Entitlement to service connection for left eye cataract is denied.

Citation Nr: A26069958 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 220427-239098 DATE: July 30, 2026 ORDER Entitlement to service connection for left eye cataract is denied. Entitlement to service connection for herpes is denied. Entitlement to an increased initial disability rating in excess of 50 percent for PTSD with polysubstance use disorder, in remission, from March 9, 2020 to December 11, 2020, is denied. FINDINGS OF FACT 1. The Veteran's left eye cataract did not begin during service or within a year of discharge; and, the persuasive weight of the evidence is against a nexus between the Veteran's left eye cataract and active military service. 2. The evidence of record persuasively weighs against a finding that the Veteran has had a current herpes disability at any time during or approximate to the pendency of the appeal. 3. For the entire period on appeal, the severity, frequency, and duration of the Veteran's PTSD symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas or total social and occupational impairment. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left eye cataract are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3. 2. The criteria for service connection for herpes have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.310, 4.3. 3. The criteria for a rating in excess of 50 percent for persistent depressive disorder with generalized anxiety disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1974 to September 1976. The present appeal comes to the Board of Veterans' Appeal (Board) following a July 2021 Higher-Level Review rating decision. The Veteran appealed that decision by filing a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)) in April 2022. She elected the Hearing docket. The Veteran testified before a Veterans Law Judge on October 23, 2025. A transcript of the hearing is included in the claims file. As a result of the Veteran's docket election, the Board may only consider the evidence of record at the time of the December 2020 initial rating decision on appeal as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing (i.e., January 21, 2026). 38 C.F.R. § 20.302(a). Evidence of record specifically identified by the Veteran in her October 23, 2025 hearing is likewise considered "submitted" during the evidence submission window. See Cash v. Collins, 166 F.4th 1046 (Fed. Cir. 2026). If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board recognizes that entitlement to an increased rating for PTSD was not explicitly listed on the April 2022 NOD. However, the Veteran's statement that the "evaluated rating is not fitting for length of and time related to" indicates that the Veteran disagreed with a disability rating assigned in the July 2021 rating decision. The sole rating issue adjudicated in the July 2021 rating decision was the initial evaluation of PTSD. Thus, the Board interprets the April 2022 NOD as a continued appeal of the initial disability rating of 50 percent for service-connected PTSD in addition to entitlement to service connection for cataracts and herpes. Lastly, the Board would like to address a procedural matter relevant to the rating period of the current appeal. After the Veteran's appeal was docketed, but prior the Board's decision, the Veteran was awarded a temporary increased 100 percent evaluation for PTSD from December 14, 2021 to April 31, 2022, a 70 percent disability rating from March 1, 2022, and a total disability rating for compensation purposes due to individual unemployability (TDIU) from January 6, 2022 in a December 2022 rating decision. This rating increase arose from the Veteran's submission of a VA 21-8940 Veterans Application for Increased Compensation Based on Unemployability on July 19, 2021. The Veteran's application for TDIU and the subsequent rating increased occurred outside of the permitted evidentiary review window for the current appeal, and the Board does not have any appellate purview over this decision. 38 U.S.C. § 7105. Instead, the Board is limited to considering the Veteran's PTSD symptoms during the rating period on appeal which is from March 9, 2020 (the date of the Veteran's initial claim for entitlement to service connection for a psychiatric disorder, to include PTSD) and December 11, 2010 (the date she was notified of the rating decision prior to the July 2021 Higher-Level Review rating decision on appeal). The issue on appeal is framed without consideration of the additional grant contained in the December 2022 rating decision. Yet, the Board's instant decision will not disturb the favorable grant of benefits in the spurious rating decision. SERVICE CONNECTION Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38?U.S.C. §§?1110, 5107; 38?C.F.R. §?3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38?C.F.R. §?3.303(d). Service connection may also be granted on a secondary basis for a disability which is due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2021) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. The threshold for finding a link between current disability and service, for the purpose of determining whether an examination is warranted, is low. See Locklear v. Nicholson, 20 Vet. App. 410 (2006); see also McLendon, 20 Vet. App. at 83. VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively weighs against the claim(s) of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim(s) will be denied on the merits. 38 U.S.C. § 5107; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for left eye cataract. The Veteran seeks service connection for left eye cataract. She initially provided no evidence or argument as why she believed her left eye cataract was related to her active service. However, more recently, she indicated that she has been unable to see out of her left eye since cataract surgery at a VA medical center in 2018. See October 2025 Hearing Transcript. In the December 2020 rating decision, the AOJ found that the evidence shows the Veteran was diagnosed with bilateral cataracts in April 2018. See Rating Decision - Narrative. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). The first Shedden element, a current disability, is met. Turning to the second Shedden element, service treatment records (STRs) lack any evidence of complaints of, treatment for, or a diagnosis of an injury or complication with the left eye or vision disorder. At the time-of-service discharge, the Veteran's visual acuity, fraction, pupil equality and reaction, and ocular motility were found to be normal. See March 1977 STR - Dental. The Veteran does not contend otherwise. During the October 2025 Board hearing, the Veteran testified that she did not injure her eyes while in service nor did she believe that any event from her military service was related to, or caused, her cataracts. The second Shedden element is not met. The Board recognizes that the Veteran has not been afforded a VA examination to address her cataract claim. VA's duty to provide an examination is not limitless and is only triggered when there is some indication of a link between a veteran's claimed disability and active military service. 38 C.F.R. § 3.159(c)(4); see also McLendon. Although McLendon sets a low bar, that bar is not met here. While the record establishes a diagnosis of left eye cataract, there is no indication that the Veteran's cataract is related to an event, injury, or disease suffered during active military service. The Veteran does not contend otherwise. Thus, the record does not include the evidence needed to require an examination under McLendon. Therefore, the Board finds the weight of the evidence is against the Veteran's claim for entitlement to service connection for cataracts, and the remaining element, a nexus, for establishing service connection need not be addressed. The benefit-of-the-doubt doctrine is not applicable here, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch. The Board acknowledges that the Veteran's testimony expressing her belief her left eye vision disabilities are related to treatment by VA providers. This raises the question of whether the Veteran intended to claim entitlement to compensation for left eye cataracts, or another left eye disability, under 38 U.S.C. § 1151. Under 38 U.S.C. § 1151, compensation shall be awarded for qualifying claimants who suffer additional disability or death caused by hospital care, medical or surgical treatment, or examination furnished under any law administered by VA. Such an argument is separate and distinct from the raised and appealed issue of service connection. This argument was also not raised until the October 2025 Board hearing. Even the most sympathetic reading of the Veteran's claim prior to the December 2020 rating decision does not indicate that the Veteran intended to raise a claim under 38 U.S.C. § 1151. Consequently, a remand is not warranted as there is no pre-decisional duty to assist error. Ultimately, as the AOJ has not adjudicated the 38 U.S.C. § 1151 issue asserted during the Board hearing in the first instance, the Board will not comment on that argument. If the Veteran wishes to pursue such a claim under a theory that she suffered additional disability due to VA medical treatment as a result of negligence, she remains free to do so by filing a new claim specifically asserting this argument. 2. Entitlement to service connection for herpes. The Veteran seeks service connection for herpes. She contends that she contracted herpes as a result of military sexual assault (MST). See March 2020 VA 21-526EZ, Fully Developed Claim (Compensation). The Board must first address the cornerstone element of every VA compensation claim - a current disability. See Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or proximate thereto. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). The Veteran was seen for herpes in 1976. See March 1977 STR - Medical. However, there is no evidence that the Veteran's herpes occurred after service and/or continued from 1976. The Veteran does not contend otherwise. During her Board hearing, she testified that she does not currently have a herpes diagnosis and has not had a herpes diagnosis since military service. Such is consistent with her medical treatment records associated with the claims file. In March 2001, her Lyons VAMC treatment records note one occurrence of herpes during her military service. See December 2022 CAPRI. The Board recognizes that the Veteran has not been afforded a VA examination to address her herpes claim. However, the bar for a VA examination under McLendon is not met. The record does not document a diagnosis of herpes and the Veteran has not provided any evidence or indication of a herpes diagnosis or recurrent symptoms of herpes at the time of filing her claim or proximate thereto. Thus, the record does not include the evidence needed to require an examination under McLendon. Therefore, the Board finds the weight of the evidence is against the Veteran's claim for entitlement to service connection for herpes, and the remaining element, a nexus, for establishing service connection need not be addressed. The benefit-of-the-doubt doctrine is not applicable here, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch. 3. Entitlement to an increased initial disability rating in excess of 50 percent for PTSD with polysubstance use disorder, in remission. The Veteran seeks a disability rating in excess of 50 percent for PTSD. Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. The VA's Rating Schedule determines a veteran's disability rating. 38 C.F.R. Part 4. As far as can be practicably determined, the percentage ratings contained in the Ratings Schedule represent the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA law provides that under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. See Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). "[T]he presence or lack of evidence of a specific sign or symptom listed in the evaluation criteria is not necessarily dispositive of any particular disability level." Id. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. 38 C.F.R. § 4.126; see also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). During the relevant period on appeal, the Veteran's PTSD is rated at 50 percent disabling under the General Formula. A 50 percent rating is assigned with an occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned with an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to symptoms to such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships. A 100 percent rating is assigned with a total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. When rating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and a veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The evidence overall does not demonstrate the level of impairment associated with a 70 percent rating. The majority of the Veteran's symptoms were either contemplated by or more consistent with a 50 percent rating under the General Formula. The Veteran underwent a VA examination in December 2020. The VA examiner opined that the Veteran's PTSD causes occupational and social impairment with reduced reliability and productivity due to intrusive memories of her MST, anxiety (without panic attacks), depressed mood, disturbances in motivation and mood, difficulty adapting to stressful circumstances, hypervigilance with suspiciousness, exaggerated startle response, difficulty trusting and connecting to others (especially men), chronic sleep impairment, avoidant tendencies, and emotional numbing. See December 2020 C&P Exam. She denied suicidal or homicidal intent. She reported that she has very supportive relationships with her children and sisters. In fact, at the time of the examination, the Veteran was living in transitional housing and would visit her sisters when she had authorization to do so. At the December 2025 Board hearing, the Veteran testified that during the period on appeal she experienced frequent periods of depression and some anxiety. She clarified that she felt her depression was more prevalent than her anxiety. She continued to deny panic attacks. She testified that she laid in bed a lot, was not focused on things she should be, and isolated from others. She explained that she struggled to have successful relationships because of her unaddressed trust issues that she held in for many years. However, she stated that such symptoms did not have too much of an impact on her daily life and she did not lose any relationships due to her PTSD symptoms. While she endorsed wanting to stay away from others, she continued to see her siblings frequently. She added that she does not like to be in big crowds and tends to lose her train of thought. She denied impulsivity, inappropriate behavior, angry outbursts, disorientation, and suicidal intent. In regard to employment, the Veteran testified that she was retired during the period on appeal. She added that when she did work, she masked her PTSD symptoms and found ways to maintain employment in order to provide for her children as a single parent. She continued to go to work even though she was depressed, and her PTSD symptoms did not impact her relationships with coworkers or customers. The findings of the December 2020 VA examination and the Veteran's testimony at the Board hearing are consistent with the Veteran's VAMC treatment records during the period on appeal. During the period on appeal, the Veteran underwent mental health and continued substance abuse remission treatment at East Orange, Bath, and Lyons VAMC. See November 2020 CAPRI; November 2020 CAPRI; December 2020 CAPRI; December 2022 CAPRI. The Veteran continued to report social isolation, hypervigilance, difficulty trusting others, and some intrusive memories. However, such symptoms did not reach the level of severity, frequency, or duration of those contemplated by a 70 percent rating. For instance, while the Veteran experienced socially isolative tendencies, the Veteran attended several social activities with peers and family throughout the period on appeal. She went to movies with peers and shared that she felt good after going even though she felt an urge to decline the invite. She also consistently attended group therapy virtually up to three times a week and reported that she benefitted from the relationships gained from those sessions. While she did not immediately trust her VAMC sponsor, she noted that she began to trust and open up to her sponsor. Even though she felt additional stress when she was looking for an apartment or experienced flare-ups of physical pain, she was able to address these feelings with effective coping skills which improved her mood and prevented near-continuous, long periods of depression. Indeed, in November 2020, she stated that "she is able to get herself out of that mood rather quickly." The Board acknowledges that the Veteran is also diagnosed with poly-substance use disorder as related to her PTSD. However, as her diagnosis indicates, her substance abuse disorder was in remission during the period relevant to the current appeal (from March 2020 to December 2021). The Veteran reported that she had maintained sobriety for one year from December 2020. Such is consistent with her VAMC records. Therefore, any additional symptoms or aggravated symptoms indicated to be present while her substance abuse disorder was not in remission are not applicable to the period on appeal. Consideration has been given to the Veteran's statement that she takes medication and attends weekly sessions with her psychiatric provider for PTSD and experiences added stress due to a constant fear of having a herpes outbreak during the Higher-Level Review Informal Conference. See July 2021 HLR - Informal Conference. In regard to her weekly sessions with her psychiatric provider, the Board has already noted that such sessions have improved her PTSD symptoms and show her improved social impairment as she established trust with her sponsor and peers at group therapy sessions. Similarly, the Board noted that the Veteran exhibits the ability to implement coping skills when she experiences stress, such as fear of a herpes disability, which prevent her from experiencing continuous or long-term depression similar to that contemplated by an increased 70 percent rating. The Veteran argues that she is entitled to an increased rating based on her use of psychiatric medication. The ameliorative effects, or improvement of symptoms, from medication when assigning a disability rating are not to be considered when the ameliorative effects of medication are not explicitly contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56 (2012). However, the General Formula for which the Veteran's PTSD is rated explicitly contemplates the effects of medication. The General Formula provides that a noncompensable disability rating is warranted when symptoms of a mental disorder do not require continuous medication for control, and a 10 percent disability rating is warranted when symptoms are controlled by continuous medication (emphasis added). By implication, the General Formula provides for higher disability ratings when psychiatric symptoms of greater severity are not controlled by continuous medication. Thus, the Board is directed to consider the ameliorative effects of medication in determining the appropriate disability rating. Stated otherwise, in determining the appropriate disability rating under the General Formula, the Board considers the severity, frequency, and duration of a veteran's symptoms caused by a mental, or psychological, disorder with the use of medication during the relevant period on appeal. Based on the foregoing, the Board finds that the Veteran's PTSD symptoms are most consistent with those contemplated by a 50 percent disability rating. The evidence persuasively weighs against a finding that the Veteran has shown deficiencies in most areas to warrant an increased 70 percent disability rating. She does not seem to be deficient in areas of family relations, judgement, thinking, or mood due to her PTSD. Additionally, even though she was not employed during the period on appeal, the Veteran consistently attended individual group and individual therapy sessions with adequate notice and good cause for her (very minimal) absences. The Board finds such evidence shows a level of independent and reliable functioning comparable to areas such as work or school. Even though the Veteran's PTSD manifests in some rituals, depression, and difficulty adapting to stressful circumstances as contemplated by a higher rating, the severity, frequency, and duration of such symptoms do not meet that of a higher disability rating for the reasons laid out above. It therefore follows that such symptoms also do not meet the more severe rating criteria of total occupational and social impairment for an increased 100 percent disability rating for the appeal period. Significantly, the Veteran has not shown the required severity of occupational and social impairment necessary for an increased 70 or 100 percent disability rating during the period on appeal, and her PTSD symptoms as a whole are not of similar severity, frequency, and duration as those particular symptoms associated with an increased 70 or 100 percent disability rating. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether an increased disability rating in excess of 50 percent for PTSD is warranted during the period on appeal (from March 09, 2020 to December 11, 2020). Rather, the evidence persuasively weighs against an increased disability rating in excess of 50 percent for PTSD for the entire period on appeal, as the Veteran's service-connected PTSD symptoms do not more closely approximate occupational and social impairment with deficiencies in most areas or total occupational and social impairment. Thus, the benefit of the doubt doctrine under 38 U.S.C. § 5107(b) is therefore not for application, and the claim is denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). The Board has considered whether entitlement to a TDIU has been raised part and parcel to the current appeal. See Rice v. Shinseki, 22 Vet. App. 447, 455 (2009). However, the evidence of record, to include lay statements, during the applicable evidentiary window and period on appeal does not indicate that the Veteran's PTSD rendered her unable to secure and follow substantially gainful employment during the applicable period on appeal. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michelle B., Associate Attorney The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.