Citation Nr: 1305138 Decision Date: 02/12/13 Archive Date: 02/21/13 DOCKET NO. 07-31 654 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for an eye disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD R.N. Poulson, Counsel INTRODUCTION The Veteran had active military service from April 1948 to March 1950 and from August 1950 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The case was subsequently transferred to the Louisville, Kentucky RO. In August 2010, the Board, in part, reopened a previously denied claim of service connection for an eye disability and remanded the claim for additional development, to include obtaining VA treatment records and scheduling a VA examination. In June and August 2011, the Board remanded the case again for additional development, to include obtaining current VA treatment records and an addendum opinion from the VA physician who had conducted a September 2010 examination. The requested records have been obtained and associated with the claims file. Further, as discussed in detail below, VA obtained a Disability Benefits Questionnaire (DBQ) in September 2011 and Veterans Health Administration (VHA) opinion in October 2012. Accordingly, the Board finds that its remand directives have been substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran submitted a lay statement in November 2012 after the last supplemental statement of the case (SSOC) was issued in August 2012. However, in January 2013 the Veteran's representative submitted a waiver of agency of original jurisdiction (AOJ) consideration. (This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002).) FINDINGS OF FACT 1. The Veteran's currently diagnosed blepharitis, dry eye syndrome, styes, and bacterial keratoconjunctivitis are as likely as not related to his military service. 2. Any other eye disorders, to include cataracts, primary open angle glaucoma (POAG), anisocoria, macular degeneration, corneal endothelial dystrophy/corneal edema, right eye nevus, and refractive error, are not attributable to military service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for blepharitis, dry eye syndrome, styes, and bacterial keratoconjunctivitis are met. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.303 (2012). 2. The Veteran does not have any other eye disability, to include cataracts, POAG, anisocoria, macular degeneration, corneal endothelial dystrophy/corneal edema, right eye nevus, and refractive error, that is the result of disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 4.9 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In this decision, the Board grants entitlement to service connection for blepharitis, dry eye syndrome, styes, and bacterial keratoconjunctivitis. Therefore, no discussion of VA's duty to notify or assist is necessary with respect to these disabilities. With respect to other eye disability, the Board finds that the notice and duty-to-assist provisions of the Veterans Claims Assistance Act of 2000 (VCAA) have been met. The VCAA, codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp 2012)), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2012), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim. They also require VA to notify the claimant and the claimant's representative of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. (The Board notes that 38 C.F.R. § 3.159 was revised, effective May 30, 2008. See 73 Fed. Reg. 23353-56 (Apr. 30, 2008). The amendments apply to applications for benefits pending before VA on, or filed after, May 30, 2008. The amendments, among other things, removed the notice provision requiring VA to request the veteran to provide any evidence in the veteran's possession that pertains to the claim. See 38 C.F.R. § 3.159(b)(1).) In addition, the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; (3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). The RO wrote to the Veteran in August 2005. The Veteran was advised of the evidence required to substantiate his claim. The letter informed the Veteran of the types of evidence that would be beneficial in supporting his claim. He was further advised of the information required from him to enable VA to obtain evidence on his behalf, the assistance that VA would provide to obtain evidence on his behalf, and that he should submit such evidence or provide VA with the information necessary for VA to obtain such evidence on his behalf. He was asked to submit any medical reports that he possessed. The letter also provided notice on how VA determined effective dates and disability ratings. See Dingess. The Veteran has not disputed the contents of the VCAA notice in this case. He was afforded a meaningful opportunity to participate in the development of his claim of service connection for an eye disability. Thus, the Board is satisfied that the duty-to-notify requirements under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) were satisfied. The Board also finds that VA has adequately fulfilled its obligation to assist the Veteran in obtaining the evidence necessary to substantiate his claim. All available evidence pertaining to the Veteran's claim has been obtained. The evidence includes his claims folder, which includes his service treatment records and report of VA examination with addendum. As noted above, the Board has also sought and obtained a medical opinion from VHA. The Veteran identified no additional source of evidence in his current claim. The examination and subsequently prepared opinions have provided sufficient information upon which to base a determination as those records fully addressed the Veteran's symptoms and the medical evidence of record in assessing the Veteran's status. See 38 C.F.R. § 3.326 (2011), Barr v. Nicholson, 21 Vet. App. 303, 311 (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). The Board finds that VA has complied, to the extent required, with the duty-to-assist requirements found at 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c)-(e). Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, 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. Hickson v. West, 12 Vet. App. 247, 252 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When all the evidence is assembled, 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 a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran contends that his current eye disorders are the result of his active service. A review of the record reveals that he has a long and complicated ophthalmologic history. Service treatment records (STRs) from the Veteran's first period of active duty service show that in October 1949 he was seen for complaints of redness and pain in the right eye since August 1949. The assessment was acute conjunctivitis of the right eye. In December 1949, the Veteran reported that he had had conjunctivitis for three months and that it was getting worse. It was noted on follow-up one week later that the condition had improved; however, the clinician noted the presence of photophobia and dark glare. A March 1950 separation examination report contains a normal clinical evaluation of the eyes. Vision was 20/30 in both eyes. An August 1950 enlistment examination report shows that the Veteran's vision was 20/20 in the right eye and 20/30 in the left eye. There is a notation in the report that the remainder of the eye examination was not performed. In December 1950, the Veteran was treated for a bump on the right eye, which was diagnosed as palpebral conjunctivitis (early blepharitis). In October 1952, the Veteran was treated for a sty on the right lower eyelid. An August 1954 discharge and reenlistment examination report contains a normal clinical evaluation of the eyes. The Veteran's vision was 20/20 in the right eye and 20/25 in the left eye. In August 1955, he was treated with ointment for bilateral conjunctivitis with crusting of the lids and blepharitis. It was noted on follow-up two days later that the condition was "much improved" although there was still some pulling of the upper lids. He was instructed to continue using the ointment. Blepharitis was again noted in November 1955. It appears that the Veteran was first prescribed glasses in July 1956. That examination revealed -.25 sphere, -.50 cylinder, and 90 axis in the right eye; and -.50 sphere, -.75 cylinder, and 95 axis in the left eye. In August 1956, the Veteran had a left eye abscess drained. In January 1958, he was treated for a stye on the right eye. A February 1958 separation and reenlistment examination report contains a normal clinical evaluation of the eyes. Vision was 20/20 in both eyes. In April 1959, the Veteran complained of a foreign body in the right eye after sawing wood. No foreign body was found on examination. On follow-up the following day, the Veteran stated that it still felt like there was a foreign body in his eye. Pupils were equal and the cornea was clear. No foreign body was found on examination, but it was noted that the Veteran had conjunctivitis. A January 1960 eye clinic record documents symptoms of recurrent redness, discharge, periodic foggy vision, and photophobia. The clinician noted a history of styes occurring at least 1-2 times per year for the past 8-9 years. This notation was based on a review of the record and questioning of the Veteran. The clinician also noted that the Veteran had been treated intermittently for blepharitis since 1955, and that he had had dandruff since childhood. Vision was 20/20 in both eyes with correction. There was scaly, crusty debris along the lid margins and lashes. The lid margins were red and thickened. The scaling extended into the adjacent skin. The lid conjunctiva showed mild hyperemia. There was slight papillary hypertrophy. Corneas were clear. There was a palpable pre-annicular node on the left eye. The impression was chronic blepharitis. The clinician noted that the history of recurrent styes and dandruff suggested combined seborrheic and staphylococcal etiology, which the clinician noted are the two most common etiologies. Lid culture and scraping were recommended, and dandruff shampoo was prescribed. In February 1960, the Veteran had a lesion removed near his right eye. Seborrheic blepharitis was noted again in August 1960. A January 1961 lid swab diagnosed hemolytic staphylococcus aureus. An early abscess on the left eye was identified in September 1962. In January 1964, conjunctivitis was identified in the right eye. During a July 1964 eye examination, the Veteran complained that he could not perform at near distance due to blur. He also reported fatigue and headaches. He indicated that he had worn glasses until 1960 when they broke. He denied any problem with distance vision. The Veteran was found to have suppression in the left eye. It appears that the clinician diagnosed nearsightedness. He also made the following notation: "I frankly don't understand this case with the suppression and all. No records are available. Will prescribe for symptom only and then recheck in 90 days." During a January 1967 eye examination, the Veteran reported diplopia when reading. The impression was "alternate suppression and fusion secondary to high [illegible] greater at 6 m than 40 cm." A December 1968 periodic examination report shows that the Veteran's distant vision was 20/20 in both eyes. Near vision was 20/70 in both eyes, corrected to 20/30 in the right eye and 20/20 in the left eye. The clinician diagnosed defective near vision, corrected. A December 1969 annual examination report shows that the Veteran's distant vision was 20/20 in the right eye and 20/30 in the left eye, corrected to 20/20 in the right eye and 20/25 in the left eye. Near vision was 20/75 in the right eye, corrected to 20/25, and 20/50 in the left eye, corrected to 20/40. Intraocular pressure was 18.9 in both eyes. The clinician diagnosed defective visual acuity. An April 1970 retirement examination report contains normal clinical and ophthalmologic examinations. The Veteran's uncorrected distance vision was 20/20 in the right eye and 20/30 in the left eye. Corrected distance vision was 20/20 in both eyes. Uncorrected near vision was 20/30 in the left eye and 20/50 in the right eye. Corrected near vision was 20/25 in the left eye and 20/50 in the right eye. Corrective refraction was -.25 sphere in the right eye and -.50 sphere in the left eye. Intraocular pressure was 17.3 in both eyes. The clinician diagnosed defective visual acuity, corrected by lenses. The Veteran submitted to a VA examination in December 1989. He reported a progressive loss of vision in the left eye since 1956. He complained of problems reading fine print. He reported that he had worn glasses since he was five years old. He glasses were changed every two years. Pupils were regular and equal. A fundoscopic examination of the left eye showed normal blood vessels. No deposits or exudates were noted. Corrected distance vision was 20/30 in both eyes. Corrected near vision was J2 in both eyes. The diagnoses included refractive error, presbyopia, and increased optic nerve cupping (chronic open angle glaucoma suspected). In correspondence dated in May and August 1990, the Veteran stated that he entered the military with 20/20 vision in both eyes and no need for glasses. In 1955 or 1956, while stationed in Italy, he began to experience severe headaches. He had his eyes examined by an Italian doctor and received a prescription. He maintained that that prescription was incorrect and that he continued to have daily headaches until his prescription was changed at Castle Air Force Base, California in 1957 or 1958. A January 1995 VA treatment record shows that corrected distance vision was 20/20 in the right eye and 20/30 in the left eye. Unfortunately, many of the handwritten notations are illegible. However, it appears that the clinician diagnosed physiologic cupping. In January 2001, corrected distance vision was 20/20 in the right eye and 20/40 in the left eye. Intraocular pressure was 16 in the right eye and 23 in the left eye. The impression was ocular hypertension in the left eye, probable glaucoma, and mild cataracts. No change of glasses was needed. Eye drops were prescribed for the left eye. VA treatment records from February 2001 to July 2002 show that intraocular pressure continued to rise. It was noted that the Veteran was not compliant with his eye drops. Different eye drops were prescribed in July 2002, after which intraocular pressure decreased. In July 2003, the Veteran's corrected distance vision was 20/30+ in both eyes. He was diagnosed with (1) POAG, large, asymmetric, with visual field defect; (2) senile cataract, not visually significant; and (3) possible corneal dystrophy, left eye. In January 2004, the Veteran was diagnosed with blepharitis in both eyes and corneal stromal changes in the left eye. He was also diagnosed with ocular hypertension, glaucoma, and early glaucoma defect. Intraocular pressure was 13 and 15, respectively. The clinician noted that this was an acceptable, but minimal, decrease. He advised the Veteran to continue using the eye drops. In August 2004, it was noted that a myopic shift in refractive error had occurred due to the Veteran's cataracts. In October 2004, the Veteran reported a family history of glaucoma. Intraocular pressure was 12 and 17. The Veteran was diagnosed with POAG and refractive error, presbyopia. New eye drops were prescribed. Humphrey visual field testing in August 2005 revealed poor reliability and arcuate defects, both inferior and superior, in the right eye, and poor reliability and dense inferior arcuate (slightly improved) with early superior arcuate (worsened) in the left eye. Intraocular pressure was 13 and 16. The assessment was POAG in both eyes, and good intraocular pressure decrease with the eye drops. In November and December 2006, the Veteran complained of intermittent left eye and periorbital pain for one month. He denied any drainage or vision changes. Fundi appeared normal. Cup to disc ratio was .55/.60 in the right eye and .65/.80 in the left eye with slightly larger nerves and narrow, orange rim tissue. Cupping was noted in both eyes. Mild changes in the maculae were noted. Reticular degeneration in the peripheral retinae was also noted. The assessment was normal tension glaucoma with stable findings, with possible small change in optic nerve cupping; constant inferior visual field loss in the left eye, which appeared stable; and cataracts affecting vision, left greater than right. In April 2007, the Veteran was diagnosed with normal tension glaucoma, asymmetric eye pressures, right greater than left, and optic nerve cupping right greater than left. In November 2007, the Veteran was diagnosed with POAG, refractive error and presbyopia, cataract, corneal endothelial dystrophy, and previously unrecorded small nevi in the right eye. It was noted that the cataract and corneal condition were causing a reduction in vision. The Veteran was prescribed additional eye drops. Visual field testing in January 2008 showed good reliability, inferior temporal depression, GHT outside normal limits, and possible field loss progression in the right eye; and poor reliability secondary to false negatives, possible inferior nasal step with superior nasal and temporal depressions, GHT outside normal limits, and possible field loss progression in the left eye. The assessment was POAG. The clinician advised the Veteran to continue using both eye drops. He noted no reduction in intraocular pressure. He also noted that the possible progression of field loss was correlated with optic nerve appearance. In January 2009, the Veteran was diagnosed with normal tension glaucoma, left greater than right; choroidal nevus, right eye; cataracts in both eyes; and refractive error in both eyes. It was noted that the Veteran maintained good vision. There was no progression of cup to disc ratios. The choroid nevus was noted to be stable in appearance without subretinal fluid, and that the cataracts contributed to mild vision reduction in both eyes. In July 2009, the Veteran denied a history of eye injury. The diagnosis was POAG with significant improvement, although the severe nature of optic nerve head damage in the left eye was noted. A slit lamp examination in October 2009 revealed grade 2 blepharitis in both eyes, an external stye in the right eye along a superior lash, a 4mm fluid filled cyst in the left eye medial canthus, and keratoconjunctivitis with grade 2 SPK in both eyes. Humphrey visual field testing revealed global loss in the left eye with severe inferior defect, and mild global loss in the right eye with inferior arcuate defect. The assessment included POAG, left eye greater than right, with good intraocular pressure and stable visual fields; refractive error in both eyes; external stye in the right eye; and dry eye syndrome in both eyes. Artificial tears were prescribed. In November 2009, the Veteran complained of redness and pain in his right eye with tearing, matting in the morning, and light sensitivity of one week's duration. Blepharitis, right greater than left, was noted with crusting, grade 1+ mixed follicular reaction, and hyperemia. He was diagnosed with corneal ulcer with bacterial conjunctivitis in the right eye. An antibiotic was prescribed, and warm compresses were recommended. The Veteran complained of significant photophobia the following day. The clinician noted that the bacterial conjunctivitis was likely secondary to significant blepharitis. A slit lamp examination in December 2009 revealed grade 3+ thickened, edematous inferior and superior lids with contact dermatitis; subtemporal sty; and inferior ectropion. There was mild lid redness inferior and superior in the right eye, with grade 1 anterior blepharitis in both eyes. There was grade 1 diffuse injection with thick, mucoid discharge in the fornix. There were trace endothelial vesicles and SPK in the right eye; and grade 2-3 endothelial vesicles, SPK, and an oily, debri-laded tear film in the left eye. The assessment was unresolved bacterial keratoconjunctivitis in the right eye. The Veteran was instructed to finish his course of antibiotics. It was noted on follow-up that none of the treatments, topical or oral, had resolved the Veteran's condition and symptoms. A January 2010 ophthalmology note shows that the Veteran denied any eye pain, stating "it's gone now." The assessment was moderate-severe blepharitis with resolved stye in the right eye. In February 2010, the Veteran reported an adverse reaction to one of his glaucoma medications, which were discontinued. The clinician noted that the Veteran had advanced glaucoma in the left eye and that the right eye cataract was not very significant. In September 2010, the Veteran reported that "his left eye feels like it is not seeing well at all." A slit lamp examination revealed that the lids, lashes, conjunctiva, sclera, and cornea were clear. Pursuant to the Board's August 2010 remand, the Veteran submitted to a VA eye examination in September 2010. Uncorrected distance acuity was 20/80 in the right eye and 20/200 in the left eye. Corrected distance vision was 20/30 in the right eye and 20/60 in the left eye. Uncorrected near acuity was 20/50 in the right eye and 20/200 in the left eye. Corrected near vision was 20/30 in the right eye and 20/60 in the left eye. A lens abnormality of "1-2+ NS" was noted in both eyes. There were no findings of chronic conjunctivitis. The examiner diagnosed cataracts and primary open angle glaucoma (POAG). The examiner opined that both disabilities were related to the aging process and not to military service. A left eye cataract was diagnosed in November 2010. The Veteran reported a painless progressive loss of vision in that eye. He underwent left cataract extraction with lens implant later that month. The Veteran received emergency treatment in December 2010, at which time it was noted that his right pupil was asymmetric. There was no direct or consensual response upon examination. The assessment was right efferent pupillary defect. It was noted that on retesting the right pupil appeared to be responsive, but sluggish. A neurology consultation was requested. An ophthalmology note one day later contains the following notation: "possible evolving IIIrd vs. Adies v. stroke." January 2011 ophthalmology notes show that an anisocoria workup was negative and that the right pupil condition had apparently resolved. No diplopia was noted. There was average retinal nerve fiber layer thickness. The Veteran reported that his left eye vision had stabilized. The diagnoses included POAG, left greater than right, and likely contributing to decreased vision in the left eye; non-exudative macular degeneration in both eyes contributing to decreased vision in both eyes; myopia, astigmatism, and presbyopia; right eye cataract contributing to decreased vision and left eye pseudophakia; and dry eye symptoms in both eyes. In February 2011, the Veteran complained that his left eye was red and irritated. The ophthalmologist indicated that it was a flare-up of blepharitis rather than an adverse reaction to the eye drops used to treat the Veteran's glaucoma. In April 2011, the Veteran underwent right cataract extraction. In June and August 2011, the Board remanded the case for additional development, to include obtaining current VA treatment records and obtaining an addendum opinion from the VA physician who had examined the Veteran's eyes in September 2010. Also of record is a September 2011 report. The Board notes that no examination was conducted. The examiner reviewed the claims file and noted that corneal foreign body, blepharitis, and refractive error were treated during service. He opined that these "are all self-limited conditions which have no impact on the cataracts which developed many years after military service was completed and are age-related." The examiner also noted that the POAG was of recent onset and opined that it was "unrelated to any of the above mentioned treated eye conditions encountered during service." He emphasized that cataracts and glaucoma occurred many years after the Veteran's service and "have no relationship to his self-limited eye problems in military service." VA obtained an VHA opinion in October 2012, provided by an ophthalmologist who had full access to the Veteran's claims file, including his entire ophthalmologic record. He noted that since January 2004, the Veteran has been diagnosed with cataract, POAG/ocular hypertension, blepharitis, anisocoria (a condition characterized by an unequal size of the pupils), chalazion (stye), macular degeneration, bacterial keratoconjunctivis, corneal endothelial dystrophy associated with corneal edema, dry eye, right eye nevus, and refractive error (myopia/presbyopia/astigmatism). With respect to cataracts, the doctor noted that the Veteran had nuclear sclerotic cataract and that this type of cataract occurs with age. Therefore, he opined that it was less likely as not that this condition was caused by or related to service. With respect to POAG/ocular hypertension, the doctor stated that these conditions increase with age although a family history of glaucoma is a risk factor. The doctor noted that blunt trauma can cause glaucoma. He also noted that the Veteran had reportedly suffered blunt trauma during service. However, the in-service examination showed no evidence of eye trauma and did not include a gonioscopic examination, which would indicate signs of blunt trauma. Therefore, the doctor opined that the Veteran's glaucoma/ocular hypertension was less likely as not caused by or related to service. With respect to blepharitis, dry eye syndrome, and styes, the doctor noted that the Veteran had been diagnosed with blepharitis during service. He explained that while the cause of this condition is unclear, certain factors are associated with it to include dandruff, certain medications, malfunctioning oil glands, bacterial infection, and allergies. He explained that styes are the result of plugged oil glands that occur as a result, and that dry eye syndrome is also common in people with blepharitis for the same reason. The doctor stated that a dry environment can also contribute to dry eye. He refused to speculate as to the etiology of these three conditions, as he did not know whether the Veteran had any of the above-mentioned risk factors or where he was stationed. With respect to bacterial keratoconjunctivitis, the doctor opined that there is a "50/50 chance" that the blepharitis predisposed the Veteran to developing this condition. However, because he could not render an opinion with respect to the blepharitis, he also refused to speculate as to the etiology of the bacterial keratoconjunctivitis. With respect to the anisocoria, the doctor noted that although the Veteran had been diagnosed with this condition after cataract surgery in 2010, the work-up at the time was negative. Furthermore, it appears that the condition subsequently resolved. Thus, he opined that given the time span between the diagnosis of anisocoria and the occurrence of this condition, it was not caused by or the result of service. With respect to macular degeneration, the doctor noted that factors associated with this diagnosis include age, sun exposure, obesity, smoking, hypertension, high fat/cholesterol diet, genetics, light skin/eye color, and hyperopia. The doctor concluded that of these, only sun exposure could be related to the Veteran's service. However, he refused to speculate as to etiology since he did not know where the Veteran had been stationed. With respect to the right eye nevus, the doctor noted that this condition reflects increased pigmentation and is likely a birthmark. He stated that sun exposure "can also predispose to the development of nevi." However, he refused to speculate as to etiology since he did not know where the Veteran was stationed during service. With respect to the corneal endothelial dystrophy/corneal edema, the doctor opined that this condition has a genetic predisposition and, therefore, is not caused by the Veteran's service. Finally, with respect to myopia and astigmatism, the doctor determined that although it is possible that the Veteran had a low level of refractive error prior to service but was still able to see very well without correction, it is unlikely. Instead, he noted that "as time went on and the lens develops cataract changes the eye's prescription changes." With respect to presbyopia, he noted that the loss of ability to see up close occurs in everyone after the age of 40. Therefore, he opined that the Veteran's refractive error is not related to his time in service and was not aggravated by, or superimposed by, a disease or injury that was service related. Based on a review of the evidence, the Board finds that service connection for blepharitis, dry eyes, styes, and bacterial keratoconjunctivitis is warranted. The Board notes that the Veteran was diagnosed with blepharitis, styes, and conjunctivitis during service. In fact, in January 1960 the blepharitis was identified as being chronic. Since the record shows that blepharitis was first manifested during active service and identified as being chronic, the record establishes that this claimed disability had its onset during service. The Veteran has reported having continuing symptoms associated with blepharitis, to include dry eyes, styes, and conjunctivitis since separation. He is competent to report experiencing ongoing symptoms and given that these symptoms are documented in service and then again in 2009, his statements are deemed credible. See Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). STRs show that in 1960, a clinician noted that the Veteran's history of recurrent styes and dandruff suggested combined seborrheic and staphylococcal etiology, which the clinician noted are the two most common etiologies. The Veteran was diagnosed during service with both dandruff and a bacterial infection in his eye. Significantly, the October 2012 examiner noted that blepharitis can be caused by dandruff or bacterial infection. As discussed above, the examiner refused to speculate as to the etiology of this condition, stating "[i]t is not noted in the record if [the Veteran] . . . had any of these factors." This statement indicates that the examiner overlooked the January 1960 treatment record. In any event, the October 2012 examiner observed that the Veteran's history of having dry eyes since service is consistent with blepharitis. He also determined that the Veteran's blepharitis may have predisposed him to developing bacterial keratoconjunctivitis. This finding is supported by the November 2009 VA clinician's opinion that the Veteran's bacterial conjunctivitis was likely secondary to his currently diagnosed blepharitis. Although the September 2010 eye evaluation did not result in diagnoses of blepharitis, styes, dry eye syndrome, or bacterial conjunctivitis, that report also does not reflect that the Veteran denied eye watering and/or dry eyes. Furthermore, the current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). The September 2011 examiner found that the blepharitis diagnosed during service was a self-limited condition. However, this finding ignores the fact that blepharitis was diagnosed by VA providers in December 2009 and February 2011, and fails to account for the in-service provider's finding of chronicity. Here, the evidence is in equipoise as to service connection for blepharitis, dry eye syndrome, styes, and bacterial keratoconjunctivitis and thus, resolving reasonable doubt in the Veteran's favor, service connection for these disabilities is warranted. The Board finds that service connection is not warranted for cataracts or POAG/ocular hypertension. STRs are silent for complaints or findings of cataracts or glaucoma. The Veteran's eyes were noted to be normal at separation and there are no complaints or findings of either condition for many years after service. Therefore, the clinical evidence does not reflect continuity of symptomatology. Moreover, the claims folder contains no competent evidence of a nexus between any current cataracts/POAG and the Veteran's military service. The Board notes that the Veteran was afforded a comprehensive VA examination in September 2010, and that opinions were obtained from VA clinicians in September 2011 and October 2012. All three examiners reviewed the claims file and determined that the Veteran's cataracts were age-related. Both the September 2010 and October 2012 examiners opined that the POAG was age-related, while the September 2011 examiner indicated that this condition was self-limited. The Board has also considered whether the Veteran developed macular degeneration and/or right eye nevus as a result of sun exposure during service. In a November 2012 correspondence, the Veteran stated that he was stationed in New Mexico for three years; Saudi Arabia for 12 months; Florida for two years; Texas for three years; and France for three years. There are no personnel records in the claims file. However, the Veteran is competent to report the various duty stations where he lived throughout his lengthy military career. Furthermore, the Board notes that a review of the claims file confirms that he was indeed stationed in New Mexico and California. However, clinical documentation of the Veteran's eye-related treatment does not support a causative nexus between these diagnosed eye disabilities and his active service. Notably absent from the STRs is a diagnosis of either condition. The first notation regarding macular degeneration and right eye nevus is dated in 2006 and 2009, respectively. In January 2011, the Veteran underwent a VA eye examination and the diagnosis of macular degeneration was confirmed. The October 2012 examiner diagnosed macular degeneration and right eye nevus. The absence of any mention of macular degeneration or right eye nevus until 2006 and 2009 is evidence that these conditions were not present at any time even remotely related to the Veteran's active service. The Court has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service, is probative evidence against the claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board acknowledges the October 2012 examiner's statement that macular degeneration and right eye nevus can be associated with sun exposure. Notably, however, the examiner refused to speculate as to a nexus between these conditions and any sun exposure the Veteran may have had during service. Instead, he merely implied that if the Veteran had been exposed to a lot of sun in service, then this could contribute to his macular degeneration and right eye nevus. He also noted that there are many other theories as to the cause of macular degeneration, including diet, obesity, smoking, hypertension, and genetics. This amounts to little more than a general theory tentatively applied, through supposition, to the Veteran's eye disabilities. As to the diagnosed anisocoria, the Board finds that there is no probative evidence medically relating this condition to military service. STRs do not contain any findings or diagnosis of this condition. In fact, the first evidence of anisocoria was in December 2010, when a VA provider noted that the Veteran's pupils were asymmetric. See id. Furthermore, the Board looks to the statement by the VA examiner in October 2012, in which he opines that the (subsequently resolved) anisocoria is unrelated to any incident in service. This opinion is supported by December 2010 VA clinician's diagnosis, which indicates a neurological cause of the Veteran's anisocoria. As to the diagnosed refractive error and corneal endothelial dystrophy/corneal edema, the Veteran contends that his vision was normal when he entered service, he was prescribed corrective lenses in service, and his eyesight has deteriorated since service. Medical opinion is of record indicating that the Veteran's corneal abnormality is a congenital disorder. Congenital or developmental defects and refractive error are not considered diseases or injuries within the meaning of applicable legislation pertaining to disability compensation for VA purposes, and provide no basis for service connection. Beno v. Principi, 3 Vet. App. 439, 441 (1992); 38 C.F.R. §§ 3.303(c), 4.9, 4.127; see also Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); Carpenter v. Brown, 8 Vet. App. 240, 243 (1995). For purposes of entitlement to benefits, the law provides that refractive errors of the eyes are not diseases within the meaning of applicable legislation. In the absence of a 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 those are not a diseases or injuries within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9 (2012). Thus, VA regulations specifically prohibit service connection for refractive error of the eyes unless the defect was subjected to a superimposed disease or injury that created additional disability. VAOPGCPREC 82-90 (1990), 55 Fed. Reg. 45,711 (1990). The Board acknowledges that the Veteran reported the presence of a foreign body in his right eye in April 1959. However, as alluded to by the October 2012 examiner, an eye examination conducted on the day of incident and the next revealed no foreign body. Even if the Board were to accept, for the sake of argument, that the Veteran had some type of trauma to the right eye during service, there would still need to be competent medical evidence relating a current condition to that trauma. There is none. The October 2012 reviewer, following a review of the claims file, considered the Veteran's reported history of a foreign body, and opined that his refractive error was not aggravated or superimposed by disease or injury that was service-related. The Board finds this aspect of the opinion to be probative. The Board finds that the Veteran's refractive error and corneal abnormality are congenital defects and there has been no evidence of aggravation by a superimposed disease or injury. Therefore, service connection for either condition is not warranted. The Board acknowledges the Veteran's opinion concerning the etiology of his currently diagnosed macular degeneration, right eye nevus, cataracts, POAG, anisocoria, corneal condition, and refractive error. However, as a layperson, lacking in medical training and expertise, the Veteran cannot provide a competent opinion on a matter as complex as the etiology of these eye disabilities and his views are of no probative value. And, even if his opinion was entitled to be accorded some probative value, it is far outweighed by the three VA examiners who reviewed the claims file and concluded that these conditions are not related to service. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). ORDER Entitlement to service connection for blepharitis, dry eye syndrome, styes, and bacterial keratoconjunctivitis is granted. Service connection for any other eye disability, to include macular degeneration, right eye nevus, cataracts, POAG, anisocoria, corneal condition, and refractive error, is denied. _________________________________ MARK F. HALSEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs