Citation Nr: 18143192 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 14-03 176 DATE: October 18, 2018 ORDER Entitlement to service connection for diabetic retinopathy, to include as secondary to service-connected diabetes mellitus is denied. FINDING OF FACT An eye disability, to include diabetic retinopathy, incipient senile cataracts, atrophic nasal pterygium, and blepharitis is not related to military service nor is it secondary to service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for establishing service connection for diabetic retinopathy, to include as secondary to service-connected diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from January 1968 to December 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for diabetic retinopathy, to include as secondary to service-connected diabetes mellitus Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.303, Hickson v. West, 12 Vet. App. 247, 252-53 (1999). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may not be granted without medical evidence of a current disability and medical evidence of a nexus between the current disability and a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512-14 (1998); see also Allen v. Brown, 7 Vet. App. 439, 488 (1995). The Veteran applied for service connection for several conditions, using a letter from a private physician summarizing the Veteran’s health problems to describe which disabilities the application encompassed. The letter noted the Veteran “presents Diabetes Mellitus type 2 with poor control of glycemia, blurred vision, and paresthesias in upper and lower limbs.” At the end of the letter, the physician included a list of diagnoses, including diabetic retinopathy. The Veteran did not submit any medical records from this private physician, nor did he submit an authorization for VA to attempt to obtain the records related to the diagnosis of diabetic retinopathy. A disability questionnaire filled out by this private physician noting a diagnosis of diabetic retinopathy is present in the Social Security Administration files associated with the record in this case, but these do not contain medical records related to the diagnosis, such as diagnostic testing. Likewise, the Veteran did not submit any private records from any provider related to diabetic retinopathy. The Veteran’s service treatment records contain his separation examination, performed in November 1970. The notes pertaining to the Veteran’s vision indicate that it was normal at that time, and there are no notes of any complaints relating to the eyes, such as infections or discomfort. In October 2011, the Veteran attended a VA diabetes mellitus examination. The examiner noted that diabetic neuropathy was a complication of the Veteran’s diabetes mellitus disability, but not diabetic retinopathy. The examiner further noted that the diabetes mellitus disability had not aggravated any other eye condition. Although the Veteran was followed for complications of diabetes mellitus and underwent routine annual eye examinations to surveil for diabetic retinopathy, a July 2011 retinal scan did not detect diabetic retinopathy. A November 2012 retinal scan did not note any active retinal diabetic changes, but noted retinal drusens and diagnosed incipient cataracts. Similar results were noted in April 2014, June 2015, May 2016, and September 2017 annual screenings. In February 2016, the Veteran was afforded a VA eye conditions examination, at which he was diagnosed with bilateral incipient senile cataracts, bilateral atrophic nasal pterygium, and bilateral mild blepharitis. The examiner also noted a refractive error in both eyes; the right eye measured distance visual acuity of 20/100 and the left eye measured 20/70. The visual acuity was noted to be corrected to 20/20 in both eyes. The examiner performed a dilated fundus examination, which detected no diabetic retinopathy in either eye. The examiner opined that the Veteran’s vision complaints are due to incipient senile cataracts, refractive error, hyperopia, astigmatism, and presbyopia, and that they are not due to diabetes mellitus. The examiner concluded that the cataracts are changes typical for a person of the Veteran’s age, and that pterygium and blepharitis were not noted in the service treatment records. In December 2017, the same examiner completed an addendum opinion regarding the Veteran’s claim for service connection for diabetic retinopathy. The examiner clarified that blepharitis is most often caused by a staphylococcal or demodex infection, or by a skin condition, and that atrophic nasal pterygium is caused by long-term exposure to sunlight, ultraviolet rays, wind, and chronic eye irritation from dry, dusty conditions. The examiner further noted that cataracts – the yellowing and hardening of the central portion of the crystalline lens – grow slowly over years, and that the Veteran’s cataracts are still early, and that his vision is still able to be corrected to 20/20 in both eyes. The examiner noted that the diagnosis of cataracts at the Veteran’s age is not earlier than usual. The examiner opined that, since no eye conditions were reported in service, the current eye conditions are not etiologically related to service, as they were not diagnosed until more than 40 years later. The examiner further explained that these diagnosed eye conditions are not known to be caused by diabetes, but rather by the factors described above – infection, environmental exposure, and age. Finally, the examiner noted that the letter from the private physician listing a diagnosis of diabetic retinopathy was not supported by any ocular examination. The Board finds the opinions of the VA examiner, taken together, to be probative, as they are based on the facts of the Veteran’s circumstances and are supported by medical research. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned). Further, there is no evidence in the record supporting a nexus between any of the diagnosed eye conditions, including incipient senile cataracts, atrophic nasal pterygium, and blepharitis, and the Veteran’s service, or between the eye conditions and the Veteran’s service-connected diabetes mellitus. Although the record contains a diagnosis of diabetic retinopathy by the Veteran’s private physician, this diagnosis is not supported by any evidence of an eye examination or other information describing how the diagnosis was made. The Veteran’s VA treatment records reflect that he undergoes retinal screening for diabetic retinopathy annually, and that none of these screenings have detected diabetic retinopathy. Therefore, as the preponderance of the evidence weighs against a finding that there is a current diagnosis of diabetic retinopathy, the Board finds that the only current disabilities are the diagnoses identified in the VA treatment records and on the VA examination, specifically incipient senile cataracts, atrophic nasal pterygium, and blepharitis. As there is no evidence of a nexus between any of these current disabilities and the Veteran’s service or his service-connected diabetes mellitus, service connection for an eye disability is not warranted. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Josey, Associate Counsel