Citation Nr: 1320500 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 07-29 147 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for a bilateral eyelid disorder, claimed as cysts of the eyelids. REPRESENTATION Appellant represented by: California Department of Veterans Affairs WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD T. M. Gillett, Counsel INTRODUCTION The Veteran had active service from January 1996 to December 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. In October 2009, the Veteran testified at a formal hearing at the RO before a Decision Review Officer (DRO). A transcript has been procured and is of record. The Board notes that, in the September 2005 decision from which this appeal arises, the RO also denied the Veteran's respective claims for service connection for a sinus disorder, a neck disorder, a right shoulder disorder, a right wrist disorder (claimed as carpal tunnel syndrome), a left knee disorder, and a disorder of the bilateral upper and lower extremities. The Veteran filed a substantive appeal to the Board regarding each of these issues. Yet, in an August 2011 statement, submitted prior to the RO's certification of this claim to the Board, the Veteran indicated that she wished to withdraw her claim for service connection for sinusitis. Therefore, that claim is no longer in appellate status and is not before the Board. In a January 2012 rating decision, the RO granted the Veteran's claim for service connection for a neck disorder, and, subsequently, in an August 2012 rating decision, the RO granted service connection for a right shoulder disorder, a right wrist disorder, a left knee disorder, and a disorder of the bilateral upper and lower extremities. As the respective January 2012 and August 2012 rating decisions fully granted the Veteran's claims for service connection for a neck disorder, a right shoulder disorder, a right wrist disorder, a left knee disorder, and a disorder of the bilateral upper and lower extremities, those issues are no longer in appellate status and are not before the Board. FINDING OF FACT The Veteran's current eyelid disorder was incurred during service. CONCLUSION OF LAW Resolving doubt in the Veteran's favor, the criteria for entitlement to service connection for a bilateral eyelid disorder have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (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 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). In this decision, the Board grants service connection for a bilateral eyelid disorder. This award represents a complete grant of the benefit sought on appeal. Thus, any deficiency in VA's compliance is deemed to be harmless error, and any further discussion of VA's responsibilities is not necessary. Service Connection Laws and Regulations Service connection is established where a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). A veteran may be granted service connection for any disease initially diagnosed after discharge, but only if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In rendering a decision on appeal, the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the veteran. By reasonable doubt is meant one that exists because of an approximate balance of positive and negative evidence that does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. The Board has reviewed all of the lay and medical evidence in the Veteran's claims folder. The Board finds that the Veteran is competent to report the symptoms and impairments associated with her eyelid disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that lay statements may serve to support a claim by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability that are susceptible of lay observation). The Board has not discounted lay evidence regarding the Veteran's claimed disorder because it is lay evidence or because it was reported by the Veteran. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005) (holding that a history given by a veteran that has not been found by the Board to be inaccurate is not a basis for discounting an opinion based on that history). That being said, the Board has an obligation to determine the credibility of all evidence, lay and medical. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the duty to assess the credibility and weight to be given to the evidence); Ashley v. Derwinski, 2 Vet. App. 307, 308-09 (1992). The Board has considered all evidence of record as it bears on the question of service connection. See 38 U.S.C.A. § 7104(a) (West 2002 & Supp. 2012) ("Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C.A. § 5107(b) ("Secretary shall consider all information and lay and medical evidence of record in a case"). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's appeal. Analysis The Veteran essentially contends that she developed an eyelid disorder during service. Reviewing the evidence of record, in an August 1995 service entrance medical examination report, a service examiner noted that the Veteran's skin and lymphatics were normal. In an October 2001 service treatment record, the Veteran reported experiencing left eye discharge and redness, and a lump inside her lower eyelid. Upon examination, the service examiner noted an inferior left conjunctiva with a three-millimeter cystic lesion. The service examiner diagnosed acute infectious conjunctivitis/chalazion. In a July 2003 service treatment record, the Veteran reported experiencing a possible eye infection. Upon examination, the service examiner noted edema and a tender palpable nodule on the lower right eyelid. The service examiner diagnosed a hordeolum. In a subsequent July 2003 service treatment record, the Veteran reported experiencing a "lump" in her right eye for the previous two weeks. After an examination, the service examiner diagnosed a chalazion infection of the right eye. In an undated service treatment record, specifically a physical examination report, a service examiner noted that the Veteran had a chalazion of the right eyelid. The record indicates that the Veteran was discharged from active service in December 2003; however, the record does not contain a service discharge medical examination report. Reviewing the post-service evidence, in a March 2005 VA treatment record, the Veteran reported experiencing recurrent styes, greater in the right eye than the left, which first appeared during her service in Pakistan. The Veteran stated that each of the styes eventually would rupture, causing itchiness and dryness of the eyes. After an examination, the VA examiner diagnosed conjunctival cysts of the tarsal convunctiva in the bilateral eyes and blepharitis. In a September 2005 statement, the Veteran wrote that a VA examiner had examined her eyes and told her that he had never seen so many cysts in a patient's eyelids. The Veteran indicated that the VA examiner told her that she would not be able to have the cysts removed via surgery. In an August 2006 statement, the Veteran reported that her eyelid disorder had worsened as she had grown more cysts. The Veteran indicated that the area around her eyelids was constantly irritated and deformed. In an October 2006 statement, the Veteran wrote that her eye cysts would occasionally come to the surface and rupture, causing an eye problem. The Veteran indicated that she constantly got small bumps on the edges of her eyelids that rubbed against and irritated her eyes. At an October 2009 hearing before a Decision Review Officer (DRO), the Veteran stated that her eye disorder would "come and go." In a November 2009 VA medical examination report, the Veteran stated that she had been diagnosed as having acute conjunctivitis and chalazion. The Veteran indicated that the condition had existed since October 2001 and involved areas on the eyelids, both inside and out. The Veteran indicated that she would experience exudation of the eyelid when a chalazion would rupture. The Veteran also reported experiencing itching and crusting in the corners of the eyes. The Veteran stated that the ruptures were frequent and irregular. She indicated that her vision was affected during ruptures. After an examination, the VA examiner diagnosed chalazion. The VA examiner did not provide an opinion regarding the etiology of the diagnosed disorder. In a September 2011 VA medical examination report, the Veteran reported experiencing recurrent chalazion of the eyelids over many years since 1999. During examination, the VA examiner noted recurrent chalazion and an erythematous rash characteristic of acne rosacea of the face, eyelids, and nose. After an examination, the VA examiner diagnosed acne rosacea with recurrent chalazion or hordeolum on each eyelid. The September 2011 VA examiner did not note reviewing the claims file prior to writing their opinion. Yet, in the September 2011 VA medical examination report, the VA examiner opined that the Veteran's eyelid disorder was less likely than not caused by the Veteran's service. In explaining this opinion, the VA examiner wrote that ocular rosacea was a related to a common inflammatory condition affecting the skin of the face and chest, as well as the eyes. The VA examiner noted that eye involvement with rosacea was not unusual, and that rosacea symptomatology would often include chalazion or hordeolum. The VA examiner wrote that the Veteran's chronic chalazion/hordeolum was directly related to the Veteran's acne rosacea, and that it was highly unlikely that the Veteran's acne rosacea was caused by the Veteran's service. In an attached undated addendum, VA requested that the September 2011 VA examiner provide an additional opinion regarding the etiology of the Veteran's eyelid disorder. Specifically, VA asked the VA examiner to clarify his etiology opinion in light of the service treatment records indicating in-service treatment for chalazion and hordeolum. In response, the VA examiner wrote that acne rosacea is a skin condition characterized by chronic inflammation and eyelid chalazion. Based on the diagnosis and the information provided by VA regarding the service treatment records, the VA examiner opined that the past and present episodes of chalazion were related to acne rosacea. As noted above, the record indicates that the Veteran experienced chronic eyelid disorder symptomatology, characterized by chalazion and hordeolum, during service and after service. In the September 2011 VA medical examination report and addendum, the VA examiner indicated that all occurrences of the eye disorder were caused by acne rosacea. In the September 2011 VA medical examination report, the VA examiner opined that it was highly unlikely that the Veteran's acne rosacea was caused by the Veteran's service. While the rigors of service might not have caused the disorder, under VA regulations, service connection may be granted for any disorder which was incurred in service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303(a). The Board notes that the record contains no notation indicating that the Veteran experienced acne rosacea or any other skin disorder prior to her entrance into service. Yet, the service treatment records indicate an in-service onset of an eyelid/skin disorder, diagnosed by the September 2011 VA examiner as acne rosacea. The post-service treatment records contain notations indicating that the Veteran has a chronic disorder, manifested by the same symptomatology noted during service. In the September 2011 VA medical examination report and addendum, the September 2011 VA examiner stated that the Veteran's in-service and post-service episodes of eyelid disorder symptomatology were all related to acne rosacea. As the record of evidence indicates that the Veteran experienced onset of acne rosacea during service and that the Veteran's current eyelid disorder symptomatology is related to acne rosacea, resolving all doubt in the Veteran's favor, the Board finds that service connection for an eyelid disorder is warranted. See 38 C.F.R. § 3.102. ORDER Service connection for a bilateral eyelid disorder, claimed as cysts of the eyelids, is granted. ____________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals ` Department of Veterans Affairs