Citation Nr: 18154908 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 15-44 201 DATE: December 4, 2018 REMANDED The appeal for entitlement to service connection for bilateral subconjunctival hemorrhages is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1988 to March 1995 and from April 2011 to August 2012, with additional Navy Reserve service. The Veteran is seeking service connection for recurrent swollen blood vessels in both eyes, which he asserts initially began during his second period of active service when he was stationed in Afghanistan. Generally, service connection may be granted for any disability resulting from injury suffered or disease contracted in line of duty, or for aggravation in service of a pre-existing injury or disease. 38 U.S.C. §§ 1110, 1131. Service connection may be established by demonstrating that the disability was first manifested during service and has continued since service to the present time or by showing that a disability which pre-existed service was aggravated during service. Service connection may be granted for any disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. Although the Veteran’s service treatment records do not include any reports generated while the Veteran was in Afghanistan, they do include the report of a June 2012 demobilization examination performed upon the Veteran’s return Stateside. According to this report, initially after arriving in Kabul, the Veteran began experiencing nasal congestion, blood shot and tearing eyes, cough, and sinus pressure. Upon examination at that time, his eyes were normal. The Veteran underwent a VA examination in December 2012. The examiner rendered a diagnosis of recurrent subconjunctival hemorrhages in both eyes. The examiner explained that the Veteran has a “history of recurrent subconjunctival hemorrhages in both eyes while in military service in Afghanistan for 10 months due to paroxysmal coughing resulting from ‘black soot’ from prevalent Afghani trash fires. These resolved after leaving military service and have not recurred since military separation.” Upon clinical examination, the Veteran had “excellent best corrected visual acuity of 20/20 in both eyes at distance and near with no visual limitations to sedentary vocations.” The examiner concluded the report by noting that the broken blood vessels represent a benign condition and that they are “not likely to be a recurrent problem under normal stateside conditions.” Based upon this evidence, the RO denied the claim for service connection on the basis that the subconjunctival hemorrhages had been an acute and transitory disability related to coughing from poor air quality in Afghanistan, and that no post-service current disability was established. Although the Veteran’s recent VA medical treatment records reflect the Veteran’s history of subconjunctival hemorrhages in Afghanistan, there is no record of a recurrence since that time. In his November 2015 substantive appeal, however, he wrote that although he has not had any more swollen vessels in his eyes, they still hurt occasionally. When this occurs, he stated his eyes become very sensitive to everything, such as touch, light, wind, and small debris. To resolve the pain, he must take his glasses off and shut his eyes which still hurt. He stated that eventually the pain goes away and he can move on with his life. The Board finds that the Veteran’s statements as to his current occasional symptoms are credible. Review of the other information in his claims file reveals that he does not appear to be exaggerating any of his other disabilities, and that he is forthright in his dealings with VA generally. Thus, the evidence is undisputed that the Veteran had an inservice injury which caused bilateral subconjunctival hemorrhages. The evidence is also undisputed that the hemorrhages have resolved and have not recurred since his return to the United States. The Veteran’s report of current eye symptoms including sensitivity and pain is credible. The question is whether these current symptoms are related to the inservice episode to support a grant of service connection. This is a medical question requiring medical expertise to resolve. We note a recent decision by the United States Court of Appeals for the Federal Circuit, which may prove to be relevant to this case. In Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018), the Court held that a Veteran’s pain must create a functional impairment to earning capacity to establish the presence of a disability. Thus, for a successful claim based upon eye pain, the Veteran must show 1) that his current eye pain is indeed a residual of the inservice injury or is otherwise related to service, and 2) that his eye pain reaches the level of a functional impairment of earning capacity. In this regard, the December 2012 VA examiner’s opinion that the Veteran had no visual limitations to sedentary vocations requires further elucidation. The Veteran is also claiming occasional eye sensitivity to touch, light, wind, and small debris. This aspect of his eye disability also requires further medical nexus opinion. As the appeal is being remanded anyway, his VA medical records should be updated for the file. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from November 2015 to the Present for inclusion in the Veteran’s claims file. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s currently shown eye pain and sensitivity to touch, light, wind, and small debris is at least as likely as not related to the bilateral subconjunctival hemorrhages in service or aggravated beyond the natural progression of these symptoms by service-connected disability. IF a nexus to service is identified, the reviewer should also provide an opinion as to whether the reported eye pain creates a functional impairment to earning capacity. IF the reviewer deems that further clinical examination and/or testing is warranted to resolve these questions, then such examination and/or testing should be arranged prior to further review of the appeal. (continued on next page) 3. Thereafter, readjudicate the claim. If any benefit sought on appeal remains denied, furnish the Veteran and his representative a supplemental statement of the case and afford an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Heather J. Harter