Citation Nr: 19190883 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 15-09 834 DATE: December 3, 2019 ORDER Entitlement to service connection for glaucoma is denied. FINDING OF FACT The most probative evidence weighs against a finding that the Veteran's glaucoma had onset during active service, manifested within one year of service discharge, or is otherwise related to active service. CONCLUSION OF LAW The criteria for service connection for glaucoma have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. § 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1980 to September 2000. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office. The Veteran testified before the undersigned Veterans Law Judge at an August 2017 videoconference hearing. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). 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- the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d) (2017). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2017); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of 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. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303 (b), 3.309 (2017); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Entitlement to service connection for glaucoma. The Veteran asserts his glaucoma is related to an eye injury caused by grenade fragments that was sustained in service. Specifically, that his glaucoma is a result of the trauma from a metallic foreign body in his left eye. At the Board hearing, the Veteran asserted that he had blurry vision at service discharge and that a diagnosis of glaucoma was provided. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA treatment records provide a diagnosis of glaucoma. See VA treatment records September 2004 - November 2014. Accordingly, the first element of service connection is met. Second, the Board finds that there is an in-service injury but not disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). In June 1995 the Veteran’s service treatment records (STRs) documented that the Veteran was treated for a grenade fragment in his left eye. The VA provider noted a metallic foreign body was projected at the left orbit. It measured approximately 2 mm and did not appear to be intra-orbital in position as seen in the lateral view. In a March 2000 report of medical history, the Veteran denied any eye trouble. In a corresponding report or medical examination, there was a normal clinical evaluation of the Veteran’s eyes. Thus, although the second element of service connection is met, there was no diagnosis of glaucoma during service. Third, the Board finds that the evidence of record does not support a finding that the Veteran’s glaucoma is related to active service. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The evidence does not indicate that there was glaucoma during service, within the year following the Veteran’s separation from active duty, or that it began during service and existed since then. Therefore, presumptive service connection for a chronic disability is not warranted. 38 C.F.R. §§ 3.307, 3.309(a). Additionally, the Board finds that the most probative evidence of record demonstrates that the Veteran’s glaucoma is not related to active service. In an April 2019 VA examination report, the examiner opined that the Veteran’s primary open angle glaucoma is less likely as not caused by or result of the left eye lid injury noted during service. The examiner explained the Veteran had no other blunt injuries that would impact both eyes and no other findings of his eye that would indicate that the glaucoma was traumatic in nature. The Board accords the VA examination significant probative weight because it is thorough, it reflects the examiner’s review of the relevant STRs, and is supported by an adequate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in determining probative value of a medical opinion is whether the examiner was informed of the relevant facts); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). The Veteran asserts that his glaucoma is related to his service and that a diagnosis was provided upon service discharge. He further argues, he developed glaucoma from the trauma of a metallic foreign body. The Board, however, finds his statements are not competent. Although it is error to categorically reject a lay person as competent to provide a nexus opinion, not all questions of nexus are subject to non-expert opinion. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Whether a layperson is competent to provide a nexus opinion depends on the facts of the particular case. “Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay witnesses are competent to report that which they have observed with their own senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). But here, providing the specific etiology of glaucoma, as opposed to symptoms or onset thereof, which is an internal process of the nervous system, is clearly distinguishable from ringing in the ears, a broken leg, or varicose veins. See Jandreau, 492 F.3d at 1377; Barr v. Nicholson, 21 Vet. App. 303, 310 (2007); Charles v. Principi, 16 Vet. App. 370, 374 (2002). Thus, any such nexus statements are not competent. Furthermore, the Veteran’s testimony regarding eye problems at discharge are not significantly credible, as the service discharge examination and report of medical history contained reports of other difficulties during service, but not any eye symptoms. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, service connection is denied on direct and presumptive bases. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Braxton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.