Citation Nr: 19125167 Decision Date: 04/04/19 Archive Date: 04/03/19 DOCKET NO. 17-60 393 DATE: April 4, 2019 ORDER Service connection for bilateral dry eye syndrome (claimed as iritis) is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s dry eye syndrome is related to disease or injury incurred in or aggravated during active service. CONCLUSION OF LAW The criteria for service connection for dry eye syndrome are not met. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.303, 3.306(b)(1), 4.9. REASONS AND BASES FOR FINDING AND CONCLUSION Entitlement to service connection for bilateral dry eye syndrome. The Veteran contends that she is entitled to service connection for bilateral dry eye syndrome because the condition began during active service. She asserts she never had the condition until after she underwent photorefractive keratectomy (PRK) laser eye surgery in May 2013 during active service. The Board concludes that the preponderance of the evidence is against finding that service connection for dry eye syndrome is warranted. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.303, 3.306(b)(1), 4.9. The probative evidence of record shows that the Veteran’s dry eye syndrome is the result of elective surgery to correct a refractive error of the eye, myopia, and that the Veteran’s myopia was not aggravated by any disease or injury during active service. Compensation may be awarded for disability resulting from disease or injury incurred in or aggravated by active duty service. 38 U.S.C. § 1110, 1131. Service connection basically means that the facts, shown by evidence, establish that an injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three element test for service connection requires evidence of: (1) a current disability; (2) in service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 67 (Fed. Cir. 2004). Pursuant to 38 C.F.R. § 3.306(b)(1), the usual effects of medical and surgical treatment in service, having the effect of ameliorating disease or other conditions incurred before enlistment, including postoperative scars, absent or poorly functioning parts or organs, will not be considered service connected unless the disease or injury is otherwise aggravated by service. Vision refractive errors, such as myopia, are due to anomalies in the shape and conformation of the eye structures, generally of congenital or developmental origin. Refractive errors are generally stationary or change slowly until the stage of presbyopia, which is also a developmental condition. Service connection will be granted when there are unusual developments, such as choroidal degeneration, retinal hemorrhage or detachment, or rapid increase of myopia of 2 diopters in a year, producing uncorrectable impairment of vision. Otherwise, service connection is prohibited for refractive errors in vision as congenital or developmental defects. See 38 C.F.R. § 4.9. The record establishes that the Veteran had myopia prior to service entry. Hence, the presumption of soundness on service entry does not apply here. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b) (A veteran is presumed to have been in sound condition when examined, accepted, and enrolled for active service, except as to defects, infirmities, or disorders noted at entrance into service, and only such conditions as are recorded in examination reports are to be considered as noted). In this regards, the Veteran’s December 2009 enlistment examination report shows she wore eye glasses and contact lenses for myopia, a refractive error in vision, prior to entering service. She denied any eye disorders or eye trouble. She had not undergone corrective vision surgery prior to service. There were no complaints or findings of dry eye syndrome. The claims file does not contain any enlistment visual test results. April 2013 and May 2013 service treatment records (STRs) show that the Veteran elected to undergo PRK laser vision surgery to correct her myopia. April 2013 STRs show that prior to surgery the Veteran attended two pre operative briefings regarding the potential side effects of PRK surgery. An April 5, 2013 pre admission examination report shows an examiner discussed the potential side effects with the Veteran and that the Veteran indicated she understood. An April 26, 2013 pre operative briefing report indicates an examiner educated the Veteran for 30 minutes regarding the risks, benefits, and alternatives to PRK surgery. An eye surgery consent form shows the Veteran initialed the warning that further treatment might be necessary after surgery including use of eye drops. A May 2013 STR notes the surgery was performed without complications, that the Veteran tolerated the procedure well, and was given instructions for medications and activity restrictions. A May 23, 2013 STR showed the Veteran was using eye lubricants after surgery as prescribed. A July 2013 STR indicated the Veteran sought medical treatment pain in the eyes, which she stated had begun abruptly upon waking three days prior to seeking treatment. The symptoms included redness, photophobia, and pain. The eye condition was treated with ophthalmic solutions. August 2013 STRs showed the Veteran was diagnosed with iritis (inflammation of the cornea with symptoms similar to dry eye syndrome), but that the condition resolved after treatment. A November 2013 STR indicated the Veteran had no further eye pain. In September 2014, the Veteran was medically separated from active duty due to unrelated health concerns. A September 2014 separation examination report indicates that no eye abnormalities were found. The record does not show the Veteran complained of dry eyes. However, there is no indication that a vision examination was performed. An April 2015 VA general examination noted the Veteran’s visual acuity was 20/20 corrected. Her eyes were normal. The Veteran did not complain of dry eyes. In August 2015, the Veteran filed a claim for service connection based on a bilateral eye condition. As a result, she was afforded a VA eye condition examination in September 2015. The September 2015 VA examination report determined that the Veteran’s visual acuity was within normal range, 20/40 or better, and that she did not have iritis at the time of the examination. The examiner noted that the Veteran developed dry eye syndrome after PRK surgery in 2013 and that dry eye syndrome was a common condition of PRK surgery. The examiner opined that it was at least as likely as not that the Veteran’s dry eye syndrome was caused by the PRK surgery. The Board finds the September 2015 VA examination to be highly probative evidence to support a finding that the Veteran’s dry eye syndrome was the result of elective surgery to treat a congenital or developmental defect (myopia) that did not aggravate her per existing myopia. Therefore, pursuant to 38 C.F.R. §§ 3.306(b)(1) and 4.9, the Veteran’s dry eye syndrome cannot be service connected. Accordingly, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Gillian A. Flynn, Associate Counsel