Citation Nr: 20031817 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 07-33 957 DATE: May 6, 2020 ORDER Entitlement to service connection for a left eye disorder is denied. FINDINGS OF FACT 1. Refractive errors of the eyes are congenital and/or developmental defects and are not considered diseases or injuries for VA compensation purposes. There is no evidence of aggravation or an additional disability or injury of the eyes superimposed on such refractive errors during the Veteran’s active military service. 2. Additional left eye disorders, to include polypoidal chorioretinopathy, cataracts, dry eyes, and conjunctival melanosis, were not present in service and were not shown to be related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left eye disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 4.9 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from July 1977 to March 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2007 rating decision. In a March 2010 decision, the Board reopened the claim for entitlement to service connection for a left eye disorder. The matter was then remanded for additional development. Thereafter, the Board again remanded this case in July 2010. In August 2012, the Board sought an advisory medical opinion from the Veterans Health Administration (VHA); it was received that same month. In February 2013, the Board sought a clarification medical opinion from VHA; it was received in March 2013. The Board remanded this matter for additional development in August 2013. In a September 2014 decision, the Board dismissed the claim of entitlement to service connection for a left eye disorder due to the Veteran’s death in August 2014. The appellant is the Veteran’s surviving spouse and was found to be the proper substituted claimant for the deceased Veteran for the purpose of pursuing the claim of entitlement to service connection for a left eye disorder in October 2019. 1. Entitlement to service connection for a left eye disorder The Veteran asserted that his left eye problems began after in-service eye injuries while welding and have persisted since service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2019). Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2019). For purposes of entitlement to benefits, the law provides that refractive errors of the eyes are congenital or developmental defects and not disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9 (2019). In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia, and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. Thus, VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury, which created additional disability. Id; see also VAOPGCPREC 82-90, 55 Fed. Reg. 45,711 (1990) (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury); Sabonis v. Brown, 6 Vet. App. 426 (1994). Service treatment records reflect that in January 1978 the Veteran reported left eye pain subsequent to welding. Examination revealed scleral redness and he was diagnosed as having scleral irritation. In November 1979, he injured his left eye while welding when a piece of metal entered his eye and scratched the inner canthus. His eye was noted to be irritated and he reported sharp pains on the inner canthus. In April 1980 and June 1980, he reported sore/tired eyes and was diagnosed as having possible refractive error. In June 1982, he reported pain when he moved his eyes. An August 1992 ARNG periodic examination report showed normal eyes on clinical evaluation. Post-service VA and private treatment records revealed that the Veteran was diagnosed with various left eye disorders. In June 1997, the Veteran complained of difficulty focusing with no abnormalities on eye examination. A September 1997 VA MRI report revealed no metallic foreign bodies in the orbits. VA treatment notes dated in June 2002 detailed findings of allergic conjunctivitis. A January 2007 VA nursing emergency department treatment note revealed that the Veteran reported experiencing chronic left eye pain ever since a welding accident in 1978. An abnormal retina was first noted on examination by an optometrist. The Veteran complained of left eye photophobia and intermittent blurriness. Multiple eye evaluations in 2007 led to a diagnosis of polypoidal choroidal neovascularization in the left eye. The Veteran was further noted to have refraction disorder NOS and presbyopia. A November 2007 private MRI report showed no metallic foreign bodies in orbits. In a February 2008 VA examination report, the examiner listed diagnoses of polypoidal choroidal dystrophy, a corneal scar in the left eye, and legal blindness of the left eye. The examiner opined that it was less likely as not that the Veteran’s polypoidal choroidal dystrophy was related to his military service. The examiner acknowledged that the Veteran provided a history of trauma to his left eye in 1979 from a welding injury. It was noted that there has never been shown to be a link between polypoidal choroidal dystrophy and trauma. The examiner detailed that the Veteran also had changes in his right eye on clinical examination consistent with polypoidal choroidal dystrophy, noting that the Veteran was fortunate that the degree of his disease was very asymmetric and mainly affected his left eye. After a thorough review of the record, the examiner provided a March 2008 VA addendum medical opinion, noting there was no linkage between the Veteran’s service and polypoidal choroidal dystrophy. Additional VA treatment records dated in 2008 detailed findings including meibomianitis/dry eyes, stable left eye polypoidal choroidal vasculopathy, and subjective photophobia. In a March 2010 VA examination report, the examiner listed diagnoses of polypoid chorioretinopathy, cataracts, mild dry eye syndrome, conjunctival melanosis, myopia with astigmatism, and presbyopia. After reviewing the record, the examiner opined that the Veteran’s decreased vision in the left eye and legal blindness with polypoidal chorioretinopathy was less likely than not related to his service-connected welding. In the cited rationale, the examiner noted that there was no evidence in the medical literature of a link between polypoidal chorioretinopathy and welding or intense light. It was noted that the condition had been most commonly linked to race (predominantly African Americans) and that the Veteran fit into that category. In addition, the examiner highlighted that the Veteran had only started to develop the condition within the previous one to two years and the condition did not correspond to the minimal corneal scarring in the left eye. In August 2010 and December 2011 VA examination reports, the same examiner noted the Veteran’s eye examination was consistent with a history of polypoidal choroidal dystrophy; visual acuity reduction of the left eye consistent with macular appearance and previous examinations reviewed in the claims file without progression today; inferior stromal scar inferior to the visual axis of the left eye not affecting vision; and visual acuity reduction consistent with appearance of mild macula consistent with history of choroidal dystrophy. In the December 2011 VA examination report, the examiner further noted a history of ocular trauma to the left eye consistent with welding injury not affecting visual acuity as well as early cataracts in both eyes. The examiner again discussed polypoidal choroidal retinopathy, clarifying that it had been shown to be prevalent in all races and in both sexes. It was indicated that there was still some doubt on the actual demographics and etiology of that condition. It was further noted that the condition was thought to be similar to age related macular degeneration but occurred at a younger age. The examiner detailed that proposals discussed that there was a genetic component with polypoidal choroidal retinopathy. However, the examiner concluded that there was no component related to any kind of arc welding incident or traumatic incident. The examiner opined that the Veteran’s reduced visual acuity was related to a disruption in the macular pigmentation. He felt the Veteran’s condition was congenital based on current literature about polypoidal choroidal retinopathy and was not related to, caused by, or a result of any arc welding incident that the Veteran experienced in his history or in any other patients with this condition. A March 2012 letter from D. J., M. D. listed a diagnosis of polypoidal/choroidal neovascularization of the left eye. In an additional June 2013 statement, the physician noted the Veteran had lost central vision in his left eye due to scarring of the retina. In an August 2012 VHA medical opinion, a VA ophthalmologist opined that it was not as least as likely as not that any of the Veteran’s currently diagnosed left eye disabilities had their onset in service, were related to his in-service left eye injuries, or were otherwise related to a disease or injury in service. The examiner highlighted the following: (1) The Veteran has no left eye conditions that are congenital as opposed to acquired. (2) Polypoidal/choroidal retinopathy refers to an accumulation of blood between the neurosensory retina and the retinal pigment epithelium (RPE) that arises from the choroidal or retinal circulation. Polypoidal/choroidal retinopathy is associated with angiogenic factors from diseases of ischemia RPE/Bruch’s membrane/choriocapillaris complex. (3) Allergic conjunctivitis, meibomitis, cataracts (trace nuclear sclerosis), and dry eye syndromes are all acquired conditions. (4) Myopia with astigmatism and presbyopia are described as specific types of refractive errors. (5) Conjunctival melanosis is a normal phenomenon in heavily pigmented individuals. It is commonly seen near the limbus in the eye. In the cited rationale, the ophthalmologist noted that the Veteran’s in-service left eye injuries were superficial, minor abrasions or irritations. None of the injuries resulted in penetration or perforation of the anterior segment of the eye and the injuries were all self-limiting. It was further concluded that there was not a medical connection of the Veteran’s non-specific eye discomfort (in 1980 and 1982) with his previously treated minor eye injuries (in 1978 and 1979). In a March 2013 VHA medical opinion, the VA physician indicated that the Veteran had a history of a welding injury and a superficial foreign body in the left eye during active duty. Both of these conditions were noted to be self-limiting and had full resolution, as was documented by multiple subsequent normal eye examinations. The physician concluded that the eye conditions identified (polypoidal chorioretinopathy, cataracts, dry eyes, conjunctival melanosis, myopia, astigmatism, or presbyopia) were not as least as likely as not a result of or related to the injuries documented in service records. The physician highlighted that his opinion did not change even when the Veteran’s statements of symptoms continuing since the in-service injury were accepted. When asked if there were medical reasons that the Veteran’s reports of continuing symptoms since service were not credible, the physician detailed that the Veteran’s complaint about his left eye was mostly likely due to the polypoidal choroidal vasculopathy first diagnosed around 2007. It was noted that that condition was a disease of the retina in which there was retinal pigment epithelial detachments not related to any prior symptoms documented during service. As an initial matter, the Board notes that service treatment records dated from 1980 detailed findings of possible refractive error. Post-service VA treatment records reflected findings of myopia, astigmatism, and presbyopia. However, VA regulations specifically prohibit service connection for refractive errors of the eyes. There is also no evidence of a superimposed disease or injury during active service resulting in any additional eye disability. The Board finds the preponderance of the competent, credible evidence is against the Veteran’s current left eye disorders having developed in service or otherwise being causally related to service. Service treatment records clearly documented eye injuries in service in January 1978 and November 1979. Post-service evidence of record showed multiple, current diagnoses including polypoidal chorioretinopathy, cataracts, dry eyes, and conjunctival melanosis. However, the record does not include any probative evidence of a causal relationship between the Veteran’s current left eye disorders and events during his active military service. The August 2012 and March 2013 VHA examiners provided a complete rationale for the stated opinions, citing to a detailed review of the evidence of record and clearly acknowledging the Veteran’s assertions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (finding that the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). Significantly, the Veteran and the appellant have not presented, identified, or alluded to the existence of any medical opinion that directly contradicts the conclusions reached by the above examiners. To the extent that the Veteran has contended he experienced ongoing eye disorders since service, the Board finds that this contention is not consistent with the contemporaneous record. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (holding that contemporaneous evidence has greater probative value than history as reported by a claimant). The statements from the Veteran that his claimed left eye disorder was related to active service are not competent evidence to establish the etiology of his current left eye disorders. The Veteran’s statements are competent evidence as to observable symptomatology, including eye pain and decreased visual acuity. However, the statements that the Veteran’s present left eye disorders were incurred during or as a result of events during service draw medical conclusions which he is not qualified to make. Although lay persons are competent to provide opinions on some medical issues, the etiology of the Veteran’s left eye disorders falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau, 492 F.3d at 1377. The Veteran’s assertions were also considered by the VHA examiners in the above medical opinions. The criteria to award entitlement to service connection for the claimed left eye disorders have not been established, either through medical or probative lay evidence. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim of entitlement to service connection for a left eye disorder, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. D. Deane, 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.