Citation Nr: 0815202 Decision Date: 05/08/08 Archive Date: 05/14/08 DOCKET NO. 05-16 549 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for keratoconus. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and Appellant's Spouse ATTORNEY FOR THE BOARD Robert J. Burriesci, Associate Counsel INTRODUCTION The veteran served on active duty from August 1948 to August 1952. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Board also notes that the appellant requested a video- conference hearing in connection with the current claim as well. The video-conference hearing was subsequently scheduled and held in March 2008 before the undersigned Veterans Law Judge. The appellant testified at that time and the hearing transcript is of record. FINDINGS OF FACT 1. The veteran's service medical records reveal complaint and treatment for an optical disorder. 2. The veteran is currently diagnosed with keratoconus. 3. Competent medical evidence shows that the veteran's keratoconus first manifested in service. CONCLUSION OF LAW The veteran's keratoconus was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Service Connection for Keratoconus The veteran seeks entitlement to service connection for keratoconus. The veteran contends that his exposure to dirt and subsequent excessive rubbing of his eyes while a radio operator and repairman aboard a tank during his service in Korea caused his current keratoconus. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. For the showing of chronic disease in service, there must be a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, evidence of continuity of symptoms after discharge is required to support the claim. 38 U.S.C.A. §§ 101(16), 1110, 1137; 38 C.F.R. § 3.303. In addition, service connection may be granted 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). Generally, to establish service connection, there must be (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in- service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a veteran seeking disability benefits must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). The Court of Appeals for Veterans Claims (Court) has also held that where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Federal Circuit has also recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). In Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Federal Circuit stated that lay evidence is competent and sufficient in certain instances related to medical matters. Specifically, the Federal Circuit commented that such instances include to establish a diagnosis of a condition when (1) a 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. Id. Similarly, the Court has held that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The veteran's service medical records (SMRs) reveal that his eyes were normal upon examination at entry into active duty in August 1948. The veteran SMRs reveal that the veteran was treated for an optical problem in May 1952 and was prescribed glasses. The veteran's separation examination, dated in July 1952, indicates that an opthalmoscopic examination was not performed. However, the veteran's sight was measured as 20/20 in both eyes at that time. The veteran was first diagnosed with keratoconus in 1954. In a letter dated in April 2004, Dr. R.P., a private doctor of optometry, reported that he treated the veteran for routine eye care and diagnosed the veteran with incipient keratoconus. Dr. R.P. referred the veteran to Dr. R.H., a private ophthalmologist, who confirmed the diagnosis of keratoconus. Subsequently, upon the referral of both Drs. R.P. and R.H., Dr. J.B. fit the veteran with a scleral contact lens to treat the veteran's keratoconus. Since 1954, the veteran has been continuously treated for keratoconus. In a letter dated in April 2006, Dr. M.A., a private corneal specialist, reported that the veteran initially sought treatment at his clinic in 1987 and by that point had already undergone two corneal transplants to his right eye and three to his left eye for keratoconus. Dr. M.A. indicated that based upon his treatment of the veteran and the treatment of Dr. R.P. the veteran had keratoconus while in service. Dr. M.A. stated that due to the difficulty of diagnosing keratoconus, the veteran's symptoms at the time, and Dr. R.P. prescription of scleral contact lens, a common treatment for keratoconus patients, he believes that veteran had keratoconus in service. In a letter dated in April 2006, Dr. J.L., a private optometrist, reported that he had treated the veteran since January 2001. Dr. J.L. stated that based upon the difficulty of diagnosing keratoconus early, the veteran's need of a scleral contact lens two years after service to provide function vision, and the slow progression of the condition, "it is conceivable and likely, that Mr. [redacted] had keratoconus prior to separating from the Marine Corps in 1952." In July 2004, the veteran was afforded a VA Compensation and Pension (C&P) eye examination. The examiner noted that the veteran had keratoconus for many years and sees very poorly. In an addendum to the examination report, dated in October 2004 the examiner reported that the veteran was not able to read any print presented to him. The examiner was unable to give an opinion, at that time, as to whether the corneal condition was related to the veteran's military service. In another addendum to the examination report, dated in October 2004, the examiner rendered the opinion, based upon the veteran's claims folder, that there was no information that the veteran's keratoconus had anything to do with the veteran's military service. The examiner stated that the veteran's keratoconus "was an individual anomaly that occurred with this patient." In a letter dated in April 2006, Dr. M.C., a private ophthalmologist and corneal specialist, reported that he had treated the veteran since February 2005. Dr. M.C. stated that keratoconus is an inherited disorder that predisposes people to an ecstasia. Dr. M.C. indicated that there is no way to determine exactly what brought on the veteran's keratoconus but that the eye irritation and visual changes in service might have triggered a worsening of the veteran's keratoconus. Dr. M.C. opined that the veteran had a tendency towards keratoconus before entering the military and that at some point either before or during service the veteran's ectasia worsened. In March 2008, the veteran and his wife testified at a hearing before the undersigned Veterans Law Judge. The veteran stated that his eyes were normal upon entry into service and that they became problematic during service. He reported that his service as a radio operator and repairman assigned to a communications tank exposed his eyes to debris. He indicated that he was not issued goggles to protect his eyes because they were not part of his military occupational specialty as an auxiliary individual assigned to the tank. The veteran reported that when he first returned to the United States he had night vision problems. The veteran stated that he was treated in service and prescribed glasses for his night vision problems because the treating physician believed that the problems stemmed from eye fatigue. The veteran's wife testified that she knew the veteran since grade school and married the veteran shortly after he was discharged from service. She stated that the veteran's eye sight was normal when he entered active duty and that it has progressively deteriorated. The Board finds that the record shows that the veteran's eyes were treated while in service as evidenced by the treatment received and noted in the veteran's service medical records in May 1952. The Board further finds that he was diagnosed as having keratoconus shortly after service as shown by the 1954 diagnosis of Drs. R.P. and R.H. Lastly, the Board finds that competent medical evidence indicates that it is at least as likely as not that the veteran's keratoconus first manifested in service as indicated in the April 2006 private medical opinion letters of Drs. M.A. and J.L. The Board finds that, resolving doubt in favor of the veteran, the positive evidence is at least in a state of equipoise with the negative evidence and, therefore, service connection for keratoconus is warranted. See 38 U.S.C.A. §§ 1110, 5107; 38 C.F.R. §§ 3.303. II. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). In this case, the Board is granting in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. ORDER Entitlement to service connection for keratoconus is granted. ____________________________________________ S. S. TOTH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs