Citation Nr: 18152802 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 15-06 138 DATE: November 26, 2018 ORDER Entitlement to service connection for a retinal hole in the left eye is denied. FINDING OF FACT The Veteran did not incur an event, injury, or disease related to his current left eye disorder of a retinal hole or macular degeneration during active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for a retinal hole in the left eye have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1966 to February 1968. VA’s duty to assist includes providing a medical examination and/or obtaining a medical opinion when necessary to make a decision on a claim, as defined by law. See 38 U.S.C. § 5103A (2012); 38 C.F.R. §§ 3.159(c)(4), 3.326(a) (2017); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Veteran has not been provided with a VA examination for his service connection claim. However, as explained below, the Board finds that there was no event, injury, or disease related to the Veteran’s current left eye disorder that occurred in service, which is one of the criteria needed for entitlement to a VA examination. McLendon, 20 Vet. App. at 81; see 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). VA, therefore, has no duty to provide a medical examination for this claim. The Veteran contends that his retinal hole in the left eye was caused by his active duty service. Specifically, he and his representative contend that his visual acuity worsened during his active duty service from February 1966 to February 1968, which caused the current left eye retinal hole. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a) (2012). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Initially, the Board notes that the Veteran has been diagnosed with a left eye disorder. Specifically, numerous VA and private treatment records since 2005 show that he has been diagnosed with macular degeneration. For example, a September 2005 VA addendum note showed that he had a stage 3 macular hole on his left side. Likewise, he complained of a hole in the left retina and was diagnosed with macular degeneration in an April 2008 private treatment record. Thus, the first element of service connection is met. However, the Board finds that the Veteran did not incur an event, injury, or disease related to his current left eye disorder of a retinal hole or macular degeneration during active duty service. Specifically, his service treatment records do not show complaints of or treatment for any left eye retinal hole or macular degeneration. For example, the Veteran’s February 1965 pre-induction report of medical examination noted that his eyes were normal. His uncorrected distance and near vision was 20/20 in both eyes. Likewise, his November 1965 pre-entrance report of medical examination also noted that his eyes were normal. His uncorrected right eye had 20/30 vision and his left eye had 20/25 vision. An evaluator also noted that the Veteran’s eyes were normal in the January 1968 service separation report of medical examination. The Veteran’s uncorrected distance vision in the right eye was 20/40 and 20/20 in the left eye. His uncorrected near vision was 20/20 in both eyes. Both eyes were correctable to 20/20 vision. The Board also notes that the Veteran denied any eye trouble in the reports of medical history from February 1965, November 1965, and January 1968. The remainder of the Veteran’s service treatment records do not discuss any abnormal left eye symptoms. The record shows that the Veteran first complained of left eye symptoms in April 2005. Specifically, an April 2005 VA nursing note shows that he complained of being unable to see clearly and blurred vision in the left eye for the previous month. Additionally, April 2005 and June 2005 VA outpatient interdisciplinary notes show that the Veteran’s symptoms of blurred vision in the left eye were diagnosed as a retinal tear and that he had macular degeneration. The Board acknowledges the Veteran’s statements in his September 2013 notice of disagreement (NOD) and February 2015 substantive appeal to the Board (VA Form 9), as well as those statements from the Veteran’s representative in an October 2018 informal hearing presentation, contending that the current retinal hole in the left eye developed because the Veteran’s vision in the left eye worsened or deteriorated from his entrance into active duty service to his separation from active duty service. They asserted that the Veteran’s vision acuity was 20/20 upon entrance into service but deteriorated during his active service to the point of being 20/40 during his service separation evaluation. In the October 2018 informal hearing presentation, the Veteran’s representative asserted that this change in vision acuity represented a “threshold shift” in vision, which was similar to a shift in puretone thresholds for hearing loss. VA does not compensate for refractive error. Under 38 C.F.R. § 3.303(c) and 38 C.F.R. § 4.9 (2017), refractive errors are considered congenital or developmental defects and are not a disease or injury for VA purposes. See Winn v. Brown, 8 Vet. App. 510, 516 (1996). Additionally, the Board notes that visual acuity of 20/40 is considered normal vision for VA purposes. See 38 C.F.R. § 4.75(c) (2017). Furthermore, while the Board acknowledges the lay statements from the Veteran and his representative that the Veteran’s eyesight worsened from 20/20 at the outset of the Veteran’s active duty service to 20/40 visual acuity during the service separation evaluation, a more thorough review of the January 1968 service separation report of medical examination shows that that the visual acuity in the left eye was 20/20 for both uncorrected distance and near vision. Rather, the 20/40 visual acuity was assigned for the right eye, and entitlement to service connection for a right eye disorder is not presently before the Board. Moreover, while the Veteran and his representative are competent to report symptoms that they perceived through their own senses, they are not competent to offer an opinion as to the cause of the Veteran’s retinal hole in the left eye due to the medical complexity of the matter involved. A retinal hole or macular degeneration require specialized training for a determination as to diagnosis, causation, and progression, and are therefore not susceptible to lay opinions on diagnosis, causation, or aggravation. Thus, the Veteran and his representative are not competent to render opinions or attempt to present lay assertions to establish the cause of this disorder. Overall, the preponderance of the evidence is against a finding that the Veteran incurred an event, injury, or disease related to his current left eye disorder of a retinal hole or macular degeneration during active duty service. The Board’s finding is buttressed by the fact that he was first diagnosed with this disorder in 2005, or approximately 37 years after separation from active duty. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Hodzic, Counsel