Citation Nr: 18159251 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 14-39 928 DATE: December 19, 2018 ORDER Entitlement to service connection for allergic rhinitis is granted. Entitlement to service connection for vernal/atopic conjunctivitis is granted. FINDING OF FACT The evidence of record shows that the cause of the Veteran’s vernal/atopic conjunctivitis, allergic rhinitis, first manifested in service. CONCLUSIONS OF LAW The criteria for entitlement to service connection for allergic rhinitis have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). The criteria for entitlement to service connection for vernal/atopic conjunctivitis have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran had active military service in the U.S. Air Force from April 1982 to April 1990. The Board notes that the Veteran originally filed a claim for service connection for keratoconjunctivitis. In Clemons v. Shinseki, 23 Vet. App. 1 (2009), the United States Court of Appeals for Veterans Claims (CAVC) held that, in determining the scope of a claim, the Board must consider the claimant’s description of the claim; symptoms described; and the information submitted or developed in support of the claim. As explained below, an expert medical opinion diagnosed the Veteran with vernal/atopic conjunctivitis associated with allergic rhinitis. Accordingly, given that the record reflects possible ophthalmic diagnoses other than keratoconjunctivitis and the cause of the disability involves another disorder, the Board has amended the issues on appeal as entitlement to service connection for an eye disability as well as entitlement to service connection for allergic rhinitis. The Board has reviewed all of 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 this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. In this regard, the Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). 1. Entitlement to service connection for allergic rhinitis 2. Entitlement to service connection for an eye disability The Veteran is seeking entitlement to service connection for an eye disability, namely keratoconjunctivitis. He stated that he first experienced issues with his eyes back in 1982 when he was stationed at Travis Air Force Base, and suffered severe allergies and hay fever, potentially as due to the surrounding onion fields near the base. 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). Service connection may 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). For some “chronic diseases,” presumptive service connection is available. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With “chronic disease” shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of a ‘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. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. If not manifest during service, where a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and the ‘chronic disease’ became manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307. The term “chronic disease,” whether as shown during service or manifest to a compensable degree within a presumptive window following service, applies only to those disabilities listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In each case where service connection for any disability is being sought, due consideration shall be given to the places, types, and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). On the November 1981 report of medical examination, the Veteran was assessed as having normal ophthalmoscopic results. Moreover, during medical history the Veteran denied any eye trouble or hay fever. Thus, the Veteran is presumed to have entered service in sound condition. 38 U.S.C. § 1111. A November 1986 record noted that the Veteran sought treatment for burning of the eyes, which was objectively noted as conjunctivitis, but assessed formally as a corneal abrasion and prescribed antibiotics. Upon the separation examination in February 1990, the Veteran was also assessed as having normal ophthalmoscopic results. However, on the corresponding report of medical history the Veteran indicated he had a history of hay fever which was acknowledged by the examiner and indicated as seasonal allergic rhinitis, moderate from 1983 to present. Additionally, on the Veteran’s enlistment examination for the Army Reserves in December 1994, he was noted to have a vision defect, but no further information followed. The corresponding report of medical history reflects seasonal hay fever, which the Veteran self-treated with over the counter medication. The Veteran underwent VA examination in June 2013, where diagnoses of chronic ocular allergies, keratoconjunctivitis, and corneal pannus, in each eye due to chronic allergies were noted. The examiner recognized the Veteran’s present disability noting that he had low vision in each eye, but opined that his eye disability is less likely related to service as the in-service notation of corneal abrasion was caused by an ocular foreign body, rather than ocular allergies, which the service treatment record makes no mention of. The aforementioned examination failed to consider the Veteran’s lay description of his symptomatology and to address whether the in-service history of allergies documented in the Veteran’s service treatment records resulted in his current eye condition, which has progressively worsened since his release from service. In connection with the claim, the Veteran submitted online research suggesting vernal conjunctivitis may be caused by an allergic reaction, allergic rhinitis, asthma, and eczema, and is most common in young males during the spring and summer months. At his June 2016 Board hearing, the Veteran reported symptoms of blurry vision, watery eyes, impaired depth perceptive, swollen eyes, throbbing pain, irritability, and light sensitivity. Moreover, the Veteran reported that he has been unable to drive since 2003 due to his blurry vision. The Board sought an additional medical opinion from a specialist to determine the etiology of the Veteran’s condition considering all relevant information of record, including his testimony. In the June 2018 medical opinion, the ophthalmologist stated that it is less likely incurred in or caused by the claimed in-service injury, event, or illness. Specifically, the examiner points out that the clinical note from November 1986 indicated that the Veteran suffered a corneal abrasion of the left eye. In this instance, there was a foreign body sensation localized to the left eye and no mention of pruritus. This does not support an atopic etiology. Being stationed at Travis Air Force Base with surrounding onion fields is not sufficient to establish a cause and effect relationship. Moreover, at separation in February 1990, the presence of any ophthalmic issue was not noted, further supporting the condition is not related to the in-service notation. The examiner also explained despite the Veteran’s allegation of suffering chronic allergies since separation, he is unable to determine whether that would have caused a chronic eye disability, as the condition has a common occurrence in general. Pertinently, the World Health Organization estimates that worldwide 10 to 30 percent of people are affected by allergies, demonstrating how common they are. The primary care and ophthalmology clinic notes in the claims file are consistent with vernal/atopic conjunctivitis which is associated with hay fever, and just being outdoors would increase someone’s risk for symptoms. The Board notes that the Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-10 (2007). He reported first experiencing an eye condition in during service as caused by the nearby onion fields which continued after service. His report of medical history during service reflects the onset of allergic rhinitis during service – from 1983 to the date of separation. Thus, the credible lay evidence reflects the onset of allergic rhinitis in service as reported in the service treatment records. (continued on next page) The VHA expert opinion indicated that the Veteran manifests vernal/atopic conjunctivitis associated with hay fever/seasonal allergies. When resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence of record shows that the cause of the Veteran’s vernal/atopic conjunctivitis, allergic rhinitis, first manifested in service. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.L. Reid, Associate Counsel