Citation Nr: 20072887 Decision Date: 11/12/20 Archive Date: 11/12/20 DOCKET NO. 15-26 930 DATE: November 12, 2020 ORDER Entitlement to a 10 percent rating for right foot plantar fasciitis, status post 5th metatarsal fracture, prior to October 31, 2019, is granted. A rating in excess of 10 percent for right foot plantar fasciitis, status post 5th metatarsal fracture, from October 31, 2019, is denied. Entitlement to a 30 percent rating for irritable bowel syndrome prior to October 31, 2019, is granted. Entitlement to a 10 percent rating for irritable bowel syndrome from October 31, 2019, is granted. Entitlement to an initial increased disability rating for hypertension, presently rated as noncompensable prior to October 31, 2019, and 10 percent disabling thereafter, is denied. Entitlement to service connection of a cardiac or other disability, claimed as chest pain is denied. Entitlement to service connection of a bilateral eye disability, claimed as dry eye is denied. FINDINGS OF FACT 1. For all periods on appeal, the Veteran’s right foot plantar fasciitis, status post 5th metatarsal fracture, has been manifested by moderate symptoms, to include pain on manipulation and tenderness of the plantar surfaces. 2. Prior to October 31, 2019, the Veteran’s irritable bowel syndrome resulted in severe diarrhea, occurring up to 10 times per day with abdominal distress; after October 31, 2019, his irritable bowel syndrome resulted in episodes of diarrhea occurring approximately 4 times per week without irritable distress. 3. Prior to October 31, 2019, the Veteran’s hypertension did not show diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control; thereafter, it did not show diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. 4. The Veteran does not have a presently diagnosed disability which may account for his reported chest pain. 5. The Veteran’s present dry eye was the result of an in-service elective PRK surgery which was conducted to correct a developmental defect; the present dry eye is not an unanticipated or extreme residual of his PRK surgery. CONCLUSIONS OF LAW 1. The criteria for a rating of 10 percent for right foot plantar fasciitis, status post 5th metatarsal fracture, have been met prior to October 31, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Codes (DCs) 5276, 5284. 2. The criteria for a rating in excess of 10 percent for right foot plantar fasciitis, status post 5th metatarsal fracture, have not been met from October 31, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, DCs 5276, 5284. 3. The criteria for an increased disability rating of 30 percent for irritable bowel syndrome been met prior to October 31, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, DC 7319. 4. The criteria for an increased disability rating of 10 percent for irritable bowel syndrome been met from October 31, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, DC 7319 5. The criteria for an initial compensable disability rating for hypertension, prior to October 31, 2019, and a rating in excess of 10 percent disabling thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.104, DC 7101. 6. The criteria for service connection for a cardiac or other disability manifested by chest pain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for dry eye are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 4.9. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 2006 to December 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As a matter of procedural background, these appeals previously came before the Board in August 2018, at which time the Board remanded them for further development. Increased Rating Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran’s entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where, as in the case of the claims presently on appeal, the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of staged ratings are required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Further, “[w]here there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.” 38 C.F.R. § 4.7. 1. Entitlement to an increased initial rating for right foot plantar fasciitis, status post 5th metatarsal fracture, presently rated as noncompensable prior to October 31, 2019, and 10 percent disabling thereafter The Veteran seeks an increased rating for right foot plantar fasciitis, presently rated as noncompensable prior to October 31, 2019, and 10 percent disabling thereafter. The Board finds that an initial rating of 10 percent should be granted from the date of service connection. However, a rating in excess of 10 percent is denied for all periods on appeal. The Veteran’s right foot disability is presently rated under Diagnostic Code (DC) 5284-5276. Hyphenated Diagnostic Codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. In the present case, DC 5284 rates “other” foot injuries not specifically accounted for by the diagnostic criteria. DC 5276 rates acquired flatfoot. Therefore, the Veteran’s disability is presently rated as an “other” foot disability, most nearly approximated by the ratings for flatfoot. Under DC 5276, a noncompensable rating is assigned for mild flatfoot; symptoms relieved by a built-up shoe or arch support. A 10 percent rating is granted for moderate symptoms; weight-bearing line over or medial to great toe, inward bowing of the tendo-achillis, pain on manipulation and use of the feet, either bilateral or unilateral. A unilateral disability which is severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is granted a 20 percent rating. Finally, a 30 percent rating is assigned for a unilateral foot disability which is pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo-achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. Also applicable in this matter, DC 5284 provides for a 10 percent rating for “moderate” symptoms of the foot; a 20 percent rating for “moderately severe” symptoms of the foot; or a 30 percent rating for “severe” symptoms of the foot. 38 C.F.R. § 4.71a, DC 5284. Terms such as “mild,” “moderate,” and “severe” are not defined by the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The Board notes that other rating criteria apply to the foot, for example, weak foot, claw foot, metatarsalgia, hallux valgus, hallux rigidus, hammer toe, malunion of the tarsal or metatarsal bones, or actual loss of use of the foot. However, as such pathology is not reported in this matter, the Board will not consider that rating criteria in adjudicating this case. The Veteran was initially afforded a VA examination in connection with his claim of service connection in December 2014. At that time he was diagnosed with plantar fasciitis, affecting the right foot, which the examiner attributed to a fracture sustained during military training. The Veteran reported foot pain impeding his ability to run, with severity increasing with inclement weather. He reported his flare-ups to involve severe pain with weather changes. His overall reported functional impairments were with walking and running. There was no objective evidence of pain on use during the examination. There was no pain on manipulation of the feet. There was no evidence of swelling or characteristic calluses. There was extreme tenderness of the plantar surface of the feet, although the examiner did not indicate if it was improved with orthopedic shoes or appliances. He did not have decreased longitudinal arch height on weight-bearing. There was no evidence of marked deformity. There was no evidence of marked pronation. The weight-bearing line did not fall over, nor was it medial to the great toe. There was no inward bowing of the achilles tendon, nor any displacement or spasm of the achilles tendon. Pain in the right foot included pain on movement and weight bearing only. Factors such a pain, weakness, fatigability and incoordination did not significantly limit functional ability during a period of flare or when the foot was used repeatedly over a period of time. The only functional loss was described as “limited use during flare up.” The Veteran did not use any assistive devices. The examiner stated that his foot disability did not limit his ability to perform any type of occupational task. The Veteran was again evaluated in October 2019. At that time, the examiner declined to diagnose any specific condition associated with the right foot, but did acknowledge his in-service fractur, although finding no residuals thereof. The Veteran’s description of his symptoms consisted of a vague report of pain in the lateral aspect of the foot. He denied any flare-ups at that time. No pain was noted on physical examination of the foot. No functional loss could be attributed to the Veteran’s reported symptoms. Factors such as pain, weakness, fatigability or incoordination did not significantly limit functional ability during flare-ups or when the foot is used repeatedly over a period of time. The Veteran denied functional loss during flare-ups. No additional loss was noted on weight-bearing or in active vs. passive movement of the foot. The examiner stated that the function of the foot, as reported was the same on repetitive use. After examination of the Veteran, listening to his complete history and current subjective complaints, combined with a review of the available records and clinical experience, there was no basis upon which to offer additional losses of function or motion when it comes to repetitive use or during flare-ups. The Veteran did not use any assistive devices. X-rays completed in October 2019 showed a completely normal foot without any trace evidence of the in-service fracture. The examiner found no functional limitations. The Board has carefully reviewed the evidence of record but finds no other medical or lay evidence upon which it may rate the Veteran’s right foot disability. In light of the above, the Board will grant an initial rating of 10 percent disabling for the entire period on appeal, but not greater. Specifically, the Board notes that the most recent examination, which was the impetus for the staged increase of 10 percent effective October 31, 2019, shows more improved symptoms than the original examination. In fact, it is the 2014 examination which accounts for pain on manipulation of the foot, which is explicitly listed in the rating criteria as indicative of moderate symptoms. Therefore, affording the Veteran the benefit of the doubt, an initial 10 percent rating will be granted prior to October 31, 2019. However, the Board finds that at no point does the evidence suggest a rating in excess of 10 percent should be granted. While the Veteran has shown some symptoms, including transient increased pain with inclement weather, at no point has he asserted that that pain has resulted in significant loss of use of the foot, short of some decreased running and walking during periods of flare. There is no indication that his foot pain has resulted in significant function loss of use of the foot. There is no evidence of marked deformity. While some pain was noted on manipulation, it was not accentuated, did not result in swelling, and he has not shown any characteristic callosities that would be indicative of such severe symptomatology. There is no evidence of pronounced deformity, such as marked pronation, extreme tenderness, marked inward displacement and severe spasm of the tendo-achillis on manipulation, and he has never required use of orthopedic shoes or appliances. Although some tenderness was noted, it has not resulted in functional loss, such as would be indicative of “pronounced” symptomatology. In sum, the Board finds that moderate symptomatology in the right foot has been shown for the entire period on appeal. As such, the Board will grant an increased rating of 10 percent for the period prior to October 31, 2019. However, at no point have more severe symptoms been shown, such as is anticipated by the diagnostic criteria. Therefore, a rating in excess of 10 percent is denied for all periods on appeal. 2. Entitlement to an initial compensable rating for irritable bowel syndrome The Veteran seeks an initial compensable rating for irritable bowel syndrome. The Board finds that a 30 percent rating should be granted prior to October 31, 2019, and a 10 percent rating should be assigned thereafter. The Veteran’s irritable bowel syndrome is rated under DC 7319, which compensates for irritable colon syndromes. Under the applicable rating criteria a noncompensable rating is granted for mild symptoms, described as disturbances of bowel functio with occasional episodes of abdominal distress. A 10 percent rating is assigned for moderate symptoms with frequent episodes of bowel disturbance with abdominal distress. Finally, severe symptoms, described as diarrhea, or alternating diarrhea and constipation with more or less constant abdominal distress is granted a 30 percent rating. 38 C.F.R. § 4.114, DC 7319. The Veteran was afforded a VA examination in December 2014, in connection with his initial service-connection claim. The Veteran’s irritable bowel syndrome was confirmed, with an in-service diagnosis date of 2011. The Veteran reported the condition occurred gradually, with current symptoms of abdominal pain, bowel incontinence, and diarrhea 10 times per day. He required continuous medication to control the condition. He had not required surgery. The examiner found more or less constant abdominal distress. He had not lost weight. He did not have malnutrition. No other physical findings, complications, conditions, signs or symptoms were found or reported. Functionally, the condition did not affect his ability to work. Although not resulting in any malnutrition or weight loss, the examiner did report more or less near constant abdominal distress with episodes of diarrhea occurring up to 10 times per day. Such symptoms are specifically attributed to the 30 percent rating and indicative of “severe” symptoms under the diagnostic criteria. As such, the Board will afford the Veteran the benefit of the doubt and assign a 30 percent increased staged rating prior to October 31, 2019. On October 31, 2019, the Veteran was afforded a new VA examination. At that time, the Veteran’s condition and diagnosis were confirmed. At that time, he reported diarrhea occurring approximately 4 times per week, sometimes as watery stools, other times as soft stools. No other symptoms were reported. He did not have any weight loss or electrolyte imbalances. He did not take any medication to control the intestinal condition, nor had he had any surgery. The episodes did not result in abdominal distress. There was no evidence of malnutrition, serious complications or other general health effects attributable to the intestinal condition. There were no tumors or neoplasms. The intestinal condition did not impact his ability to work. In light of this examination, the Board will afford an increased rating of 10 percent effective October 31, 2019, the date of the examination. This staged increased rating is granted based on a finding of moderate symptoms. In this regard, the Board notes that the Veteran’s disability has improved from the time of his 2014 examination. At most, he experiences episodes of diarrhea four times per week, which is frequent, but not more or less constant. He does not take medication to control his symptoms, and those symptoms which do exist do not result in any functional or occupational impact. As such, given that the symptoms are more than occasional but not constant, the Board will afford the Veteran the benefit of the doubt and grant a 10 percent rating, but no higher, effective October 31, 2019. 3. Entitlement to an initial increased disability rating for hypertension, presently rated as noncompensable prior to October 31, 2019, and 10 percent disabling thereafter The Veteran’s hypertension is presently rated as noncompensable prior to October 31, 2019, and 10 percent disabling thereafter. He seeks higher ratings for that disability. The Board finds that the claim should be denied. The Veteran’s hypertension is rated under DC 7101, which compensates for hypertensive vascular diseases, to specifically include hypertension. Under the applicable rating criteria, a rating of 10 percent is granted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is granted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent rating is granted for diastolic pressure predominantly 120 or more. Finally, a 60 percent rating is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. For purposes of rating the disability, the term hypertension means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. Id., note (1). The Veteran was initially afforded a VA examination in December 2014, in connection with his initial service connection claim. At that time, blood pressure readings were 126/88, 128/86, and 126/84. He did not have a history of diastolic blood pressure predominantly 100 or more. My medical history, he was noted to have blood pressure of 142/76 on June 10, 2014, while exercising. The Board finds that this examination does not support a compensable rating based on the specific diagnostic criteria applicable to hypertension. He did not demonstrate diastolic blood pressure of 100 or more upon multiple tests. Likewise, he did not show systolic blood pressure predominantly above 160. Although he was noted to take Lisinopril, which is an ACE inhibitor, there is no indication that he ever had a history of diastolic blood pressure a predominantly at 100 or more. The Veteran did not provide any further medical evidence regarding the severity of his hypertension, to include blood pressure readings. The Veteran was afforded a new VA examination on October 31, 2019. The Veteran’s diagnosis of hypertension was confirmed. He took losartan daily. Blood pressure readings were 167/111, 157/100, and 151/96. No other pertinent physical findings were reported. Functionally the Veteran denied that his hypertension impacted his ability to work, and the examiner found no functional limitations. It was noted that the Veteran did not take his medication that day, and that his readings did not represent an uncontrolled condition. He had normal renal function. The Board finds that this does not support a rating in excess of the 10 percent already assigned effective October 31, 2019. In this regard, the Veteran’s hypertension, while not on medication to control the disability, did not show sustained diastolic blood pressure predominantly 110 or more, nor sustained systolic blood pressure of 160 or more. Although he was shown to have one reading with systolic blood pressure of 167, that was not sustained upon retesting, and it is noted that the Veteran had failed to take his medication that morning. He does take continuous medication for the condition, although that also provides for a 10 percent disability rating. The Board has carefully reviewed the evidence of record, but finds no other medical evidence which may accommodate a higher rating, to include blood pressure readings. In sum, the Board finds that the evidence does not support a compensable rating prior to October 31, 2019, or a 10 percent rating thereafter for hypertension. As such, the claim for an increased rating is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 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). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) 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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). In addition, certain chronic diseases, including various cardiovascular-renal diseases, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. 4. Entitlement to service connection of a cardiac or other disability, claimed as chest pain The Veteran seeks service connection of a disability, claimed as chest pain. The Board finds that the claim must be denied. The Veteran was initially afforded an examination at separation from service, in connection with his various claims for VA compensation benefits, in December 2014. At that time, a muscular examination revealed no pathology which might account for chest pain, as described by the Veteran. Likewise, although right bundle branch block was noted on EKG testing, but a follow-up echocardiogram was within normal limits, and the examiner stated there was no pathology to render a diagnosis of a heart condition at that time. Despite the findings of the examiner in 2014, in August 2018, the Board noted that chest pain resulting in functional impairment may still be considered a disability for VA purposes, and requested that a new examination be scheduled. In October 2019, the Veteran was afforded a new VA examination in connection with his claim. Although he appeared for the general examination, the Veteran cancelled additional requested studies without explanation or an attempt to reschedule. The Veteran described his chest pain as “chest discomfort.” Heart rhythm was regular. Point of maximal impact was not palpable. Heart sound was normal. There was no jugular-venous distension. The lungs were clear. Peripheral pulses were normal. There was no sign of peripheral edema. No pertinent physical findings were noted. There was no evidence of cardiac dilatation or hypertrophy. ECHO and stress tests from 2014 were normal. A chest X-ray from 2019 showed completely normal results. The Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. The examiner then concluded that any chest pains reported by the Veteran could be multifactorial, but based upon the evidence available, there was insufficient evidence to warrant or confirm a diagnosis of an acute or chronic cardiac condition at that time. Unfortunately, pain is simply not relatable as a diagnostic or prognostic indicator. The Board finds the examiner’s conclusion that no disability exists to be persuasive. It was rendered by a medical specialist, in contemplation of the Veteran’s complete medical history (to include his own lay statements regarding the nature and severity of his reported chest pain), and following a physical examination. Here, the Board notes that the examiner did not complete all possible requested testing, however, the Veteran cancelled those tests without explanation or any attempt to reschedule. The Board notes that the Veteran has a duty to assist and cooperate with VA in developing evidence; the duty to assist is not a one-way street. Wood v. Derwinski, 1 Vet. App. 190 (1991); Hayes v. Brown, 5 Vet. App. 60 (1993) (if a veteran wants help, he cannot passively wait for it in those circumstances where his own actions are essential in obtaining evidence). However, following a physical evaluation which revealed no abnormalities, and in consideration of all historical and contemporary testing available, the examiner could not confirm any diagnosis which may account for the Veteran’s reported chest pain. Given that two separate examiners have not been able to provide a diagnosis, the Board must conclude that no diagnosis exists. To the extent that the Board previously noted that pain alone may be sufficient to qualify as a disability, such consideration would require that the pain rises to a compensable level of functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed Cir. 2018) (holding that pain resulting in functional impairment constitutes a current disability). In this matter, the Veteran has described his chest pain to the examiner as general chest discomfort and has denied any type of functional impairment that would accompany a cardiac disability. As such, the Board concludes that, based on the Veteran’s own reports of the severity of his disability, his chest pain alone, without an associated diagnosis, does not constitute a disability for VA compensation purposes. Finally, the Board recognizes that the Veteran believes his reported chest pain is a disability for which service connection may be granted. While lay evidence may be competent on a variety of matters concerning the nature and cause of disability, etiology of dysfunctions and disorders is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed.Cir.2010) (recognizing that in some cases lay testimony “falls short” in proving an issue that requires expert medical knowledge). In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of his chest pain, especially in light of the both VA examiner’s conclusions to the contrary and the fact that the evidence fails to demonstrate any physical abnormality which may account for his reported symptoms. See id. In sum, the Board finds that the claim for a disability manifested by chest pain must be denied. Specifically, the Board finds that the claim fails the primary criteria of service connection, namely, a presently diagnosed disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 5. Entitlement to service connection of a bilateral eye disability, claimed as dry eye The Veteran seeks service connection of a bilateral eye disability, claimed as dry eye. The Board finds the claim must be denied. As an initial matter, the evidence confirms that the Veteran has a present diagnosis of bilateral dry eye (it is noted that the claim was originally adjudicated as one for “blurry vision,” however, the Veteran’s myopic disability was treated during active service and has resolved; in his notice of disagreement, the Veteran clarified that the claim should be for dry eye). For his part, the Veteran asserts that his dry eye is the result of photorefractive keratectomy (PKR) surgery, which he had during active service. Indeed, in October 2019, a VA examiner concluded that his present dry-eye, which did not exist prior to that surgery, is an anticipated result of that surgery. Service connection can be established for dry eye syndrome when it is directly caused by an in-service incident. However, elective/ameliorative procedures, such as laser eye surgery (PRK), without unusual results or additional disability attributed to the procedure are not eligible for service connection. Dry eye syndrome is a common result of PRK surgery, and thus would not be eligible for service connection if the etiology of the dry eye syndrome is due solely to an elective procedure. See 38 C.F.R. § 3.306(b)(1). In the present matter, the 2019 examiner concluded that the present dry eye is exclusively the result of the Veteran’s PRK surgery and there is no indication that his dry eye was an unanticipated side effect of the surgery, or worse than would ordinarily be expected. Further, for service connection to be granted for residuals of an elective procedure, that procedure must be due to an in-service disease or injury. In the present matter, the PRK procedure was performed due to the Veteran’s refractive error, which is considered a developmental defect and not disease or injury within the meaning of applicable legislation. See 38 C.F.R. §§ 3.303(c), 4.9. Therefore, the Veteran cannot establish an in-service disease or injury for the purposes of VA compensation. In sum, while the Veteran’s present dry eye was the result of an in-service elective procedure, as that elective procedure was conducted to correct a developmental defect, and the symptom now claimed was not an unanticipated residual, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Pryce, Counsel