Citation Nr: 18150302 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-35 728 DATE: November 14, 2018 ORDER Entitlement to service connection for glaucoma, including as secondary to service-connected diabetes mellitus type II, is denied. REMANDED Entitlement to service connection for bilateral peripheral neuropathy of the upper and lower extremities is remanded. FINDING OF FACT The evidence is at least in relative equipoise that the Veteran has a current diagnosis of glaucoma; however, there is no competent evidence suggesting it is related to his service or his diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for glaucoma, including as secondary to service-connected diabetes mellitus type II, have not been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1965 to September 1968, including service in the Republic of Vietnam. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Regional Office (RO) rating decision dated August 2014 which denied service connection for glaucoma, bilateral upper extremity peripheral neuropathy, and bilateral lower extremity peripheral neuropathy, all claimed as secondary to the Veteran’s service-connected diabetes mellitus type II (diabetes). During the pendency of this appeal, the RO issued a rating decision dated July 2018 granting the Veteran service connection for certain conditions secondary to Parkinson’s Disease (paralysis agitans) associated with herbicide agent exposure, including tremors with muscle rigidity and stiffness in his right upper extremity and tremors in his left upper extremity. The Board has thoroughly reviewed all evidence in the claims file. Consistent with the law, the analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim, and the Board’s reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The appellant must not assume the Board has overlooked evidence not explicitly discussed herein. In addition, pertinent regulations for consideration were provided in the July 2011 statement of the case and are not repeated here in full. Neither the appellant nor his representative raised any issues with the duty to notify or the duty to assist not addressed herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Thus, the Board need not discuss any potential issues in this regard. Finally, neither the appellant nor her representative has raised any other issues not addressed herein, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming Board not required to address issues unless specifically raised by claimant or reasonably raised by evidence of record). Service Connection - Glaucoma The Veteran seeks service connection for glaucoma, which he contends is caused by his service-connected diabetes. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires competent evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service; and (3) a causal relationship or nexus between the current disability and any injury or disease during service. See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may also be established for those “chronic diseases” listed in 38 C.F.R. § 3.309(a) where the evidence shows a diagnosis manifest to a compensable degree within the presumptive period after service, or a continuity of symptomatology since service. See 38 C.F.R. §§ 3.303(b), 3.307; Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). In addition, if a veteran was exposed to an herbicide agent (such as Agent Orange) during active service, presumptive service connection is warranted for several medical conditions. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a), 3.309(e). Secondary service connection may be established for a non-service connected disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. To substantiate a secondary service connection claim, the Veteran must show: (1) a present disability (for which service connection is sought); (2) a service-connected disability; and (3) competent evidence that the service-connected disability caused or aggravated the disability for which service connection is sought. The threshold question that must be addressed with respect to this claim is whether the Veteran has a current disability of glaucoma. Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“In the absence of proof of a present disability there can be no valid claim.”). The Veteran underwent VA examinations for his eyes in February 2012 and July 2014, both of which diagnosed him with “glaucoma suspect” as opposed to actual glaucoma. The July 2014 examiner noted the Veteran was taking preventative medication (Xalatan a/k/a latanoprost) for his condition. Although the Veteran’s VA treatment records do not contain a formal diagnosis of actual glaucoma, they do include glaucoma in his list of active medical problems, with an onset of date of December 2015, and further show the Veteran continues to take latanoprost once per day and another medication, brimonidine, three times per day, for glaucoma. He also undergoes periodic follow up eye check-ups to monitor his condition. Resolving reasonable doubt in favor of the Veteran, the Board finds the evidence is in at least relative equipoise that he has a current glaucoma disability. Turning next to the Veteran’s contention that his glaucoma is caused by his service-connected diabetes, the February 2012 VA examiner opined the Veteran’s condition (then diagnosed as glaucoma suspect) “is unlikely due to or the result of” his service connected diabetes because glaucoma “is a completely separate identifiable disease that is independent of diabetes.” The July 2014 VA examiner opined the Veteran’s condition (also then diagnosed as glaucoma suspect) is not as likely proximately due to or the result of his service-connected diabetes because there have been “no links” between diabetes and glaucoma. The Board finds theses opinions highly probative because they are each based on a review of the medical evidence in the record and physical examination of the Veteran, and set forth adequate rationale and sound reasoning (i.e., glaucoma is independent of and has no link to diabetes). See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In addition, an August 2016 VA treatment record shows a VA nurse practitioner explained to the Veteran that glaucoma is not complicated by diabetes, that many patients that do not have diabetes have glaucoma and vice versa. The Board finds the nurse practitioner’s statement to be probative evidence that the Veteran’s service-connected diabetes did not aggravate his glaucoma condition, as it based on the absence of a medical link between the two conditions. The Board finds the preponderance of the evidence shows the Veteran’s service-connected diabetes did not cause or aggravate his glaucoma condition. Secondary service connected is not warranted. The Board also notes the medical evidence does not show diagnosis of diabetic retinopathy. As to direct service connection, no presumption of service connection is applicable to the Veteran’s glaucoma because it is not on the list of diseases for which service connection is presumed based on herbicide agent exposure, nor the list of chronic diseases. Service treatment records make no mention of glaucoma and there is no evidence linking those conditions to the Veteran’s active service. For these reasons, the Board concludes the in-service and nexus elements have not been met as far as direct, including presumptive, service connection for glaucoma. The Board has considered the applicability of the benefit-of-the-doubt doctrine and finds it inapplicable because the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND The claims of entitlement to service connection for bilateral peripheral neuropathy of the upper and lower extremities are remanded. The RO denied these claims on the basis the Veteran did not have a peripheral neuropathy disability, based on the findings and opinions of the July 2014 VA examiner. However, a January 2014 VA treatment record shows the Veteran reported he had been diagnosed with diabetic neuropathy, had been receiving weekly neuropathy treatments for his arms and legs at Regenerate Neuropathy Center for the past 2½ months, and was continuing to do so. As these private medical records are relevant to adjudicating the Veteran’s claims for bilateral peripheral neuropathy of the upper and lower extremities, VA has a duty to assist the Veteran in obtaining them. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). In addition, the July 2014 VA examiner concluded the Veteran did not have upper extremity diabetic peripheral neuropathy, but rather bilateral carpal tunnel syndrome. The examiner stated carpal tunnel syndrome “can be more prevalent in diabetics,” but that he could not resolve whether the Veteran’s service-connected diabetes caused or aggravated his carpal tunnel syndrome without resort to mere speculation, without providing any supporting analysis or reasons to explain why an opinion could not be provided. That opinion is inadequate. See Jones v. Shinseki, 23 Vet. App. 382 (2010). Moreover, although the Veteran contends his asserted peripheral neuropathy is the result of his service-connected diabetes, the intervening grant of service connection for certain Parkinson’s Disease-related conditions affecting the Veteran’s bilateral upper and lower extremities warrants a VA addendum medical opinion addressing whether the Veteran’s asserted peripheral neuropathy and/or diagnosed bilateral carpal tunnel syndrome were caused or permanently worsened by his service-connected Parkinson’s Disease. Accordingly, the matters are REMANDED for the following action: 1. Send the Veteran a letter asking him to identify and authorize VA to obtain all private treatment records from Regenerate Neuropathy Center and any other provider the Veteran has been seen for any neuropathy-related conditions, and notifying him that, in the alternative, he can obtain these records and submit them to VA. Document all efforts and any negative responses in the claims file. 2. DO NOT schedule the VA examination until the above records have been obtained to the extent possible. 3. Then, schedule the Veteran for a VA examination. The examiner is requested to provide an opinion as to the following questions: (a.) Does the Veteran have a current diagnosis of peripheral neuropathy of the left and/or right upper and/or lower extremities? For any currently-diagnosed neuropathy indicated, thoroughly explain the current nature of the disability. (i) If Veteran has currently-diagnosed peripheral neuropathy, is it at least as likely as not (i.e., at least a 50 percent probability) that the condition was caused or aggravated (permanently worsened) by any of his service-connected disabilities (to include diabetes mellitus type II and Parkinson’s Disease)? (b.) Does the Veteran have a current diagnosis of carpal tunnel syndrome? For any current diagnosis indicated, thoroughly explain the current nature of the disability. (i) If the Veteran has currently-diagnosed carpal tunnel syndrome, is it at least as likely as not (i.e., at least a 50 percent probability) that the condition was caused or aggravated (permanently worsened) by any of his service-connected disabilities (to include diabetes mellitus type II and Parkinson’s Disease)? A complete rationale for all opinions rendered is required. If the medical professional is unable to provide any required opinion, he or she should explain why. If he or she cannot provide an opinion without resorting to mere speculation, he or she must provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Leamon, Associate Counsel