Citation Nr: 18157462 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 10-04 348 DATE: December 13, 2018 ORDER Entitlement to service connection for a bilateral eye condition claimed as glaucoma, to include as secondary to service-connected hypertension and/or diabetes mellitus type II, is denied. FINDING OF FACT The Veteran’s bilateral eye condition is neither proximately due to, nor aggravated beyond its natural progression, by his service-connected hypertension or diabetes mellitus type II, and is not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral eye condition claimed as glaucoma, to include as secondary to service-connected hypertension and/or diabetes mellitus type II, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from August 1987 to January 1988 and from January 2003 to April 2004. This matter before the Board of Veterans’ Appeals (Board) is on appeal from a February 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky (Agency of Original Jurisdiction (AOJ)). This matter was previously before the Board in March 2017. The Board remanded on the issue of entitlement to service connection for a bilateral eye condition to afford the Veteran the opportunity to present for a new VA examination, as his previous evaluation was deemed inadequate. A review of the file reflects that a new examination was completed and associated with the record. The Board thus finds that the AOJ substantially complied with the remand directive in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a bilateral eye condition, claimed as glaucoma, to include as secondary to service-connected hypertension and/or diabetes mellitus type II Service connection may be granted for a current disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §1110; 38 C.F.R. §3.303. 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). The requirement that a current disability exist is satisfied if the claimant had a disability at the time the claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted, 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; Allen v. Brown, 7 Vet. App. 439 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) medical nexus evidence establishing a connection between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. 38 U.S.C. §1154(a); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). The Veteran contends that his current eye disability, originally claimed as glaucoma, is related to his service-connected hypertension and/or his service-connected diabetes mellitus type II. Specifically, he claims that after returning from service, he developed glaucoma and has since sought treatment from a private physician. The Veteran has received somewhat inconsistent information regarding his eye condition over the years. In July 2008, a private examination was conducted, where the Veteran was counseled on glaucoma and prescribed Alphagan drops. In November 2008, the Veteran underwent a VA examination to assess the nature and etiology of his current eye disability. At that time, a diagnosis of glaucoma was confirmed; the examiner also opined that there was no diabetic retinopathy which would warrant eye inclusion in service-connection in a December 2008 addendum opinion. The AOJ subsequently denied service connection in a February 2009 rating decision, rationalizing that the Veteran was not entitled to direct or secondary service connection for glaucoma. The Veteran timely appealed this decision. In August 2013, the Board found the November 2008 opinion to be insufficient, as it did not specifically address whether an eye disability was caused or aggravated by the service-connected diabetes mellitus and/or hypertension. In September 2013, the Veteran underwent another VA examination, where the examiner indicated the Veteran has 20/20 vision and is myopic, with no background diabetic retinopathy of macular edema. He reported that the Veteran is a “glaucoma suspect,” but did not provide an opinion. It was recorded that medication was stopped due to the stabilization of his glaucoma. This rendered the examination inadequate because the examiner did not comment on whether the Veteran’s current eye disability was related to or aggravated by his service-connected diabetes mellitus type II and/or hypertension. As a result of the April 2016 Board remand, the same examiner provided an opinion in May 2016 that it was less likely than not that the Veteran’s disability was caused by his service or that it was caused by and/or aggravated by his diabetes mellitus type II and/or hypertension. He further noted there was no pathology of glaucoma. The Board subsequently found this opinion to be inadequate in its March 2017 decision, stating that the examiner did not consider the Veteran’s prior medical examinations when formulating an opinion in violation of the remand directives. The most recent VA examination took place in April 2017 with an addendum opinion provided in July 2017. The physician noted the Veteran had the following diagnoses: glaucoma suspect in both eyes, early age-related nuclear cataracts (bilateral), and diabetes without complications. In describing the Veteran’s history, he stated the Veteran was “seen by an outside doctor and started on Alphagan for glaucoma based on increased cup to disc ratio…When seen in the VA system [in] 2008, he was diagnosed as a glaucoma suspect because of the appearance of the nerve but no intraocular pressure or evidence of progression despite not being on any treatment. Patient is now being followed yearly, with [optic coherence tomography] of the optic nerve that demonstrates a stable nerve.” He concluded, “[the Veteran] does not have glaucoma, rather he is a glaucoma suspect with no need for therapy…he does have an increased cup to disc ratio in both eyes, which puts him at a greater risk of developing glaucoma in the future…but currently, there is no diagnosis of glaucoma.” In the follow-up opinion provided by the April 2017 examiner in July 2017, he reiterated there was no diagnosis of glaucoma and no eye disabilities were present on the examination. Furthermore, he stated it was “determined” since the 2008 examination that the Veteran did not have glaucoma and does not currently have the condition either. He speculates that the Veteran more likely has physiologic cupping, a variant of normal but unrelated to the Veteran’s military service, his diabetes mellitus type II, or his hypertension. He concluded by saying “there will never be a relationship between physiologic cupping and military service, diabetes mellitus type II, or hypertension.” At this time, it appears the former diagnosis of glaucoma was in error. Nonetheless, even if the Board determined that the Veteran has a present eye condition to satisfy the initial prong of both direct and secondary service connection, the evidence of record does not include an opinion establishing a nexus between either the Veteran’s service or one of his service-connected disabilities, to include diabetes mellitus type II or hypertension. The Board has deemed the examinations prior to April 2017 to be inadequate, and cites to the opinion provided by the April 2017 examiner in coming to this conclusion. Moreover, the Veteran’s VA treatment records do not suggest a nexus to either service or his service-connected disabilities. The Board acknowledges that the prior diagnoses of glaucoma was rendered by competent professionals and, thus, has probative value. However, the probative weight of those opinions are outweighed by the 2017 VA examiner opinion who, based on review of the entire history, found that the Veteran had physiologic cupping which was a normal variant of normal and explained the misdiagnosis. The Veteran is not shown to be competent to speak to the complex issue of an eye disorder and, as such, his self-opinion and diagnosis holds no probative weight. As such, the Board must deny the Veteran’s claim for service connection for an eye condition, claimed as glaucoma, to include as secondary to his service-connected diabetes mellitus type II and/or hypertension. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Victoria A. Narducci, Associate Counsel