Citation Nr: 18140185 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 15-15 276 DATE: October 2, 2018 ORDER Service connection for glaucoma is granted. FINDING OF FACT Glaucoma was manifest within a year of service separation. CONCLUSION OF LAW Glaucoma is presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had multiple periods of active service to beginning in 1988, and, importantly, from October 2005 to May 2013. He appeals a September 2014 rating decision denying this claim. He testified at a Board hearing before the undersigned Veterans Law Judge in May 2018, at which time the undersigned agreed to hold the record open for 90 days to allow for the submission of additional evidence.   Service Connection The Veteran primarily contends that his glaucoma is due to service. He testified that the condition manifested in service as glaucoma suspect, noted in 2008, and the full diagnosis of glaucoma was made in late 2013, within a year of his May 2013 separation from service. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1110, 1131. In general, to establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Glaucoma The issue for the Board is whether the Veteran’s glaucoma, initially noted as glaucoma suspect in approximately December 2008 and then diagnosed in late 2013 at VA, manifested in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that Veteran’s glaucoma is a chronic disease pursuant to 38 U.S.C. 1101 (3); 38 C.F.R. 3.309 (a). It is an organic disease of the nervous system. See M21-1 Adjudication Procedures Manual (VBA Manual), Part III, Subpart iv, Ch. 4, Sect. G (recognizing glaucoma as an organic disease of the nervous system). The glaucoma was manifest within the applicable presumptive period, a year following separation from service, service connection is warranted.   Service treatment records show no complaints or findings of glaucoma. VA Treatment records show the Veteran was not identified with glaucoma suspect until about December 2008. VA treatment records show a diagnosis on the right in November 2013 and on the left in March 2014. The March 2015 VA examining ophthalmologist physician offered a negative opinion that the glaucoma was, “less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.” The rationale was as follows: This patient undoubtedly has uncontrolled open angle glaucoma today--despite two previous surgical procedures and an intolerance to topical glaucoma medications. There is no reported proximal service connected incident that can be attributed as a casual etiology for his glaucoma OD. Early VA records indicate the possibility of his maternal grandmother having possible glaucoma. The only possible traumatic event relating to his right eye (in or out of service) was the IED explosion in Iraq in 2003 which "slammed" his right side of his face against the inside of his vehicle. But he denies any direct trauma to his right eye or any resulting ocular sequelae requiring any immediate or subsequent medical attention or treatment. He was not diagnosed to be a "Glaucoma Suspect" until many years later in 2008. So the likelihood that his current glaucoma is traumatic in origin is remote. Even though his glaucoma is more advanced in his right eye today, his left eye has ocular hypertension (Glaucoma Suspect--the identical presenting signs as with his right eye years ago) if not actual chronic open angle glaucoma already. And there is absolutely no claim that the condition in his left eye has any service connection whatsoever. The probability that his current chronic open angle glaucoma OD (and even possibly OS) has its origins with this patient as it does with all other patients in the general (non-military) populations is much more likely--viz. de novo. In addition, the working diagnosis/condition (GLAUCOMA WITH APHAKIA) for this claim is incorrect. Aphakia means that the anatomic lens is absent--either by trauma or surgical removal. This patient is actually PHAKIC OU, which means that his anatomic lenses are still present OU. Perhaps had this patient been APHAKIC, there may be reason to suspect some type of previous traumatic insult to his eye--which could also result in glaucoma. But since the patient is still PHAKIC, there is no basis to suspect his glaucoma is caused by anything other than hereditary or just de novo (like the general population). My conclusion is there is no direct service connection, no secondary service connection, no aggravation of a pre-service disability, and no aggravation of a non-service connected disability by a service connected disability.   Here, while the Board notes this negative etiology opinion, it also notes that glaucoma is in fact a chronic disease subject to presumptive service connection as set forth above. The Board finds that the glaucoma was present within a year of service separation and manifest to a compensable degree. Service connection is warranted. 38 C.F.R. §§ 3.307, 3.309. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Rippel, Counsel