

text: of

text: the

text: potential

text: physical

text: residuals

text: or

text: sequelae

text: of

text: a

text: TBI

text: TBI

text: residuals

text: can

text: resolve

text: in

text: a

text: short

text: period

text: of

text: time

text: persist

text: chronically

text: or

text: permanently

text: or

text: may

text: also

text: have

text: a

text: delayed

text: onset

text: See

text: M

text: Live

text: Manual

text: Part

text: III

text: Subpart

text: iv

text: Chapter

text: Section

text: G

text: Topic

text: Block

text: d

text: change

text: date

text: September

text: However

text: the

text: VA

text: Live

text: Manual

text: also

text: states

text: that

text: VA

text: should

text: not

text: automatically

text: concede

text: that

text: a

text: new

text: sign

text: symptom

text: or

text: diagnosis

text: is

text: a

text: residual

text: of

text: a

text: TBI

text: simply

text: because

text: it

text: is

text: listed

text: in

text: the

text: table

text: or

text: evaluation

text: criteria

text: See

text: Id

text: at

text: Block

text: j

text: In

text: any

text: event

text: service

text: connection

text: for

text: residuals

text: of

text: a

text: TBI

text: can

text: be

text: either

text: on

text: a

text: direct

text: or

text: secondary

text: basis

text: In

text: this

text: regard

text: secondary

text: service

text: connection

text: may

text: be

text: awarded

text: under

text: C

text: F

text: R

text: d

text: for

text: any

text: condition

text: under

text: the

text: generally

text: applicable

text: provisions

text: of

text: service

text: connection

text: See

text: also

text: M

text: Live

text: Manual

text: Part

text: III

text: Subpart

text: iv

text: Chapter

text: Section

text: G

text: Topic

text: Blocks

text: a

text: to

text: i

text: change

text: date

text: May

text: The

text: October

text: VA

text: eye

text: examination

text: provides

text: strong

text: evidence

text: against

text: any

text: secondary

text: relationship

text: for

text: blurred

text: vision

text: to

text: the

text: Veteran

text: s

text: service

text: connected

text: TBI

text: With

text: regard

text: to

text: the

text: Veteran

text: s

text: lay

text: assertions

text: the

text: Veteran

text: is

text: indeed

text: competent

text: to

text: report

text: purported

text: symptoms

text: of

text: bilateral

text: eye

text: blurriness

text: during

text: and

text: after

text: service

text: See

text: C

text: F

text: R

text: a

text: Barr

text: Vet

text: App

text: at

text: But

text: the

text: Veteran

text: s

text: lay

text: assertions

text: in

text: the

text: present

text: case

text: are

text: outweighed

text: by

text: the

text: clinical

text: findings

text: of

text: the

text: October

text: VA

text: eye

text: examiner

text: who

text: determined

text: that

text: the

text: Veteran

text: s

text: current

text: bilateral

text: eye

text: disabilities

text: did

text: not

text: originate

text: during

text: service

text: or

text: as

text: the

text: result

text: of

text: the

text: Veteran

text: s

text: TBI

text: The

text: Federal

text: Circuit

text: has

text: held

text: that

text: the

text: Board

text: can

text: favor

text: competent

text: medical

text: evidence

text: over

text: lay

text: statements

text: offered

text: by

text: the

text: Veteran

text: as

text: long

text: as

text: the

text: Board

text: neither

text: deems

text: lay

text: evidence

text: categorically

text: incompetent

text: nor

text: improperly

text: requires

text: a

text: medical

text: opinion

text: as

text: the

text: sole

text: way

text: to

text: prove

text: causation

text: King

text: v

text: Shinseki

text: F

text: d

text: In

text: this

text: case

text: the

text: VA

text: eye

text: examiner

text: reviewed

text: and

text: considered

text: the

text: evidence

text: of

text: record

text: including

text: the

text: Veteran

text: s

text: statements

text: and

text: provided

text: a

text: medical

text: opinion

text: with

text: a

text: supporting

text: rationale

text: relying

text: on

text: medical

text: training

text: knowledge

text: and

text: expertise

text: Accordingly

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: Veteran

text: s

text: service

text: connection

text: claim

text: and

text: secondary

text: service

text: connection

text: claim

text: of

text: bilateral

text: eye

text: blurriness

text: from

text: ocular

text: hypertension

text: glaucoma

text: or

text: cataracts

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: The

text: Board

text: now

text: turns

text: to

text: the

text: Veteran

text: s

text: diagnosis

text: of

text: refractive

text: error

text: RE

text: in

text: the

text: record

text: In

text: this

text: regard

text: the

text: Veteran

text: has

text: been

text: diagnosed

text: with

text: refractive

text: error

text: and

text: presbyopia

text: in

text: both

text: eyes

text: in

text: post

text: service

text: VA

text: treatment

text: records

text: See

text: June

text: October

text: October

text: and

text: April

text: VA

text: eye

text: notes

text: and

text: VA

text: eye

text: examinations

text: Defects

text: are

text: defined

text: as

text: structural

text: or

text: inherent

text: abnormalities

text: or

text: conditions

text: which

text: are

text: more

text: or

text: less

text: stationary

text: in

text: nature

text: VAOPGCPREC

text: July

text: VAOPGCPREC

text: July

text: Congenital

text: or

text: developmental

text: defects

text: such

text: as

text: refractive

text: error

text: automatically

text: rebut

text: the

text: presumption

text: of

text: soundness

text: and

text: are

text: therefore

text: considered

text: to

text: have

text: preexisted

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: c

text: In

text: this

text: regard

text: the

text: courts

text: have

text: held

text: that

text: the

text: presumption

text: of

text: soundness

text: does

text: not

text: apply

text: to

text: congenital

text: defects

text: such

text: as

text: refractive

text: error

text: Terry

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: Winn

text: v

text: Brown

text: Vet

text: App

text: holding

text: that

text: a

text: non

text: disease

text: or

text: non

text: injury

text: entity

text: such

text: as

text: a

text: congenital

text: defect

text: is

text: not

text: the

text: type

text: of

text: disease

text: or

text: injury

text: related

text: defect

text: to

text: which

text: the

text: presumption

text: of

text: soundness

text: can

text: apply

text: In

text: addition

text: service

text: connection

text: is

text: generally

text: precluded

text: by

text: VA

text: regulation

text: for

text: congenital

text: or

text: developmental

text: defects

text: such

text: as

text: refractive

text: error

text: because

text: they

text: are

text: not

text: diseases

text: or

text: injuries

text: within

text: the

text: meaning

text: of

text: applicable

text: legislation

text: C

text: F

text: R

text: c

text: Palczewski

text: v

text: Nicholson

text: Vet

text: App

text: However

text: a

text: congenital

text: defect

text: such

text: as

text: refractive

text: error

text: can

text: still

text: be

text: subject

text: to

text: superimposed

text: disease

text: or

text: injury

text: during

text: active

text: service

text: VAOPGCPREC

text: If

text: such

text: superimposed

text: disease

text: or

text: injury

text: does

text: occur

text: service

text: connection

text: may

text: be

text: warranted

text: for

text: the

text: resulting

text: disability

text: Id

text: In

text: contrast

text: VA

text: s

text: Office

text: of

text: General

text: Counsel

text: has

text: distinguished

text: between

text: congenital

text: or

text: developmental

text: defects

text: such

text: as

text: refractive

text: error

text: for

text: which

text: service

text: connection

text: is

text: precluded

text: by

text: regulation

text: and

text: congenital

text: or

text: hereditary

text: diseases

text: for

text: which

text: service

text: connection

text: may

text: be

text: granted

text: if

text: initially

text: manifested

text: in

text: or

text: aggravated

text: by

text: service

text: See

text: VAOPGCPREC

text: VAOPGCPREC

text: The

text: General

text: Counsel

text: draws

text: on

text: medical

text: authorities

text: and

text: case

text: law

text: from

text: other

text: federal

text: jurisdictions

text: and

text: concludes

text: that

text: a

text: defect

text: differs

text: from

text: a

text: disease

text: in

text: that

text: a

text: defect

text: is

text: more

text: or

text: less

text: stationary

text: in

text: nature

text: while

text: a

text: disease

text: is

text: capable

text: of

text: improving

text: or

text: deteriorating

text: See

text: VAOPGCPREC

text: at

text: para

text: The

text: VA

text: Live

text: Manual

text: further

text: instructs

text: that

text: defects

text: of

text: form

text: or

text: structure

text: of

text: the

text: eye

text: that

text: are

text: of

text: congenital

text: or

text: developmental

text: origin

text: may

text: not

text: be

text: considered

text: as

text: disabilities

text: or

text: service

text: connected

text: on

text: the

text: basis

text: of

text: incurrence

text: or

text: aggravation

text: beyond

text: natural

text: progress

text: during

text: service

text: Rather

text: actual

text: pathology

text: other

text: than

text: refractive

text: error

text: is

text: required

text: to

text: support

text: impairment

text: of

text: visual

text: acuity

text: The

text: fact

text: that

text: a

text: Veteran

text: was

text: supplied

text: with

text: glasses

text: for

text: correcting

text: refractive

text: error

text: is

text: not

text: in

text: itself

text: considered

text: indicative

text: of

text: aggravation

text: by

text: service

text: that

text: would

text: warrant

text: compensation

text: See

text: M

text: Part

text: III

text: Subpart

text: iv

text: Chapter

text: Section

text: B

text: Topic

text: Blocks

text: b

text: c

text: and

text: e

text: May

text: The

text: Veteran

text: s

text: presbyopia

text: as

text: diagnosed

text: by

text: the

text: VA

text: eye

text: examiners

text: in

text: the

text: present

text: case

text: is

text: considered

text: to

text: be

text: a

text: form

text: of

text: refractive

text: error

text: See

text: Id

text: at

text: Block

text: d

text: In

text: adults

text: refractive

text: errors

text: are

text: generally

text: stationary

text: or

text: change

text: slowly

text: until

text: the

text: stage

text: of

text: presbyopia

text: See

text: Id

text: at

text: Block

text: e

text: Thus

text: as

text: mentioned

text: service

text: connection

text: for

text: refractive

text: error

text: in

text: most

text: circumstances

text: is

text: precluded

text: by

text: VA

text: regulation

text: and

text: by

text: the

text: opinions

text: of

text: VA

text: s

text: Office

text: of

text: General

text: Counsel

text: and

text: by

text: VA

text: s

text: Live

text: Manual

text: However

text: a

text: congenital

text: defect

text: such

text: as

text: refractive

text: error

text: can

text: still

text: be

text: subject

text: to

text: superimposed

text: disease

text: or

text: injury

text: during

text: active

text: service

text: VAOPGCPREC

text: If

text: such

text: superimposed

text: disease

text: or

text: injury

text: does

text: occur

text: service

text: connection

text: may

text: be

text: warranted

text: for

text: the

text: resulting

text: disability

text: Id

text: In

text: the

text: present

text: case

text: although

text: the

text: Veteran

text: sustained

text: a

text: TBI

text: during

text: service

text: no

text: probative

text: evidence

text: of

text: record

text: establishes

text: that

text: his

text: refractive

text: error

text: resulted

text: in

text: additional

text: disability

text: from

text: the

text: TBI

text: Absent

text: any

text: probative

text: evidence

text: that

text: his

text: current

text: refractive

text: error

text: is

text: due

text: to

text: in

text: service

text: trauma

text: or

text: was

text: subject

text: to

text: a

text: superimposed

text: disease

text: or

text: injury

text: during

text: service

text: resulting

text: in

text: additional

text: disability

text: the

text: refractive

text: error

text: is

text: not

text: a

text: disability

text: for

text: purposes

text: of

text: VA

text: disability

text: compensation

text: as

text: it

text: is

text: congenital

text: in

text: nature

text: C

text: F

text: R

text: c

text: See

text: e

text: g

text: Browder

text: v

text: Derwinski

text: Vet

text: App

text: pertaining

text: to

text: refractive

text: error

text: Thus

text: service

text: connection

text: for

text: refractive

text: error

text: and

text: presbyopia

text: is

text: denied

text: Accordingly

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: service

text: connection

text: for

text: bilateral

text: eye

text: refractive

text: error

text: presbyopia

text: See

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: D

text: Left

text: Eye

text: Blindness

text: with

text: Loss

text: of

text: Visual

text: Acuity

text: However

text: with

text: regard

text: to

text: secondary

text: service

text: connection

text: there

text: is

text: some

text: probative

text: medical

text: and

text: lay

text: evidence

text: of

text: record

text: that

text: demonstrates

text: that

text: the

text: Veteran

text: s

text: current

text: left

text: eye

text: blindness

text: with

text: loss

text: of

text: visual

text: acuity

text: is

text: proximately

text: due

text: to

text: or

text: the

text: result

text: of

text: his

text: service

text: connected

text: TBI

text: with

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: C

text: F

text: R

text: a

text: d

text: Velez

text: v

text: West

text: Vet

text: App

text: Initially

text: it

text: is

text: noted

text: the

text: Veteran

text: s

text: in

text: service

text: June

text: TBI

text: injury

text: was

text: moderate

text: to

text: severe

text: due

text: to

text: loss

text: of

text: consciousness

text: for

text: around

text: hours

text: or

text: alteration

text: of

text: consciousness

text: or

text: mental

text: state

text: for

text: more

text: than

text: hours

text: See

text: C

text: F

text: R

text: d

text: As

text: to

text: evidence

text: of

text: a

text: secondary

text: nexus

text: to

text: service

text: connected

text: TBI

text: with

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: a

text: June

text: STR

text: documenting

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: also

text: mentions

text: something

text: about

text: the

text: left

text: eye

text: but

text: the

text: writing

text: explaining

text: the

text: notation

text: is

text: illegible

text: However

text: November

text: January

text: May

text: and

text: August

text: VA

text: eye

text: notes

text: opined

text: there

text: was

text: visual

text: loss

text: of

text: the

text: left

text: eye

text: of

text: due

text: to

text: trauma

text: from

text: the

text: service

text: connected

text: TBI

text: Current

text: visual

text: acuity

text: in

text: the

text: left

text: eye

text: was

text: while

text: in

text: the

text: right

text: eye

text: it

text: was

text: much

text: better

text: at

text: These

text: VA

text: eye

text: notes

text: and

text: examinations

text: provide

text: strong

text: evidence

text: in

text: support

text: of

text: the

text: left

text: eye

text: claim

text: In

text: addition

text: VA

text: eye

text: notes

text: dated

text: in

text: October

text: and

text: August

text: reflected

text: that

text: visual

text: acuity

text: in

text: the

text: left

text: eye

text: was

text: reduced

text: but

text: the

text: etiology

text: was

text: unclear

text: A

text: VA

text: eye

text: note

text: dated

text: in

text: April

text: observed

text: that

text: the

text: Veteran

text: s

text: left

text: eye

text: acuity

text: was

text: reduced

text: but

text: again

text: the

text: etiology

text: was

text: unclear

text: VA

text: optometrists

text: added

text: that

text: although

text: the

text: Veteran

text: s

text: left

text: eye

text: cataract

text: was

text: consistent

text: with

text: reduced

text: vision

text: the

text: loss

text: of

text: visual

text: acuity

text: still

text: appears

text: to

text: VA

text: medical

text: professionals

text: to

text: be

text: worse

text: than

text: expected

text: with

text: a

text: cataract

text: alone

text: Accordingly

text: secondary

text: service

text: connection

text: for

text: left

text: eye

text: blindness

text: with

text: loss

text: of

text: visual

text: acuity

text: is

text: warranted

text: U

text: S

text: C

text: A

text: b

text: C

text: F

text: R

text: The

text: Board

text: emphasizes

text: that

text: it

text: is

text: granting

text: secondary

text: service

text: connection

text: left

text: eye

text: blindness

text: with

text: loss

text: of

text: visual

text: acuity

text: on

text: the

text: basis

text: that

text: it

text: is

text: the

text: direct

text: result

text: of

text: a

text: service

text: connected

text: TBI

text: disability

text: as

text: opposed

text: to

text: aggravation

text: E

text: PTSD

text: with

text: Depression

text: and

text: Polysubstance

text: Abuse

text: Service

text: connection

text: for

text: PTSD

text: has

text: unique

text: evidentiary

text: requirements

text: It

text: generally

text: requires

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: i

text: e

text: DSM

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: actually

text: occurred

text: and

text: medical

text: evidence

text: of

text: a

text: link

text: between

text: current

text: symptomatology

text: and

text: the

text: claimed

text: in

text: service

text: stressor

text: C

text: F

text: R

text: f

text: See

text: also

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: Effective

text: August

text: VA

text: amended

text: the

text: portion

text: of

text: its

text: Schedule

text: for

text: Rating

text: Disabilities

text: dealing

text: with

text: mental

text: disorders

text: and

text: its

text: adjudication

text: regulations

text: that

text: define

text: the

text: term

text: psychosis

text: to

text: remove

text: outdated

text: references

text: to

text: the

text: DSM

text: IV

text: and

text: replace

text: them

text: with

text: references

text: to

text: the

text: recently

text: updated

text: Diagnostic

text: and

text: Statistical

text: Manual

text: Fifth

text: Edition

text: the

text: DSM

text: See

text: Fed

text: Reg

text: August

text: VA

text: adopted

text: as

text: final

text: without

text: change

text: this

text: interim

text: final

text: rule

text: and

text: clarified

text: that

text: the

text: provisions

text: of

text: this

text: interim

text: final

text: rule

text: do

text: not

text: apply

text: to

text: claims

text: that

text: have

text: been

text: certified

text: for

text: appeal

text: to

text: the

text: Board

text: or

text: are

text: pending

text: before

text: the

text: Board

text: on

text: or

text: before

text: August

text: See

text: Schedule

text: for

text: Rating

text: Disabilities

text: Mental

text: Disorders

text: and

text: Definition

text: of

text: Psychosis

text: for

text: Certain

text: VA

text: Purposes

text: Fed

text: Reg

text: March

text: In

text: the

text: present

text: case

text: the

text: RO

text: certified

text: the

text: Veteran

text: s

text: PTSD

text: appeal

text: to

text: the

text: Board

text: in

text: March

text: which

text: is

text: after

text: August

text: Thus

text: the

text: amended

text: C

text: F

text: R

text: a

text: conforming

text: to

text: the

text: DSM

text: is

text: applicable

text: in

text: the

text: present

text: case

text: In

text: any

text: event

text: the

text: Board

text: will

text: still

text: consider

text: any

text: private

text: or

text: VA

text: examiner

text: s

text: discussion

text: of

text: both

text: the

text: DSM

text: IV

text: and

text: DSM

text: in

text: adjudicating

text: the

text: current

text: Veteran

text: s

text: PTSD

text: claim

text: in

text: order

text: to

text: provide

text: the

text: Veteran

text: with

text: every

text: benefit

text: of

text: the

text: doubt

text: If

text: VA

text: determines

text: either

text: that

text: the

text: veteran

text: did

text: not

text: engage

text: in

text: combat

text: with

text: the

text: enemy

text: or

text: that

text: the

text: veteran

text: did

text: engage

text: in

text: combat

text: but

text: that

text: the

text: alleged

text: stressor

text: is

text: not

text: combat

text: related

text: the

text: veteran

text: s

text: lay

text: testimony

text: by

text: itself

text: is

text: not

text: sufficient

text: to

text: establish

text: the

text: occurrence

text: of

text: the

text: alleged

text: stressor

text: Instead

text: the

text: record

text: must

text: contain

text: credible

text: supporting

text: evidence

text: that

text: corroborates

text: the

text: veteran

text: s

text: testimony

text: or

text: statements

text: C

text: F

text: R

text: f

text: Stone

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: Moreau

text: v

text: Brown

text: Vet

text: App

text: With

text: regard

text: to

text: an

text: actual

text: diagnosis

text: of

text: PTSD

text: lay

text: persons

text: are

text: not

text: categorically

text: incompetent

text: to

text: speak

text: on

text: matters

text: of

text: medical

text: diagnosis

text: or

text: etiology

text: Davidson

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: The

text: Board

text: must

text: consider

text: the

text: type

text: of

text: condition

text: specifically

text: claimed

text: and

text: whether

text: it

text: is

text: readily

text: amenable

text: to

text: lay

text: diagnosis

text: or

text: probative

text: comment

text: on

text: etiology

text: See

text: Woehlaert

text: v

text: Nicholson

text: Vet

text: App

text: In

text: this

text: regard

text: the

text: Federal

text: Circuit

text: recently

text: held

text: that

text: PTSD

text: is

text: not

text: the

text: type

text: of

text: medical

text: condition

text: that

text: lay

text: evidence

text: is

text: competent

text: and

text: sufficient

text: to

text: identify

text: Young

text: v

text: McDonald

text: F

text: d

text: Fed

text: Cir

text: Regardless

text: the

text: Board

text: acknowledges

text: the

text: Veteran

text: is

text: competent

text: to

text: report

text: psychiatric

text: symptoms

text: both

text: during

text: and

text: after

text: service

text: See

text: C

text: F

text: R

text: a

text: Jandreau

text: F

text: d

text: at

text: discussing

text: that

text: Veteran

text: is

text: competent

text: to

text: report

text: a

text: contemporaneous

text: medical

text: diagnosis

text: Buchanan

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: discussing

text: general

text: competency

text: of

text: a

text: Veteran

text: to

text: report

text: psychiatric

text: symptoms

text: That

text: is

text: lay

text: evidence

text: can

text: also

text: be

text: competent

text: and

text: sufficient

text: evidence

text: of

text: a

text: diagnosis

text: or

text: to

text: establish

text: etiology

text: if

text: the

text: layperson

text: is

text: competent

text: to

text: identify

text: the

text: medical

text: condition

text: the

text: layperson

text: is

text: reporting

text: a

text: contemporaneous

text: medical

text: diagnosis

text: or

text: lay

text: testimony

text: describing

text: symptoms

text: at

text: the

text: time

text: supports

text: a

text: later

text: diagnosis

text: by

text: a

text: medical

text: professional

text: Davidson

text: F

text: d

text: at

text: See

text: also

text: Jandreau

text: F

text: d

text: at

text: In

text: this

text: case

text: the

text: Veteran

text: does

text: not

text: allege

text: that

text: he

text: was

text: in

text: combat

text: Instead

text: the

text: Veteran

text: contends

text: that

text: he

text: has

text: PTSD

text: attributable

text: to

text: his

text: in

text: service

text: physical

text: assault

text: by

text: two

text: Korean

text: civilians

text: in

text: June

text: outside

text: of

text: Camp

text: Casey

text: Korea

text: During

text: the

text: attack

text: the

text: Veteran

text: was

text: struck

text: on

text: the

text: left

text: side

text: of

text: his

text: head

text: and

text: face

text: with

text: an

text: unknown

text: object

text: but

text: described

text: at

text: times

text: as

text: a

text: brick

text: He

text: was

text: knocked

text: unconscious

text: for

text: an

text: unknown

text: period

text: of

text: time

text: but

text: he

text: does

text: remember

text: waking

text: up

text: in

text: an

text: Army

text: medical

text: facility

text: He

text: has

text: inconsistently

text: reported

text: that

text: the

text: attack

text: occurred

text: while

text: he

text: was

text: on

text: guard

text: duty

text: or

text: in

text: the

text: alternative

text: while

text: he

text: was

text: at

text: a

text: nightclub

text: He

text: was

text: transported

text: to

text: MEDEVAC

text: hospital

text: in

text: Camp

text: Casey

text: and

text: then

text: placed

text: in

text: another

text: Army

text: Hospital

text: in

text: Korea

text: STRs

text: only

text: document

text: a

text: fracture

text: of

text: his

text: left

text: zygoma

text: something

text: illegible

text: with

text: his

text: left

text: eye

text: and

text: a

text: fracture

text: of

text: his

text: left

text: maxilla

text: He

text: says

text: he

text: engaged

text: in

text: alcohol

text: and

text: drug

text: abuse

text: while

text: in

text: service

text: subsequent

text: to

text: the

text: assault

text: He

text: also

text: contends

text: that

text: behavioral

text: issues

text: began

text: to

text: arise

text: such

text: that

text: he

text: was

text: eventually

text: reduced

text: in

text: rank

text: and

text: had

text: a

text: change

text: of

text: assignment

text: Post

text: service

text: he

text: became

text: depressed

text: and

text: treated

text: himself

text: by

text: way

text: of

text: drugs

text: and

text: alcohol

text: As

text: a

text: result

text: of

text: this

text: traumatic

text: in

text: service

text: assault

text: the

text: Veteran

text: has

text: claimed

text: that

text: he

text: developed

text: PTSD

text: with

text: depression

text: and

text: polysubstance

text: abuse

text: and

text: at

text: times

text: has

text: been

text: homeless

text: See

text: November

text: stressor

text: statement

text: for

text: PTSD

text: VA

text: Form

text: August

text: stressor

text: statement

text: for

text: PTSD

text: based

text: on

text: assault

text: VA

text: Form

text: a

text: September

text: VA

text: psychiatry

text: note

text: June

text: VA

text: psychological

text: examination

text: January

text: VA

text: History

text: and

text: Physical

text: January

text: Travel

text: Board

text: hearing

text: testimony

text: February

text: VA

text: TBI

text: examination

text: The

text: Veteran

text: s

text: PTSD

text: claim

text: is

text: predicated

text: on

text: an

text: allegation

text: of

text: a

text: physical

text: assault

text: while

text: he

text: was

text: in

text: the

text: military

text: Because

text: personal

text: trauma

text: is

text: an

text: extremely

text: personal

text: and

text: sensitive

text: issue

text: many

text: incidents

text: are

text: not

text: officially

text: reported

text: which

text: creates

text: a

text: proof

text: problem

text: with

text: respect

text: to

text: the

text: occurrence

text: of

text: the

text: claimed

text: stressor

text: In

text: such

text: situations

text: it

text: is

text: not

text: unusual

text: for

text: there

text: to

text: be

text: an

text: absence

text: of

text: service

text: records

text: documenting

text: the

text: events

text: the

text: veteran

text: has

text: alleged

text: The

text: victims

text: of

text: such

text: trauma

text: may

text: not

text: necessarily

text: report

text: the

text: full

text: circumstances

text: of

text: the

text: trauma

text: for

text: many

text: years

text: after

text: the

text: trauma

text: See

text: VA

text: Live

text: Manual

text: M

text: III

text: iv

text: H

text: b

text: Change

text: date

text: March

text: Therefore

text: VA

text: cannot

text: use

text: the

text: absence

text: of

text: service

text: record

text: documentation

text: or

text: lack

text: of

text: report

text: of

text: in

text: service

text: sexual

text: assault

text: or

text: physical

text: assault

text: to

text: military

text: authorities

text: as

text: evidence

text: to

text: conclude

text: that

text: an

text: assault

text: did

text: not

text: occur

text: AZ

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Thus

text: when

text: a

text: PTSD

text: claim

text: is

text: based

text: on

text: in

text: service

text: personal

text: assault

text: evidence

text: from

text: sources

text: other

text: than

text: the

text: veteran

text: s

text: service

text: records

text: may

text: corroborate

text: the

text: veteran

text: s

text: account

text: of

text: the

text: stressor

text: incident

text: C

text: F

text: R

text: f

text: See

text: also

text: Patton

text: v

text: West

text: Vet

text: App

text: It

text: is

text: often

text: necessary

text: to

text: seek

text: alternative

text: evidence

text: that

text: may

text: demonstrate

text: the

text: presence

text: of

text: markers

text: The

text: term

text: marker

text: refers

text: to

text: evidentiary

text: signs

text: events

text: or

text: circumstances

text: indicating

text: a

text: possibility

text: that

text: the

text: claimed

text: stressor

text: occurred

text: such

text: as

text: reports

text: lay

text: statements

text: or

text: behavioral

text: changes

text: that

text: may

text: be

text: associated

text: with

text: the

text: approximate

text: timeframe

text: of

text: the

text: claimed

text: stressor

text: See

text: VA

text: Live

text: Manual

text: M

text: IV

text: ii

text: D

text: m

text: Change

text: date

text: March

text: Examples

text: of

text: such

text: evidence

text: include

text: but

text: are

text: not

text: limited

text: to

text: records

text: from

text: law

text: enforcement

text: authorities

text: rape

text: crisis

text: centers

text: mental

text: health

text: counseling

text: centers

text: hospitals

text: or

text: physicians

text: pregnancy

text: tests

text: or

text: tests

text: for

text: sexually

text: transmitted

text: diseases

text: and

text: statements

text: from

text: family

text: members

text: roommates

text: fellow

text: service

text: members

text: or

text: clergy

text: C

text: F

text: R

text: f

text: Evidence

text: of

text: behavior

text: changes

text: following

text: the

text: claimed

text: assault

text: is

text: another

text: type

text: of

text: relevant

text: evidence

text: that

text: may

text: be

text: found

text: in

text: these

text: sources

text: That

text: is

text: if

text: STRs

text: and

text: SPRs

text: contain

text: no

text: explicit

text: documentation

text: that

text: personal

text: trauma

text: occurred

text: and

text: alternative

text: sources

text: of

text: evidence

text: do

text: not

text: provide

text: credible

text: supporting

text: evidence

text: of

text: personal

text: trauma

text: VA

text: should

text: consider

text: secondary

text: evidence

text: including

text: evidence

text: of

text: behavioral

text: changes

text: around

text: the

text: time

text: of

text: and

text: after

text: the

text: incident

text: s

text: See

text: VA

text: Live

text: Manual

text: M

text: III

text: iv

text: H

text: d

text: Change

text: date

text: March

text: Examples

text: of

text: behavior

text: changes

text: that

text: may

text: constitute

text: credible

text: evidence

text: of

text: the

text: stressor

text: include

text: but

text: are

text: not

text: limited

text: to

text: a

text: request

text: for

text: a

text: transfer

text: to

text: another

text: military

text: duty

text: assignment

text: deterioration

text: in

text: work

text: performance

text: substance

text: abuse

text: episodes

text: of

text: depression

text: panic

text: attacks

text: or

text: anxiety

text: without

text: an

text: identifiable

text: cause

text: or

text: unexplained

text: economic

text: or

text: social

text: behavior

text: changes

text: C

text: F

text: R

text: f

text: Furthermore

text: corroboration

text: of

text: every

text: detail

text: of

text: a

text: claimed

text: stressor

text: including

text: the

text: veteran

text: s

text: personal

text: participation

text: is

text: not

text: required

text: rather

text: a

text: veteran

text: only

text: needs

text: to

text: offer

text: independent

text: evidence

text: of

text: a

text: stressful

text: event

text: that

text: is

text: sufficient

text: to

text: imply

text: his

text: or

text: her

text: personal

text: exposure

text: See

text: Pentecost

text: v

text: Principi

text: Vet

text: App

text: quoting

text: Suozzi

text: v

text: Brown

text: Vet

text: App

text: The

text: Court

text: has

text: set

text: a

text: relatively

text: low

text: bar

text: for

text: interpreting

text: a

text: claim

text: for

text: PTSD

text: as

text: one

text: involving

text: a

text: personal

text: assault

text: stressor

text: for

text: which

text: the

text: provisions

text: of

text: C

text: F

text: R

text: f

text: are

text: applicable

text: See

text: e

text: g

text: Bradford

text: v

text: Nicholson

text: Vet

text: App

text: veteran

text: alleged

text: that

text: his

text: sergeant

text: kicked

text: him

text: down

text: a

text: set

text: of

text: stairs

text: VA

text: itself

text: has

text: defined

text: personal

text: trauma

text: very

text: broadly

text: Personal

text: trauma

text: for

text: the

text: purpose

text: of

text: VA

text: disability

text: compensation

text: claims

text: based

text: on

text: PTSD

text: refers

text: broadly

text: to

text: stressor

text: events

text: involving

text: harm

text: perpetrated

text: by

text: a

text: person

text: who

text: is

text: not

text: considered

text: part

text: of

text: an

text: enemy

text: force

text: Examples

text: include

text: assault

text: battery

text: robbery

text: mugging

text: stalking

text: and

text: harassment

text: Military

text: sexual

text: trauma

text: is

text: a

text: subset

text: of

text: personal

text: trauma

text: and

text: refers

text: to

text: sexual

text: harassment

text: sexual

text: assault

text: or

text: rape

text: that

text: occurs

text: in

text: a

text: military

text: setting

text: See

text: VA

text: Live

text: Manual

text: M

text: IV

text: ii

text: D

text: a

text: Change

text: date

text: March

text: For

text: a

text: PTSD

text: claim

text: based

text: on

text: personal

text: assault

text: an

text: after

text: the

text: fact

text: medical

text: opinion

text: can

text: serve

text: as

text: the

text: credible

text: supporting

text: evidence

text: of

text: the

text: stressor

text: That

text: is

text: VA

text: examiners

text: can

text: interpret

text: the

text: evidence

text: of

text: record

text: to

text: confirm

text: the

text: occurrence

text: of

text: in

text: service

text: physical

text: assault

text: sexual

text: assault

text: or

text: harassment

text: C

text: F

text: R

text: f

text: Menegassi

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Bradford

text: v

text: Nicholson

text: Vet

text: App

text: Patton

text: v

text: West

text: Vet

text: App

text: In

text: fact

text: secondary

text: evidence

text: or

text: behavior

text: change

text: evidence

text: typically

text: needs

text: interpretation

text: by

text: a

text: clinician

text: in

text: personal

text: trauma

text: claims

text: The

text: VA

text: examiner

text: should

text: determine

text: whether

text: credible

text: factual

text: evidence

text: of

text: behavior

text: changes

text: demonstrated

text: by

text: the

text: Veteran

text: is

text: consistent

text: with

text: the

text: expected

text: reaction

text: or

text: adjustment

text: of

text: a

text: person

text: who

text: has

text: been

text: subjected

text: to

text: an

text: assault

text: See

text: VA

text: Live

text: Manual

text: M

text: III

text: iv

text: H

text: f

text: Change

text: date

text: March

text: IV

text: ii

text: D

text: r

text: Change

text: date

text: March

text: Upon

text: review

text: of

text: the

text: evidence

text: of

text: record

text: the

text: Board

text: concludes

text: that

text: the

text: Veteran

text: is

text: entitled

text: to

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: and

text: polysubstance

text: abuse

text: STRs

text: dated

text: from

text: to

text: are

text: negative

text: for

text: any

text: complaint

text: treatment

text: or

text: diagnosis

text: of

text: PTSD

text: or

text: other

text: acquired

text: psychiatric

text: disorder

text: In

text: addition

text: no

text: psychiatric

text: disorder

text: was

text: objectively

text: found

text: at

text: the

text: Veteran

text: s

text: May

text: separation

text: examination

text: and

text: the

text: Veteran

text: denied

text: a

text: history

text: of

text: insomnia

text: depression

text: excessive

text: worry

text: or

text: nervous

text: trouble

text: In

text: any

text: event

text: as

text: to

text: PTSD

text: an

text: in

text: service

text: diagnosis

text: is

text: not

text: required

text: See

text: C

text: F

text: R

text: f

text: SPRs

text: document

text: that

text: the

text: Veteran

text: s

text: military

text: occupational

text: specialty

text: MOS

text: was

text: a

text: physical

text: activities

text: specialist

text: He

text: served

text: in

text: Korea

text: from

text: August

text: to

text: September

text: A

text: June

text: SPR

text: personnel

text: action

text: reclassification

text: board

text: several

text: weeks

text: after

text: his

text: June

text: TBI

text: occurred

text: noted

text: that

text: the

text: Veteran

text: had

text: been

text: counseled

text: for

text: the

text: past

text: three

text: months

text: on

text: his

text: completely

text: disinterested

text: attitude

text: towards

text: his

text: military

text: duties

text: The

text: counseling

text: had

text: a

text: completely

text: negative

text: result

text: He

text: was

text: noted

text: to

text: be

text: three

text: months

text: behind

text: in

text: filing

text: and

text: posting

text: of

text: orders

text: and

text: correspondence

text: to

text: the

text: personnel

text: records

text: He

text: was

text: recommended

text: for

text: reduction

text: in

text: rank

text: for

text: inefficiency

text: He

text: had

text: the

text: lowest

text: academic

text: standing

text: of

text: all

text: students

text: He

text: was

text: separated

text: from

text: service

text: in

text: April

text: Upon

text: review

text: there

text: is

text: evidence

text: of

text: record

text: corroborating

text: that

text: the

text: early

text: June

text: in

text: service

text: physical

text: assault

text: and

text: TBI

text: occurred

text: C

text: F

text: R

text: f

text: Cohen

text: Vet

text: App

text: at

text: Moreau

text: Vet

text: App

text: at

text: Specifically

text: the

text: RO

text: has

text: already

text: service

text: connected

text: the

text: Veteran

text: for

text: the

text: underling

text: TBI

text: with

text: various

text: residuals

text: to

text: include

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: a

text: left

text: cheek

text: scar

text: and

text: tension

text: headaches

text: with

text: loss

text: of

text: balance

text: dizziness

text: and

text: fatigue

text: among

text: other

text: TBI

text: residuals

text: In

text: addition

text: a

text: February

text: photo

text: of

text: the

text: Veteran

text: s

text: face

text: clearly

text: shows

text: significant

text: indentation

text: and

text: injury

text: to

text: the

text: left

text: side

text: of

text: face

text: which

text: is

text: grossly

text: distorted

text: with

text: elevation

text: and

text: depression

text: The

text: undersigned

text: Veterans

text: Law

text: Judge

text: also

text: remarked

text: upon

text: this

text: fact

text: during

text: the

text: Veteran

text: s

text: January

text: hearing

text: testimony

text: Thus

text: the

text: Veteran

text: has

text: already

text: been

text: service

text: connected

text: by

text: VA

text: for

text: the

text: in

text: service

text: TBI

text: with

text: various

text: residuals

text: The

text: evidence

text: of

text: deterioration

text: in

text: work

text: performance

text: is

text: not

text: fully

text: clear

text: because

text: it

text: appears

text: his

text: work

text: performance

text: problems

text: preceded

text: his

text: in

text: service

text: TBI

text: by

text: several

text: months

text: In

text: any

text: event

text: for

text: corroboration

text: in

text: assault

text: cases

text: what

text: is

text: required

text: is

text: that

text: sufficient

text: circumstantial

text: evidence

text: exists

text: that

text: the

text: alleged

text: assault

text: may

text: have

text: a

text: basis

text: in

text: fact

text: The

text: Board

text: emphasizes

text: that

text: a

text: stressor

text: need

text: not

text: be

text: corroborated

text: in

text: every

text: detail

text: Pentecost

text: Vet

text: App

text: at

text: In

text: the

text: present

text: case

text: corroborative

text: evidence

text: of

text: the

text: alleged

text: in

text: service

text: physical

text: assault

text: in

text: June

text: is

text: circumstantial

text: in

text: nature

text: not

text: definitive

text: in

text: nature

text: However

text: again

text: the

text: in

text: service

text: TBI

text: was

text: service

text: connected

text: by

text: the

text: RO

text: in

text: a

text: recent

text: February

text: rating

text: decision

text: In

text: addition

text: as

text: discussed

text: below

text: multiple

text: VA

text: psychiatrists

text: have

text: concluded

text: that

text: the

text: Veteran

text: s

text: in

text: service

text: assault

text: did

text: occur

text: With

text: respect

text: to

text: the

text: criteria

text: of

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: the

text: threshold

text: consideration

text: for

text: any

text: service

text: connection

text: claim

text: is

text: the

text: existence

text: of

text: a

text: current

text: disability

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Boyer

text: F

text: d

text: at

text: Brammer

text: Vet

text: App

text: at

text: In

text: particular

text: aside

text: from

text: corroboration

text: of

text: an

text: in

text: service

text: stressor

text: current

text: medical

text: evidence

text: diagnosing

text: PTSD

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: i

text: e

text: DSM

text: is

text: required

text: as

text: well

text: as

text: competent

text: evidence

text: of

text: a

text: nexus

text: between

text: current

text: PTSD

text: symptomatology

text: and

text: his

text: verified

text: in

text: service

text: stressor

text: C

text: F

text: R

text: f

text: See

text: also

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: However

text: again

text: medical

text: opinions

text: in

text: cases

text: of

text: personal

text: assault

text: for

text: PTSD

text: are

text: exceptions

text: to

text: the

text: general

text: rule

text: as

text: for

text: example

text: announced

text: in

text: Moreau

text: v

text: Brown

text: Vet

text: App

text: that

text: an

text: opinion

text: by

text: a

text: medical

text: professional

text: based

text: on

text: a

text: post

text: service

text: examination

text: cannot

text: be

text: used

text: to

text: establish

text: the

text: occurrence

text: of

text: a

text: stressor

text: C

text: F

text: R

text: f

text: Patton

text: v

text: West

text: Vet

text: App

text: For

text: assault

text: stressors

text: the

text: examiner

text: can

text: interpret

text: the

text: meaning

text: of

text: behavioral

text: changes

text: during

text: service

text: to

text: determine

text: if

text: an

text: assault

text: stressor

text: did

text: occur

text: Id

text: In

text: the

text: present

text: case

text: VA

text: psychiatric

text: treatment

text: records

text: dated

text: from

text: to

text: have

text: rendered

text: a

text: current

text: diagnosis

text: of

text: PTSD

text: This

text: is

text: not

text: in

text: dispute

text: But

text: more

text: importantly

text: with

text: regard

text: to

text: a

text: nexus

text: VA

text: medical

text: opinions

text: of

text: record

text: assessed

text: that

text: a

text: personal

text: assault

text: accompanied

text: by

text: a

text: TBI

text: did

text: occur

text: in

text: June

text: in

text: addition

text: to

text: concluding

text: that

text: a

text: diagnosis

text: of

text: PTSD

text: due

text: to

text: the

text: credible

text: June

text: personal

text: assault

text: was

text: proper

text: C

text: F

text: R

text: f

text: In

text: particular

text: the

text: record

text: reflects

text: several

text: favorable

text: VA

text: medical

text: opinions

text: and

text: treatment

text: records

text: from

text: VA

text: psychiatrists

text: dated

text: from

text: to

text: The

text: Board

text: has

text: reviewed

text: VA

text: psychiatry

text: notes

text: and

text: VA

text: history

text: and

text: physicals

text: dated

text: in

text: September

text: January

text: December

text: and

text: August

text: from

text: the

text: same

text: VA

text: psychiatrist

text: who

text: was

text: familiar

text: with

text: the

text: Veteran

text: due

text: to

text: repeated

text: treatment

text: This

text: VA

text: psychiatrist

text: opined

text: that

text: the

text: Veteran

text: had

text: PTSD

text: more

text: likely

text: than

text: not

text: to

text: be

text: the

text: direct

text: result

text: of

text: the

text: attack

text: on

text: him

text: during

text: service

text: in

text: Korea

text: Several

text: of

text: the

text: latter

text: opinions

text: considered

text: the

text: DSM

text: This

text: VA

text: psychiatrist

text: repeatedly

text: discussed

text: details

text: of

text: the

text: TBI

text: incident

text: in

text: Korea

text: and

text: repeatedly

text: discussed

text: the

text: Veteran

text: s

text: PTSD

text: symptoms

text: In

text: a

text: January

text: opinion

text: the

text: same

text: VA

text: psychiatrist

text: when

text: advised

text: by

text: VA

text: of

text: inconsistent

text: descriptions

text: of

text: the

text: in

text: service

text: TBI

text: by

text: the

text: Veteran

text: nonetheless

text: opined

text: that

text: she

text: was

text: convinced

text: that

text: the

text: injury

text: was

text: done

text: by

text: a

text: brick

text: thrown

text: at

text: him

text: was

text: done

text: by

text: a

text: Korean

text: and

text: that

text: everything

text: is

text: as

text: I

text: had

text: opined

text: in

text: all

text: my

text: documentation

text: on

text: this

text: patient

text: The

text: VA

text: examiner

text: also

text: described

text: the

text: Veteran

text: as

text: highly

text: credible

text: In

text: addition

text: a

text: different

text: May

text: VA

text: psychiatrist

text: came

text: to

text: the

text: same

text: favorable

text: conclusion

text: as

text: to

text: PTSD

text: Also

text: the

text: Veteran

text: underwent

text: positive

text: PTSD

text: screens

text: in

text: August

text: November

text: December

text: September

text: July

text: October

text: and

text: October

text: These

text: PTSD

text: screens

text: revealed

text: positive

text: symptomatology

text: such

text: as

text: nightmares

text: avoidance

text: numbness

text: detachment

text: and

text: hypervigilance

text: They

text: were

text: also

text: often

text: accompanied

text: by

text: positive

text: depression

text: screens

text: Moreover

text: in

text: July

text: a

text: VA

text: nurse

text: practitioner

text: opinion

text: stated

text: that

text: both

text: VA

text: primary

text: care

text: and

text: VA

text: psychiatry

text: suggest

text: that

text: the

text: Veteran

text: s

text: PTSD

text: could

text: be

text: related

text: to

text: the

text: head

text: trauma

text: he

text: received

text: while

text: in

text: the

text: Army

text: in

text: Korea

text: Finally

text: VA

text: Vet

text: Center

text: counseling

text: records

text: dated

text: from

text: to

text: assessed

text: the

text: Veteran

text: with

text: multiple

text: symptoms

text: consistent

text: with

text: the

text: diagnosis

text: of

text: PTSD

text: based

text: on

text: the

text: in

text: service

text: assault

text: in

text: Korea

text: Pursuant

text: to

text: C

text: F

text: R

text: a

text: if

text: the

text: diagnosis

text: of

text: a

text: mental

text: disorder

text: does

text: not

text: conform

text: to

text: DSM

text: IV

text: DSM

text: or

text: is

text: not

text: supported

text: by

text: the

text: findings

text: on

text: the

text: examination

text: report

text: the

text: rating

text: agency

text: shall

text: return

text: the

text: report

text: to

text: the

text: examiner

text: to

text: substantiate

text: the

text: diagnosis

text: Mental

text: health

text: professionals

text: are

text: experts

text: and

text: are

text: presumed

text: to

text: know

text: the

text: DSM

text: requirements

text: applicable

text: to

text: their

text: practice

text: and

text: to

text: have

text: taken

text: them

text: into

text: account

text: in

text: providing

text: a

text: PTSD

text: diagnosis

text: As

text: such

text: the

text: Court

text: has

text: held

text: that

text: a

text: PTSD

text: diagnosis

text: provided

text: by

text: a

text: mental

text: health

text: professional

text: must

text: be

text: presumed

text: to

text: have

text: been

text: made

text: in

text: accordance

text: with

text: the

text: applicable

text: DSM

text: IV

text: or

text: DSM

text: criteria

text: as

text: to

text: both

text: the

text: adequacy

text: of

text: the

text: symptomatology

text: and

text: the

text: sufficiency

text: of

text: the

text: stressor

text: unless

text: there

text: is

text: evidence

text: to

text: the

text: contrary

text: Cohen

text: v

text: Brown

text: Vet

text: App

text: The

text: DSM

text: IV

text: or

text: DSM

text: cannot

text: be

text: used

text: as

text: a

text: basis

text: for

text: rejecting

text: the

text: Veteran

text: s

text: favorable

text: medical

text: evidence

text: as

text: to

text: the

text: sufficiency

text: of

text: a

text: stressor

text: or

text: the

text: adequacy

text: of

text: the

text: Veteran

text: s

text: symptomatology

text: Id

text: As

text: such

text: in

text: order

text: to

text: make

text: a

text: finding

text: that

text: the

text: Veteran

text: in

text: this

text: case

text: did

text: not

text: have

text: a

text: valid

text: PTSD

text: diagnosis

text: the

text: Board

text: must

text: clearly

text: articulate

text: its

text: reasons

text: for

text: finding

text: that

text: the

text: PTSD

text: diagnosis

text: was

text: not

text: made

text: in

text: accordance

text: with

text: the

text: DSM

text: IV

text: or

text: DSM

text: requirements

text: If

text: the

text: Board

text: cannot

text: support

text: a

text: conclusion

text: that

text: the

text: diagnosis

text: was

text: not

text: made

text: in

text: accordance

text: with

text: DSM

text: IV

text: or

text: DSM

text: requirements

text: it

text: must

text: accept

text: the

text: diagnosis

text: as

text: valid

text: In

text: the

text: present

text: case

text: the

text: Board

text: will

text: therefore

text: accept

text: the

text: above

text: PTSD

text: diagnoses

text: rendered

text: by

text: VA

text: medical

text: professionals

text: as

text: valid

text: and

text: in

text: accordance

text: with

text: the

text: DSM

text: IV

text: and

text: DSM

text: In

text: any

text: event

text: the

text: VA

text: psychiatrists

text: of

text: record

text: described

text: the

text: reasons

text: for

text: their

text: conclusions

text: and

text: also

text: discussed

text: the

text: Veteran

text: s

text: underlying

text: PTSD

text: symptomatology

text: Overall

text: the

text: above

text: VA

text: psychiatry

text: notes

text: and

text: opinions

text: were

text: thorough

text: supported

text: by

text: explanations

text: and

text: considered

text: the

text: Veteran

text: s

text: history

text: and

text: relevant

text: longitudinal

text: complaints

text: In

text: short

text: there

text: is

text: probative

text: evidence

text: in

text: support

text: of

text: the

text: PTSD

text: claim

text: The

text: Board

text: emphasizes

text: that

text: VA

text: may

text: not

text: order

text: additional

text: development

text: for

text: the

text: sole

text: purpose

text: of

text: obtaining

text: evidence

text: unfavorable

text: to

text: a

text: claimant

text: Mariano

text: v

text: Principi

text: Vet

text: App

text: The

text: Board

text: acknowledges

text: that

text: some

text: unfavorable

text: evidence

text: of

text: record

text: with

text: respect

text: to

text: the

text: Veteran

text: s

text: PTSD

text: exists

text: Specifically

text: a

text: VA

text: psychological

text: examiner

text: in

text: July

text: and

text: August

text: the

text: same

text: VA

text: examiner

text: after

text: a

text: mental

text: health

text: examination

text: of

text: the

text: Veteran

text: and

text: a

text: review

text: of

text: the

text: evidence

text: of

text: record

text: opined

text: that

text: the

text: Veteran

text: did

text: not

text: meet

text: any

text: of

text: the

text: DSM

text: IV

text: criteria

text: for

text: PTSD

text: However

text: the

text: underlying

text: premise

text: of

text: this

text: opinion

text: is

text: flawed

text: The

text: VA

text: examiner

text: determined

text: that

text: the

text: in

text: service

text: June

text: TBI

text: never

text: took

text: place

text: But

text: subsequently

text: the

text: RO

text: determined

text: that

text: it

text: did

text: in

text: fact

text: take

text: place

text: based

text: on

text: the

text: findings

text: of

text: a

text: later

text: February

text: VA

text: TBI

text: examiner

text: At

text: that

text: point

text: the

text: RO

text: in

text: a

text: February

text: rating

text: decision

text: service

text: connected

text: the

text: Veteran

text: for

text: the

text: underlying

text: incident

text: in

text: question

text: and

text: awarded

text: the

text: Veteran

text: service

text: connected

text: compensation

text: for

text: various

text: residuals

text: of

text: his

text: in

text: service

text: TBI

text: from

text: the

text: assault

text: The

text: Court

text: has

text: held

text: on

text: a

text: number

text: of

text: occasions

text: that

text: a

text: medical

text: opinion

text: premised

text: upon

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text: inaccurate

text: factual

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text: Thus

text: the

text: unfavorable

text: VA

text: psychological

text: examination

text: reports

text: dated

text: in

text: July

text: and

text: August

text: are

text: entitled

text: to

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text: limited

text: probative

text: value

text: against

text: the

text: claim

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text: the

text: law

text: and

text: the

text: medical

text: evidence

text: of

text: record

text: the

text: Board

text: is

text: compelled

text: to

text: grant

text: the

text: Veteran

text: the

text: benefit

text: of

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text: doubt

text: and

text: allow

text: service

text: connection

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text: PTSD

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text: Veteran

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text: PTSD

text: claim

text: raised

text: the

text: issue

text: of

text: whether

text: service

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text: is

text: warranted

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text: any

text: other

text: acquired

text: psychiatric

text: disorder

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text: PTSD

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text: Clemons

text: v

text: Shinseki

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text: holding

text: that

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text: scope

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text: mental

text: health

text: disability

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text: any

text: mental

text: disability

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text: may

text: reasonably

text: be

text: encompassed

text: by

text: the

text: claimant

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text: description

text: of

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text: claim

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text: symptoms

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text: the

text: other

text: information

text: of

text: record

text: In

text: this

text: regard

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text: record

text: also

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text: the

text: Veteran

text: has

text: depression

text: NOS

text: and

text: polysubstance

text: abuse

text: disorder

text: as

text: secondary

text: to

text: his

text: service

text: connected

text: PTSD

text: and

text: his

text: service

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text: TBI

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text: C

text: F

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text: Specifically

text: in

text: August

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text: May

text: VA

text: psychiatric

text: notes

text: it

text: was

text: mentioned

text: that

text: the

text: Veteran

text: began

text: to

text: use

text: alcohol

text: and

text: drugs

text: to

text: deal

text: with

text: his

text: physical

text: TBI

text: pain

text: after

text: he

text: left

text: service

text: The

text: Board

text: has

text: also

text: reviewed

text: VA

text: psychiatry

text: notes

text: and

text: history

text: and

text: physicals

text: dated

text: in

text: September

text: January

text: December

text: and

text: August

text: from

text: the

text: same

text: VA

text: psychiatrist

text: who

text: was

text: familiar

text: with

text: the

text: Veteran

text: due

text: to

text: repeated

text: treatment

text: Psychiatric

text: testing

text: revealed

text: moderate

text: depression

text: This

text: VA

text: psychiatrist

text: opined

text: that

text: the

text: Veteran

text: had

text: a

text: TBI

text: based

text: pain

text: disorder

text: with

text: psychological

text: factors

text: and

text: that

text: his

text: drug

text: and

text: alcohol

text: addiction

text: was

text: the

text: result

text: of

text: his

text: in

text: service

text: TBI

text: In

text: September

text: the

text: VA

text: psychiatrist

text: remarked

text: that

text: chemical

text: dependency

text: was

text: his

text: way

text: of

text: self

text: medicating

text: for

text: the

text: pain

text: and

text: PTSD

text: In

text: any

text: event

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text: present

text: decision

text: is

text: considered

text: a

text: full

text: grant

text: of

text: the

text: benefits

text: sought

text: by

text: the

text: Veteran

text: for

text: his

text: acquired

text: psychiatric

text: disorder

text: claim

text: to

text: include

text: PTSD

text: In

text: granting

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: and

text: polysubstance

text: abuse

text: the

text: RO

text: should

text: assign

text: a

text: disability

text: rating

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text: ratings

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text: symptoms

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text: v

text: Shinseki

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text: diagnoses

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text: purposes

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text: they

text: have

text: overlapping

text: symptomatology

text: but

text: bipolar

text: disorder

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text: PTSD

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text: have

text: different

text: symptoms

text: and

text: it

text: could

text: therefore

text: be

text: improper

text: in

text: some

text: circumstances

text: for

text: VA

text: to

text: treat

text: these

text: separately

text: diagnosed

text: conditions

text: as

text: producing

text: only

text: the

text: same

text: disability

text: ORDER

text: Service

text: connection

text: for

text: left

text: face

text: nerve

text: damage

text: to

text: include

text: as

text: secondary

text: to

text: a

text: service

text: connected

text: TBI

text: with

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: is

text: denied

text: Service

text: connection

text: for

text: a

text: bilateral

text: eye

text: disability

text: claimed

text: as

text: blurred

text: vision

text: to

text: include

text: as

text: secondary

text: to

text: a

text: service

text: connected

text: TBI

text: with

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: is

text: denied

text: Subject

text: to

text: the

text: provisions

text: governing

text: the

text: award

text: of

text: monetary

text: benefits

text: service

text: connection

text: for

text: left

text: eye

text: blindness

text: with

text: loss

text: of

text: visual

text: acuity

text: as

text: secondary

text: to

text: a

text: service

text: connected

text: TBI

text: with

text: a

text: fracture

text: of

text: the

text: left

text: zygoma

text: is

text: granted

text: Subject

text: to

text: the

text: provisions

text: governing

text: the

text: award

text: of

text: monetary

text: benefits

text: service

text: connection

text: for

text: PTSD

text: with

text: depression

text: and

text: polysubstance

text: abuse

text: is

text: granted

text: DAVID

text: L

text: WIGHT

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs