Citation Nr: 18146275 Decision Date: 10/31/18 Archive Date: 10/30/18 DOCKET NO. 11-20 811 DATE: October 31, 2018 ORDER Entitlement to service connection for a bilateral eye condition is denied. Entitlement to service connection for right ear hearing loss is denied. FINDINGS OF FACT 1. The Veteran's current bilateral eye condition was not present in service or for many years thereafter, and is not otherwise etiologically related to service. 2. The Veteran's right ear hearing loss was not present in service or for many years thereafter, and is not otherwise etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral eye condition have not been met. 38 U.S.C. §§ 1110, 1131; 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1110, 1131; 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS This claim was the subject of three previous Board remands. In October 2014, the Board remanded the Veteran's claim so that additional records could be associated with the file. In August 2016, the Board remanded the claim so that an examination and addendum opinion could be completed. As further medical opinions were necessary regarding the nature and etiology of the Veteran's disabilities, the Board again remanded the claim in November 2017 to obtain such an opinion. The Board notes that the opinions rendered by the March 2018 and July 2018 VA examiners comply with the directives of the November 2017 Board remand. As such, no further remand is necessary. Service Connection Service connection is awarded for disability that is the result of a disease or injury in active service. 38 U.S.C. § 1110. 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), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107 (b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 1. Eye Condition The Veteran asserts that her current eye condition began in or is otherwise related to her active duty service. Specifically, she states that the note of blurry vision on her exit examination is evidence of her current eye condition. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, or disease. The Board concludes that, while the Veteran has diagnoses of cataracts and pseudophakia OS, the preponderance of the evidence is against finding that either of these began during active service, or are otherwise related to an in-service injury or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). On the Veteran's report of medical history filled out during her separation examination, she indicated that she had occasional blurred vision. The Veteran indicated that there was no injury that caused the blurred vision. The March 2018 VA examiner stated that the Veteran's in-service blurred vision could not have been an early indication of the Veteran's current cataracts or pseudophakia. The reason being, the blurred vision caused by her current conditions is constant, not occasional. As the Veteran described her blurriness as occasional, they could not be the same thing. Further, the Veteran's vision upon separation was noted as 20/20 for both near and distant vision. While the Veteran believes her cataracts are related to her in-service blurred vision, she is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the VA examiner. The Board has considered the benefit-of-the-doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim, so that doctrine is not applicable. 2. Right Ear Hearing Loss The Veteran asserts that her right ear hearing loss is due to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease. The Board concludes that, while the Veteran has a current diagnosis of right ear hearing loss, and evidence shows that the Veteran was exposed to loud noise while in service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of right ear hearing loss began during service or is otherwise related to an in-service injury or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show the Veteran was not diagnosed with right ear hearing loss until 2011, more than 35 years after her separation from service. Further the Veteran’s medical records and testimony indicate that she did not have surgery to repair a ruptured ear drum until 1978, two years after separation. While the Veteran is competent to report having experienced symptoms of decreased hearing since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of hearing loss disability. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The record contains conflicting medical opinions regarding whether the Veteran’s right ear hearing loss is at least as likely as not related to an in-service injury or disease, including noise exposure. The July 2018, November 2016, and July 2011 VA examiners opined that the Veteran's right ear hearing loss was less likely as not related to an in-service injury or disease. The rationale was that the conductive hearing loss the Veteran suffered is not due to noise exposure. Further, the Veteran had normal hearing upon separation from service. The VA examiners’ opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The July 2018 VA examiner further addressed the Veteran's conductive hearing loss. This examiner stated that if the Veteran's ear drum had been punctured upon separation, she would have had conductive hearing loss upon separation. As she did not have any hearing loss at her separation examination, the rupture must have taken place after service. The examiner also stated that the Veteran's otitis externa would not have caused a punctured ear drum. Private practitioner JE opined that the Veteran's right ear hearing loss was at least as likely as not related to her service. The rationale was that the Veteran had a documented external ear infection and an undocumented internal infection which caused the ruptured ear drum. This opinion is, however, less probative than the VA examiner’s opinion. JE’s opinion is speculative as there is no evidence in the Veteran's service treatment records of an internal ear infection. Further this opinion does not explain the lack of right ear hearing loss upon separation that would accompany a ruptured or punctured ear drum. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Consequently, the Board gives more probative weight to the multiple VA examiners’ opinions. While the Veteran believes her right ear hearing loss is related to an in-service injury or disease, including exposure to helicopter engines and gunfire, she is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinions of the three VA examiners. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Uller