Citation Nr: 18152597 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 16-41 102 DATE: November 23, 2018 ORDER Service connection for residuals of an injury of the right eye is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has a right eye disability that is due to an event, injury, or disease in service. CONCLUSION OF LAW The criteria for service connection for a right eye disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, served on active duty from September 1960 to September 1983. The case was previously before the Board in May 2017. At that time, the issues of entitlement to service connection for a right eye disability, right knee arthritis, degenerative disc disease of the lumbar spine, hypertension, and residuals of a stroke were remanded for further development of the evidence. After development, service connection was established for all but the right eye disability. That issue has now been returned for further appellate consideration. Service connection for residuals of an injury of the right eye Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition, as identified in 38 C.F.R. § 3.309(a), noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). VA regulations provide that refractive error of the eyes are not diseases or injuries within in the meaning of applicable legislation for disability compensation purposes. See 38 C.F.R. §§ 3.303(c), 4.9; see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). Presbyopia is a visual condition that becomes apparent especially in middle age and in which loss of elasticity of the lens of the eye causes defective accommodation, and inability to focus sharply for near vision. McNeely v. Principi, 3 Vet. App. 357, 364 (1992). Presbyopia is “hyperopia and impairment of vision due to … old age.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1349 (28th ed. 1994). Hyperopia is that error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus behind the retina, as a result of the eyeball being too short from front to back … Called also farsightedness and hypermetropia.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 797 (28th ed. 1994). Myopia is that error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1094 (28th ed. 1994). Astigmatism is due to unequal curvature of the refractive surfaces of the eye, hence a point source of light cannot be brought to a point focus on the retina, but is spread over a more or less diffuse area. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 151 (28th ed. 1994). The government may carry its burden of showing that there was no aggravation of a congenital, developmental, or hereditary disease “‘by establishing that there was no increase in disability during service or that any increase in disability was due to the natural progress of the preexisting condition.’” O’Bryan v. McDonald, 771 F.3d 1376, 1381 (Fed. Cir. 2014). In order to prevail on the issue of service connection, there must be medical evidence of current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1990). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1990); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board has reviewed all the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence where appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran contends that service connection is warranted for his current right eye disabilities, which have been diagnosed as cataracts, myopia, astigmatism, hyperopia, and presbyopia. It is asserted that he sustained an injury in service when he was struck in the eye by a baseball, and that this has caused the development of the disorders in his right eye. The Veteran’s service treatment records (STRs) confirm that he sustained an injury to his right eye while playing baseball in December 1965. The diagnosis at that time was hyphenia due to trauma, manifested by hemorrhage. 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 the in-service injury he sustained to his right eye. The Board concludes that, while the Veteran has various diagnoses in the right eye and the evidence also shows he sustained a right eye injury in service, the preponderance of the evidence weighs against finding that the Veteran’s current diagnoses of cataracts, myopia, astigmatism, hyperopia, and presbyopia began during service or are otherwise related to an in-service injury, event, 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). A review of the Veteran’s STRs shows that after his right eye injury in service and throughout the remaining years of his active duty, there were no complaints, findings, or treatment for any manifestations of residuals of the eye trauma that he sustained, with eye examinations being normal, but for myopia and astigmatism. Post-service medical evidence includes two examinations that were conducted by VA. The first, performed in April 2015, included diagnoses of cataracts of both eyes, hyperopia of both eyes, and presbyopia of both eyes. After examination and review of the evidence, the examiner rendered an opinion that the claimed conditions were less likely than not incurred in or caused by a claimed in-service injury, event or illness. The rationale was that the treatment for a right eye disorder resolved without complications and that the Veteran’s current vision complaints were more likely than not secondary to uncompensated refractive error and age-related cataracts. A second VA examination was conducted by VA in September 2017 pursuant to the Board’s remand. At that time, the examiner was asked to render an opinion regarding whether the Veteran’s cataracts were likely to be related to the injury he sustained in December 1965. The examiner stated that they were less likely than not incurred in or caused by the in-service injury. It was explained that although STRs showed that the Veteran suffered hyphema with hemorrhage to the right eye in December 1965, during follow-up visits for this injury in March and April 1966, the Veteran’s eyes were noted to be normal with normal pressures and no ocular pathology. Military physicals from 1970 to 1981 also noted normal eyes with no ocular trouble. An eye examination in May 2015 noted vision problems due to refractive error and age-related cataracts. The current examination confirmed the diagnosis was age-related cataracts, with no other ocular pathology. In addition, the examiner noted that the Veteran had hyperopia, a congenital refractive error, and presbyopia, an age-related refractive error. This accounted for the Veteran’s complaints of blurred vision, along with senile cataracts. The blurry vision was less likely than not incurred in, cause by, or medically related to active military service, including any trauma he may have suffered during the in-service baseball accident. Specifically, the myopia, astigmatism, hyperopia and presbyopia were not affected by the in-service accident to the right eye. The rationale included that the medical records did not indicate any injury to the right eye other than being hit with a ball in December 1965, with no residuals of that injury present on the current examination. The injury did not accelerate the rate of decreased vision as the vision continued to be 20/20 on physical examination in February 1981 and correctable to 20/50 distance and 20/20 near on current examination. Visual acuity was the same in both the right and left eyes, indicating that the right eye trauma did not affect visual acuity. Taken together, the two VA opinions of record establish that the Veteran’s current right eye disorders are not at least as likely as not related to an in-service injury, event, or disease, including the right eye trauma incurred in December 1965. The VA examiners opined that the Veteran’s disabilities were not at least as likely as not related to the injury. The combined rationale was that his cataracts were age-related and the refractive error was not worsened by the right eye trauma. The examiners’ combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his right eye disorders are related to an in-service injury, event, or disease, he 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 or the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA medical opinions. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for residuals of an injury of the right eye, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joseph P. Gervasio