Citation Nr: 0814400 Decision Date: 05/01/08 Archive Date: 05/12/08 DOCKET NO. 06-34 945 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for keratitis. 2. Entitlement to service connection for polycystic ovarian syndrome. ATTORNEY FOR THE BOARD S. J. Janec, Counsel INTRODUCTION The veteran had active military service from September 1997 to October 2004. This matter comes before the Board of Veterans' Appeals (Board) from a December 2005 rating decision of the Huntington, West Virginia, Regional Office (RO) of the Department of Veterans Affairs (VA) that, in relevant part, denied service connection for keratitis and polycystic ovarian syndrome. The claim of entitlement to service connection for polycystic ovarian syndrome is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDING OF FACT The medical evidence shows that the veteran's in-service keratitis was acute and transitory in nature. CONCLUSION OF LAW Chronic keratitis was not incurred in or aggravated while on active duty. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act The requirements of the Veterans Claims Assistance Act of 2000 (VCAA) have been met. There is no issue as to providing an appropriate application form or completeness of the application. VA notified the veteran in April 2005 correspondence of the information and evidence needed to substantiate and complete a claim, to include notice of what part of that evidence is to be provided by the claimant, and notice of what part VA will attempt to obtain. VA has fulfilled its duty to assist the claimant in obtaining identified and available evidence needed to substantiate a claim, and as warranted by law, affording VA examinations. VA informed the claimant of the need to submit all pertinent evidence in her possession. While the veteran was not informed how disability ratings and effective dates are assigned, that error was harmless in light of the decision reached below. Further, while the veteran did not receive full notice prior to the initial decision, after pertinent notice was provided the claimant was afforded a meaningful opportunity to participate in the adjudication of the claims, and the claims were readjudicated in an October 2007 supplemental statement of the case. The claimant was provided the opportunity to present pertinent personal testimony at a hearing before a Veterans Law Judge at the RO in February 2008. She failed to report to the schedule hearing. In sum, there is no evidence of any VA error in notifying or assisting the veteran that reasonably affects the fairness of this adjudication. Analysis The Board has reviewed all the evidence in the veteran's claims file, which includes her written contentions, service treatment records, VA medical records, private medical records, and lay statements. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the veteran or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be warranted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The veteran's service treatment reports show that she was seen on several occasions for recurrent keratitis of the right eye; on at least one occasion she had complaints for both eyes. The condition was treated and resolved on each occasion. She was also seen for keratoconjunctivitis which resolved. In an October 2006 letter, Lorie A. Logan, O.D., reported that she saw the veteran in July 2006 for complaints of swelling of the eyelids. She gave a history of similar complaints at the same time of year for the past three years. She was diagnosed with a corneal ulcer of the left eye, corneal neovascularization in both eyes, and superficial punctuate keratitis in both eyes. She was advised to discontinue contact lens use and start Vigamox every two hours. On subsequent visits, the infiltrate improved and silicone hydrogel contacts lenses were recommended to improve oxygen permeability to the cornea. At a September 2007 VA ophthalmologic contract examination the appellant reported a history of keratitis. She did not report current pathology, Following examination the diagnoses were corneal neovascularization, superiorly in both eyes, dry eye syndrome of both eyes, and refractive error of both eyes. There was no keratitis. The physician reviewed the veteran's records and concluded that the in-service keratitis was most likely an acute disease process that was fully resolved. It was opined that her in-service problems were due to soft contact lens overuse. The Board finds that service connection for keratitis is not warranted because the medical evidence does not establish that the veteran has chronic keratitis that was incurred in or aggravated during active service. While the veteran was treated for keratitis in service, and while she was seen for episodes of the disease subsequent to service, the VA medical opinion shows that the disability in service was acute in nature and fully resolved. In fact, it was attributed most likely to soft contact lens overuse, which was rectified after treatment and the proper use of contact lenses. Even the private medical statement from Dr. Logan indicates that contact lens use was a causal factor in the development of the condition. Dr. Logan did not report chronic keratitis after beginning medication postservice. Consequently, without medical evidence that a chronic disease that may be attributed to service exists, service connection for the disorder may not be granted. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of a present disability there can be no valid claim); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (service connection may not be granted unless a current disability exists). The Board recognizes that the United States Court of Appeals for Veterans Claims recently held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Here, however, the Board is denying the claim primarily because the evidence preponderates against finding that the appellant has chronic keratitis. Indeed, the evidence shows that the disorder to be acute. Therefore, based on the evidence of record, service connection is not warranted. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the appellant's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). ORDER Service connection for keratitis is denied. REMAND Service treatment reports show that the veteran was seen for polycystic ovarian syndrome. A pelvic sonogram in May 2005, however, showed no evidence of polycystic ovarian syndrome. The veteran subsequently submitted a September 2006 letter from a private medical doctor who remarked that a pelvic ultrasound in August 2006 was consistent with polycystic ovarian syndrome. The ultrasound report, however, noted mildly prominent ovaries with peripherally oriented follicles that "may represent" polycystic ovaries "if lab values are consistent." There is no notation on the report, or in the physician's letter, to show that the lab values were checked and found to be consistent with polycystic ovarian syndrome. Consequently, the Board finds that additional development is necessary to ascertain whether the veteran has the claimed disability. Accordingly, the case is REMANDED for the following action: 1. The RO is to obtain the names and addresses of all medical care providers who have treated the veteran for polycystic ovarian syndrome since September 2006. After securing any necessary release, request any records not previously secured and associate them with the claims file. 2. Schedule the veteran for a VA gynecological examination to ascertain whether she has polycystic ovarian syndrome. The examiner must review the entire claims file in conjunction with the examination, including the service treatment records and post-service medical records. All studies or tests deemed necessary should be conducted, including any laboratory findings. If polycystic ovarian syndrome is present, the examiner should indicate whether it is at least as likely as not, i.e., is there a 50/50 chance, that it is related to her in- service pathology. 3. The veteran is hereby notified that it is her responsibility to report for the examination and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2007). In the event that the veteran does not report for the examination, documentation should be obtained which shows that notice scheduling the examination was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. After the development requested above has been completed to the extent possible, the issue of entitlement to service connection for polycystic ovarian syndrome should be readjudicated. If the benefit sought on appeal remains denied, the veteran and her representative, if any, should be furnished a supplemental statement of the case and given the opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). ______________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs