Citation Nr: 20030188 Decision Date: 04/29/20 Archive Date: 04/29/20 DOCKET NO. 16-23 151 DATE: April 29, 2020 ORDER Entitlement to service connection for ocular histoplasmosis is granted. FINDING OF FACT The Veteran’s ocular histoplasmosis was aggravated beyond its natural progression by his service-connected diabetes mellitus (DM). CONCLUSION OF LAW The criteria for service connection for ocular histoplasmosis have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1965 to September 1968. He appeals an April 2013 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for loss of vision, among other issues. A Board of Veterans’ Appeals (Board) hearing was held in March 2019. A transcript is of record. Subsequent to the Veteran’s testimony at the March 2019 Board hearing, the Board remanded his claims to obtain VA examinations. See April 2019 Board Remand at 5. Now, the claim for service connection for loss of vision is back before the Board. Service Connection A Veteran is entitled to VA disability compensation for service connection if there is a current disability resulting from personal injury or disease incurred in, or aggravated by, active service. 38 U.S.C. §§ 1110, 1131. Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disease or injury. See 38 C.F.R. § 3.310(a). To prevail on the issue of entitlement to secondary service connection, there must be evidence of (1) a current disability; (2) a service-connected disability; and, (3) a nexus establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As to the third Wallin element, the current disability may be either (a) proximately caused by, or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran contends his current loss of vision is secondary to his service-connected DM. See March 2018 VA treatment records. The Board notes visual impairment, including loss of vision, is the result of an eye disorder, rather than being the eye disorder or condition itself; thus, the Board can only grant service connection for the condition that caused the Veteran’s loss of vision. Here, the Veteran has been diagnosed with legal blindness and ocular histoplasmosis. See August 2019 VA examination report. Since July 2011, the Veteran has been service connected for DM. See September 2019 rating decision codesheet. Therefore, the Board finds the first and second Wallin elements are met and not in dispute. As such, the crux of this claim centers on whether there is an etiological relationship between the Veteran’s service-connected DM and his ocular histoplasmosis. The Veteran was afforded a VA examination in August 2019 to assess the nature and etiology of his loss of vision. There, the VA examiner, an optometrist, reviewed the Veteran’s record, examined the Veteran and opined it was “at least as likely as not” the Veteran’s loss of vision was aggravated beyond its natural progression by his service-connected DM. See August 2019 VA examination report. As rationale, the VA examiner stated "it is more likely than not that a hemorrhage with legal blindness and histoplasmosis retinitis of the right eye can be aggravated beyond natural progression by diabetes. The reason is diabetes affects microvasculature (tiny blood vessels in the eyes) and weakens the endothelial walls of the capillaries. Even in the absence of visible diabetic retinopathy, the capillary linings are compromised, and this would aggravate the leakage from histoplasmosis retinitis.” Id. The Board finds this VA opinion probative. (Continued on the next page)   Accordingly, the Board finds the competent and credible medical evidence of record connects the Veteran’s ocular histoplasmosis to his service-connected DM and, thus, the third Wallin element is met. Thus, the Board grants service connection for ocular histoplasmosis. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, 1 Vet. App. at 53. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Bona, 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.