Citation Nr: 20044044 Decision Date: 06/30/20 Archive Date: 06/30/20 DOCKET NO. 10-02 114A DATE: June 30, 2020 ORDER Entitlement to service connection for bilateral central corneal abrasions with overlying keratitis, claimed as bilateral eye disorder is denied. Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. The weight of the evidence does not show that the Veteran currently has a bilateral eye disorder that was incurred in or due to her active duty service. 2. The weight of the evidence does not show that the Veteran's hypertension is at least as likely as not etiologically related to her active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral central corneal abrasions with overlying keratitis, claimed as bilateral eye disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from March 1980 to July 1982. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an October 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, these matters were before the Board and remanded for additional development. This remand also directed the RO to issue a Statement of the Case in regard to an earlier effective date claim for service connection for posttraumatic stress disorder (PTSD), as the Veteran’s representative, in a June 2014 Notice of Disagreement, had argued for a November 2006 effective date. However, the RO had previously granted a 100 percent evaluation for PTSD as of November 17, 2006 in a March 2018 rating decision. The Board’s prior remand thus appears to have been in error, and this matter is deemed fully resolved in the Veteran’s favor. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish service connection, the evidence generally must show: (1) the existence of 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 disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases (to include hypertension) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time post-service (one year for tinnitus). 38 U.S.C. § 1137; 38 C.F.R. §§ 3.307, 3.309. Nexus of a chronic disease to service may be established by showing continuity of symptomatology following service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). 1. Entitlement to service connection for bilateral central corneal abrasions with overlying keratitis, claimed also as bilateral eye disorder The Veteran asserts she has a bilateral eye disorder related to her active duty service. She related that she started having eye problems in service, including while performing duties as a military police officer. Specifically, she stated she was unable to see to write her reports and would receive punishment that included running through the woods at night after an inmate. On one such occasion, she fell and was struck in the eyes with tree limbs and branches. She went to the medic’s station for treatment for her eyes and was administered medication, which caused her eyes to burn. She later learned that she was given the wrong medication, which had caused damage to her cornea and scar tissues in her eyes. Her service treatment records reveal she was seen for emergency care treatment in June 1981 with complaints of discoloration and burning in her eyes. She received a diagnosis of conjunctivitis. A July 1981 service treatment record shows the Veteran was seen at an in-service clinic with complaints of eye irritation for the past month. She reported that her eye color changed from white to a yellow tint. The assessment was rule out conjunctivitis. On her July 1982 service separation medical examination report there were no complaints regarding the eyes; on clinical evaluation her eyes were reported as normal. In April 2002 the Veteran was seen at a VA Medical Center (VAMC) for a primary care initial evaluation. On review of systems, specifically the eyes, her vision was “ok”. On physical examination, extraocular movement was intact, and her pupils were equal, round and reactive to light. There were no abnormalities noted regarding the eyes. In November 2005 the Veteran presented at a VAMC ophthalmology clinic for an evaluation of blurred vision, especially the right eye. The assessment was presbyopia and decreased vision right eye. In November 2006 the Veteran reported having problems with her eyesight. She stated that sometimes her vision is clear and other times it is cloudy, and she has not identified a cause. In December 2006 the Veteran was seen at a VAMC eye clinic with complains of blurry vision. She was prescribed lubricating ointment for the eyes. On January 2008 VA eye examination, the Veteran reported a history of bilateral central corneal abrasion with keratitis (first diagnosed in 2006 and treated with eyedrop and ointment), eye pain and/or visual symptoms, and blurry vision (near) without glasses. She reported past ocular injuries, diseases or surgery in 2002 or 2004 when she wore a patch over the right eye for two weeks. In 2006 she had keratitis of both eyes, which she treated with eyedrops and ointment. On physical examination, her conjunctiva, sclera, and cornea were normal bilaterally. There were no corneal scars, corneal abrasion, fluorescein staining, or keratitis noted in either eye. The diagnosis was subnormal vision without known etiology both eyes. The examiner noted there was moderate visual impairment or reduction of both eyes, there were no known causes for her subnormal vision. No corneal scar or any signs of keratitis was noted for either eye. There were no retinal findings to offer for reduced vision. The examiner opined that the Veteran’s current eye condition was not caused by or a result of her bilateral eye condition first treated during her military service. At a January 2020 VA examination the Veteran had complaints referring to cataracts and reported current symptoms of dry eyes, blurry vision in both eyes, difficulty reading up close and trouble making out objects at a distance. The diagnoses were bilateral lacrimal system conditions, including dry eye syndrome; and bilateral lens conditions, including cataracts. The examiner noted this was the only record of cataracts as it had not been previously diagnosed. The examiner noted further that the Veteran had one corneal abrasion in 2006 (no residual vision reduction or impairment) and that would not have caused cataracts. The examiner opined it was less likely than not that the Veteran’s bilateral eye disorders were incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that in 1981 the Veteran was diagnosed with having conjunctivitis. Conjunctivitis was not present on examination in January 2020. The eye conditions found on examination were cataracts and dry eye. There was no known etiology for the Veteran’s vision decrease. Cataracts are age-related. Dry eye syndrome can be due to aging, certain medical conditions including diabetes mellitus, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, thyroid disorders and Vitamin A deficiency. While the Board found the January 2008 VA opinion inadequate because the examiner did not provide rationale for the opinion proffered, the Board affords the January 2020 VA examiner’s opinion significant probative value, as the examiner is a trained eye specialist who based his opinion on an accurate factual premise and a thorough and supporting rationale. Based on the evidence of record, the Board finds that service connection for the claimed bilateral central corneal abrasions with overlying keratitis, claimed as bilateral eye disorder, is not warranted. The Veteran has current diagnoses of eye disorders that include bilateral subnormal vision, bilateral dry eye syndrome, and bilateral cataracts. None of these eye disorders were incurred in or due to an incident in service. The Veteran’s service treatment records show she had a diagnosis of conjunctivitis in service in 1981. According to the January 2020 VA examiner, conjunctivitis does not have a lasting visual impact; it is an eye infection which resolves sometimes on its own or with antibiotic. When the Veteran was examined for service separation in 1982, she had a normal eye examination on clinical evaluation. This suggest that the Veteran’s conjunctivitis diagnosed in service was acute and transitory and resolved without residual eye disability. Furthermore, while the Veteran is competent to report having experienced such symptoms as blurred vision and eye pain, she is not competent to provide a diagnosis in this case or ascertain that such symptoms were manifestations of a bilateral eye disorder related to her active service. The Board finds that this issue is medically complex due to the intricacies of the human eye, and the Veteran lacks the training and credentials to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Thus, the claim is denied. 2. Entitlement to service connection for hypertension The Veteran asserts she had a diagnosis of high blood pressure in service. She stated she was started on medication and cannot recall whether the medication “helped” her high blood pressure. VA regulations require that hypertension or isolated systolic hypertension be confirmed by readings taken two or more times on at least three different days. For compensation purposes, 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. 38 C.F.R. § 4.104, Diagnostic Code 7101. The Veteran’s service enlistment medical history report shows her blood pressure was 114/74 in March 1980. Service treatment records show she was seen at a branch clinic in September 1980, her blood pressure was 108/80. Upon receiving emergency care in December 1981, her blood pressure was 130/84. In April 1982, it was 130/90. Her July 1982 service separation medical examination report shows her blood pressure was 104/70. The Veteran’s blood pressure was 130/91 in August 2001, when she was seen at a VAMC. An October 2001 VA outpatient treatment report reveals the Veteran’s blood pressure was 149/92. An April 2002 VA outpatient treatment report shows her blood pressure at 140/94. The assessment was mild elevation of blood pressure. A January 2003 VAMC outpatient note shows blood pressure of 140/90, with an assessment of hypertension. A June 2004 VA outpatient note reveals the Veteran had been taking blood pressure medications regularly. Her blood pressure was 137/80. The assessment was hypertension, controlled; it was recommended that the Veteran continue present medications. In January 2020 the Veteran underwent a VA hypertension examination, incorporating repeat blood pressure testing revealing elevation. The diagnosis was hypertension. With respect to a nexus opinion, the examiner opine that the Veteran’s hypertension was less likely than not (less than 50 percent probability) incurred in or caused by service. The rationale for the opinion was that there is no diagnosis for hypertension during active duty service or in close proximity after separation from service. The elevated blood pressure readings noted in service are more than likely isolated elevated readings and not indicative of hypertension, as there is no objective evidence of blood pressure monitoring or treatment with blood pressure medication during service. Additionally, the Veteran’s blood pressure at service separation in 1982 was within normal limits. The examiner noted that blood pressure can elevate due to factors other than hypertension, such as stress, pain, and caffeine intake. The Board acknowledges the Veteran’s belief that her currently diagnosed hypertension is related to her military service. However, absent any evidence that she has specialized training, knowledge, or experience in rendering medical opinions, the Veteran does not possess the requisite expertise to competently discuss the nature and etiology of hypertension, which is a medically complex disability. See Jandreau v. Nicholson, supra. For this reason, the Board must rely on the medical evidence of record. The Board finds that the evidence weighs against finding that hypertension is related to the Veteran’s service or manifested within one year of separation from service. The evidence of record shows the Veteran was first diagnosed with hypertension in 2003, more than 20 years after separation from service. While there were isolated blood pressure readings in service that were elevated, they do not meet VA's definition of hypertension, and in any event the Veteran’s blood pressure was not elevated upon separation from service. Furthermore, the January 2020 VA examiner opined that the Veteran’s current hypertension is etiologically unrelated to her service and supported this opinion with a rationale. As such, in weighing the Veteran’s belief against the only competent medical opinion of record, the Board accords the VA medical opinion greater probative weight. For these reasons, the Board finds that the evidence weighs against finding that hypertension is related to service or manifested within one year of separation from service. Accordingly, service connection for hypertension is denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Young, 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.