Citation Nr: 1107323 Decision Date: 02/23/11 Archive Date: 03/04/11 DOCKET NO. 06-09 005 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUE Entitlement to service connection for bilateral blurry vision, with right eye cataract. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel INTRODUCTION The Veteran served on active duty from October 1961 to August 1964. This appeal originally came before the Board of Veterans' Appeals (Board) from a January 2006 decision by the Denver, Colorado Regional Office (RO) of the United States Department of Veterans Affairs (VA). In February 2008, in pertinent part, the Board remanded the issue of entitlement to service connection for bilateral blurry vision with right eye cataract for additional development. The Board is satisfied that there has been substantial compliance with the remand directives and it may proceed with review. Stegall v. West, 11 Vet. App. 268 (1998). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2010). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran's current bilateral blurry vision, attributable to cataracts, was caused by any incident of service. CONCLUSION OF LAW Service connection for bilateral blurry vision with right eye cataract is not established. 38 U.S.C.A. §§ 1110, 1131 (West 2001); 38 C.F.R. §§ 3.303 (2010). REASONS AND BASES FOR FINDING AND CONCLUSION Notice and Assistance Upon receipt of a complete or substantially complete application for benefits and prior to an initial unfavorable decision on a claim by an agency of original jurisdiction, VA is required to notify the appellant of the information and evidence not of record that is necessary to substantiate the claim. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159; Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The notice should also address the rating criteria or effective date provisions that are pertinent to the appellant's claim. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Substantially compliant notice was sent in February 2005, April 2005, June 2005, and August 2007 letters and the claim was readjudicated in an October 2010 supplemental statement of the case. Mayfield, 444 F.3d at 1333. Moreover, the record shows that the appellant was represented by a Veteran's Service Organization and its counsel throughout the adjudication of the claim. Overton v. Nicholson, 20 Vet. App. 427 (2006). VA has obtained service treatment records, assisted the appellant in obtaining evidence, afforded the appellant physical examinations, obtained a medical opinion as to the etiology of the eye disorder, and afforded the appellant the opportunity to give testimony before the Board although he declined to do so. All known and available records relevant to the issue on appeal have been obtained and associated with the appellant's claims file; and the appellant has not contended otherwise. VA has substantially complied with the notice and assistance requirements and the appellant is not prejudiced by a decision on the claim at this time. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition to the above requirements, there are alternative methods of establishing service connection under 38 C.F.R. § 3.303(b). For example, a claimant may establish service connection by chronicity. Chronicity is established if the claimant can demonstrate (1) the existence of a chronic disease in service and (2) present manifestations of the same disease. See Savage v. Gober, 10 Vet .App. 488 (1997). Alternatively, the claimant may establish service connection by continuity of symptomatology. Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) there is post service evidence of the same symptomatology; and (3) there is medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post service symptomatology. Savage, 10 Vet. App. at 495. For purposes of entitlement to benefits, the law provides that refractive errors of the eyes are congenital or developmental defects and are not a disease or injury within the meaning of applicable legislation. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia, and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9. Thus, VA regulations specifically prohibit service connection for refractive errors of the eyes unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (July 18, 1990) (cited at 55 Fed. Reg. 45,711) (Oct. 30, 1990). The Veteran contends that he has bilateral blurry vision as a result of his period of active duty. Specifically, he contends that his eyes were injured in the explosion of a generator in 1962 and/or due to exposure to electromagnetic energy while working with communications equipment. The service treatment records include the September 1961 enlistment examination which noted normal eyes examination and 20/20 vision in both eyes. There are no references to a generator explosion in the service treatment records. The only reference to eye complaints is in June 1962 when the Veteran reported seeing spots before his eyes after physical training. He also reported feeling light-headed and weak. Examination noted the eyes were okay. The impression was probable physiological syncope. The June 1964 service separation examination noted normal eyes and 20/20 vision bilaterally. On the report of medical history completed by the Veteran at the time of the examination, he denied eye trouble. The first documented eye complaint in the postservice medical record comes in December 2004, when the Veteran reported increased blurry vision in the right eye for the past 11 months. He also reported a history of bilateral eye damage in a generator explosion in 1962, with problems with blurry vision ever since. In February 2005, the Veteran again reported a history of eye injury in 1962 with continuing vision problems. He stated that over the years he would take a few aspirin before his driver's vision test and would get "20/20 vision." A December 2005 VA ophthalmology note included the Veteran's reported history of explosion in the early 1960s "with vision loss?" Examination showed a white cataract of the right eye. The impression included "? some component of trauma." The Veteran submitted a statement dated in March 2006 from C.N.B., M.D., a neuro-radiologist, who provided an opinion that the Veteran's blurry vision was due to bilateral cataracts which are "likely due to his exposure to high uncontrolled levels of electromagnetic energy for the following reasons: 1. He entered fit for duty. 2. He was likely exposed to high levels of electromagnetic energy while in service as he operated and worked around high energy communications equipment and antennas which are known to produce high levels of electromagnetic radiation. 3. High level of electromagnetic radiation is known to cause cataracts. In fact, according to Electromagnetic Energy Association (EEA) '...The lens of the eye is particularly sensitive to intense heat, and exposure to high levels of microwaves can cause cataracts....' 4. His record does not contain a more likely etiology as he developed his bilateral cataracts at a relatively young age. A VA examination was conducted in December 2008 by an ophthalmology consultant physician who reviewed the Veteran's claims folder in conjunction with the examination. That physician diagnosed cataract left eye and aphakic right eye. He stated that cataracts are the cause of the Veteran's blurred vision and "they are not related to his head injury in 1962 because traumatic cataracts manifest themselves within the first few years after the injury; his cataract in the left eye is mild and typical of his age...although a private Dr. noted cataracts in 2006 and thought they were related to electromagnetic energy, I would attribute these cataracts to age." The same VA physician examined the Veteran again in April 2010. The Veteran stated that he did not see an ophthalmologist or optometrist for at least 40 years after his 1962 injury. He had undergone right eye cataract surgery in 2006 and was scheduled to have cataract surgery on the left eye the following week. The examiner noted that the Veteran's right eye cataract, which had been removed, and his left eye cataract, were not related to proximity to an explosion or exposure to electromagnetic energy during service. He noted again that traumatic cataracts occur within a few weeks or months after injury and the Veteran did not require cataract surgery for more than 40 years following his claimed injury, and that they did not cause enough vision problem to require an examination during those 40 years. The examiner also stated that electromagnetic energy exposure does not cause cataracts except in exceptional circumstances, and in those cases the cataract would also occur in the first few weeks after the exposure. Further, the examiner stated that the Veteran's brief episodes of spots in front of his eyes were related to changes in circulation and not directly to his eyes; that his decreased vision in the right eye was related to a small residual refractive error after cataract surgery; and that his left eye decreased vision was related to his cataract which was scheduled to be removed. He noted that the Veteran's vision was sufficient to pass a driver's test and that he could read normal print. To the extent that the December 2005 VA ophthalmology note attributed the Veteran's eye problems to "? some component of trauma," the Board finds that statement speculative and without any indication as to what evidence the physician relied up in formulating that opinion. Medical evidence that is speculative, general or inconclusive in nature cannot be used to support a claim. Obert v. Brown, 5 Vet. App. 30 (1993). The private medical opinion that attributes the Veteran's current cataracts to an inservice cause was prepared by a physician who was not an ophthalmologist or a specialist in eye disorders. The Board cannot reject an opinion of a health care provider merely because of the level of his or her training. See Goss v. Brown, 9 Vet. App. 109 (1996); Black v. Brown, 10 Vet. App. 297 (1997). The private opinion also states that the Veteran's record does not include a more likely etiology for his cataracts than exposure to electromagnetic energy. However, the subsequent VA examination reports, provided by an ophthalmologist, do provide opinions that include a more likely etiology. Guiding factors in evaluating the probity of a medical opinion are whether the opinion was based on sufficient facts or data, whether the opinion was the product of reliable principles and methods, and whether the medical professional applied the principles and methods reliably to the facts of the case. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Most of the probative value of a medical opinion lies in its reasoning. Id. at 304. In contrast to the private physician's opinion, the VA ophthalmologist who examined the Veteran in December 2008 and April 2010, reviewed the Veteran's complete claims file, including the service treatment records and post-service treatment records, prior to offering his opinion that the Veteran's current cataracts were related to age and not to injury or exposure to electromagnetic energy during active service. He pointed out that cataracts from these causes would have shown up within months rather than the 40 years it took for the Veteran to seek treatment for cataracts. This opinion included a detailed and well-reasoned rationale for why the current disability was likely not related to an inservice cause. Greater weight may be placed on one medical professional's opinion over another's depending on factors such as reasoning employed by the medical professional, and whether or not and to what extent they review prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). Accordingly, the Board finds the VA examiner's opinion more probative on the issue of whether the Veteran's current eye pathology is related to active service. With regard to continuity of symptomatology, the Board notes the Veteran has reported that he experienced blurry vision since service. The Board finds, however, that this testimony is outweighed by the objective evidence of record. No eye problem was noted at the time of the Veteran's discharge examination and the Veteran specifically denied eye trouble at that time. By his own account, he did not seek eye treatment for 40 years following service; clearly, someone experiencing ongoing blurry vision for that length of time would be expected to seek appropriate treatment. As a lay person, the Veteran is not competent to opine on medical matters such as the etiology of medical disorders. The record does not show, nor does the Veteran contend, that he has specialized education, training, or experience that would qualify him to provide an opinion on this matter. Accordingly, the Veteran's lay statements are entitled to no probative value. See Bostain v. West, 11 Vet. App. 124, 127 (1998). In the absence of a medical nexus between the Veteran's current bilateral eye pathology and any incident of service, the Board finds that service connection for bilateral blurry vision with cataract is not warranted. As the preponderance of the evidence is against the Veteran's claim, the benefit-of- the- doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App at 55-57. ORDER Service connection for bilateral blurry vision, with right eye cataract is denied. ____________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs