Citation Nr: 18155738 Decision Date: 12/06/18 Archive Date: 12/04/18 DOCKET NO. 12-30 857 DATE: December 6, 2018 ORDER Entitlement to service connection for a right eye disability other than non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar, to include as secondary to service-connected right eye disability, is denied. Entitlement to service connection for a left eye disability, to include as secondary to service-connected right eye disability, is denied. FINDINGS OF FACT 1. The Veteran’s right eye disorders other than non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar did not have their onset in service and are not otherwise related to service or a service-connected disability. 2. The Veteran’s left eye disorders did not have their onset in service and are not otherwise related to service or a service-connected disability. 3. The Veteran’s floaters and impaired night vision are not reflective of a separate disability, but rather are symptoms of his currently-diagnosed bilateral cataracts. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right eye disability other than non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar are not met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.9. 2. The criteria for entitlement to service connection for a left eye disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.9. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from September 1964 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2014, the Veteran testified before the undersigned Veterans Law Judge. The appeal was remanded in April 2015 and June 2017 for further development. In May 2018, the Board requested a Veterans Health Administration (VHA) expert medical opinion. In September 2018, the Board provided the Veteran with a copy of the opinion and informed him of his right to submit any additional evidence or argument within 60 days of the notification letter. The Veteran responded, indicating he had no further evidence or argument to submit; therefore, the Board will proceed with adjudication of this appeal. Service Connection 1. Entitlement to service connection for a right eye disability other than non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar, to include as secondary to service-connected right eye disability, is denied. 2. Entitlement to service connection for a left eye disability, to include as secondary to service-connected right eye disability, is denied. Service connection may be established for a disability resulting from injury or disease incurred in or aggravated during active service. 38 U.S.C. § 1110. 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). Generally, to establish service connection the evidence 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 in or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Secondary service connection generally requires (1) a current disability; (2) a service-connected disability; and (3) a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran asserts that his bilateral eye disability is a result of an in-service right eye injury and subsequent surgery. Alternatively, he maintains that his bilateral eye disability is secondary to his service-connected right eye non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar disability. See October 2011 VA Form 9 and December 2014 Board Hearing Transcript at 4, 10. The Veteran has current diagnoses of bilateral dispersion syndrome, bilateral refractive error, left eye cataract, left eye macular degeneration, left eye vitreoretinal tuft, and left eye pterygium. See September 2015 VA examination report. Notably, refractive errors are not considered diseases or injuries for VA purposes, and the Veteran does not allege, and the record does not otherwise support, any superimposed disease or injury on such refractive error resulting in additional disability. 38 C.F.R. §§ 3.303(c), 4.9; see also VAOPGCPREC 82-90 (1990). Thus, refractive error is not available for service connection and will not be further addressed. Thus, given the other current diagnoses of record, element one is met for his bilateral eye disabilities for both direct and secondary service connection. Regarding element two for direct service connection, in-service incurrence of a disease or injury, the Veteran’s service treatment records (STRs) note an injury to his right eye after he was struck by a flying piece of wire causing a corneoscleral laceration, which was subsequently surgically repaired. See September 1967 STR. Moreover, the Veteran is service-connected for right eye non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar. Thus, element two is met for his bilateral eye disabilities as to an in-service injury and for secondary service connection. As to element three of direct and secondary service connection, nexus, the only competent opinion, that of the June 2018 VHA expert, is against the claims (the Board notes that the March 2010 and September 2010 VA examiners only offered opinions on the Veteran’s already service-connected right eye disability and the September 2015 and July 2017 VA examination reports are inadequate, but notably rendered negative nexus opinions so there is no prejudice to the Veteran in not considering them). Specifically, the VHA expert opined that it is extremely unlikely (much less likely than a 50 percent probability) that a nuclear cataract left eye, bilateral dispersion syndrome, left eye macular degeneration, left eye vitreoretinal tuft, left eye pterygium not affecting the vision 40 plus years later (it is documented that visual acuity was 20/20 in both eyes in 2010) had their onset in service or are otherwise related to service, including injury to the right eye or subsequent surgery done in the 1960’s; are casually related to service-connected elderly (floaters). Regarding bilateral dispersion syndrome, he noted that while pigment dispersion can potentially be caused by direct trauma to the eye, pigment over trabecular meshwork would be expected to cause no visual symptoms (especially no night driving problems or floaters). Moreover, he stated that trauma to the right eye would not cause pigment dispersion in the left eye, although the March 2010 VA examiner describes heavy endothelial pigment over trabecular meshwork in the left eye. As to left eye vitreoretinal tuft, he noted this disorder is a common variant usually found incidentally. Regarding left eye pterygium, he indicated this disorder is related to sun exposure over many years and neither was reported to be present soon after service nor should cause night blindness or floaters. Finally, he noted that hyperopia and presbyopia disorders are not trauma related either. There is no competent evidence to the contrary. The Board acknowledges the Veteran’s statements that his in-service right eye injury caused his current right eye disorders in addition to service-connected right eye non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar and his current left eye disorders or that his bilateral eye disabilities are secondary to his service-connected right eye disability. However, the Veteran is not competent to opine on the etiology of his bilateral eye disabilities, as to do so requires specialized training and expertise. As a lay person, he does not have the requisite medical expertise to reach such conclusions on inherently medical questions. The link between his current bilateral eye disabilities and his in-service right eye injury or service-connected right eye disability is one requiring specialized training sufficient to render such an opinion. The Veteran has not indicated that he has such training and experience. Thus, the preponderance of the evidence is against a finding that the Veteran’s right eye disability other than his service-connected right eye non-reactive conjunctival embedded foreign bodies with cataracts and limbus scar and his left eye disability were incurred in service or otherwise related to service, or are proximately due to or have been aggravated by his service-connected right eye disability. Accordingly, the benefit-of-the-doubt doctrine is not applicable in this instance, and the claims for entitlement to direct and secondary service connection for his bilateral eye disabilities are not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Asante, Associate Counsel