Citation Nr: 20050179 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 18-29 581 DATE: July 28, 2020 ORDER Entitlement to service connection for detached retina, left eye, is denied. FINDING OF FACT The most probative evidence establishes that the appellant’s detached retina, left eye, was not incurred during active service or otherwise causally related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for detached retina, left eye have not been met. 38 U.S.C. §§ 1110; 1154(b); 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant served on active duty in the U.S. Army from January 1969 to August 1970, including service in the Republic of Vietnam. He is the recipient of multiple awards and decorations, including the Combat Infantryman Badge, Air Medal, and Bronze Star Medal. This matter comes before the Board of Veterans’ Appeals (Board) from a December 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which, inter alia, denied service connection for detached retina, left eye. The appellant was afforded a hearing before the undersigned in October 2019. A transcript is of record. The Board remanded this matter in December 2019. A Supplemental Statement of the Case (SSOC) was issued in May 2020. 1. Entitlement to service connection for detached retina, left eye, is denied. The Board finds that the most probative evidence establishes that entitlement to service connection for detached retina, left eye, is not warranted. During his October 2019 hearing, the appellant testified that, while serving in Vietnam, he was thrown by the concussive force of 500-pound bombs dropped by American forces and incoming enemy mortar rounds. The appellant did not experience residuals immediately, but later, an optometrist told him in 2004 that his left eye problems, including retinal detachment, could be the result of old concussive trauma such as this event. The appellant denied other trauma to the head. He noted that the private medical records from this eye doctor were no longer available. On his substantive appeal, the appellant noted that he experienced concussive blasts when he was five feet away from an M-60 gun firing at the enemy. Service treatment records reveal that the appellant entered active service with no history of eye problems save for myopic refractive error. He already wore glasses. Vision was correctable to 20/20 bilaterally. Service treatment records are negative for pertinent complaints or observations. Spectacles prescriptions are of record. The appellant’s August 1970 separation examination was essentially normal with respect to the eyes and ophthalmoscopic. He wore glasses and vision was correctable to 20/20 bilaterally. The appellant was afforded a VA examination in January 2020. The claims file was reviewed. Left eye retinal detachment was diagnosed. The appellant reported that his eyesight in his left eye started going bad in the summer of 2004. After noticing a spot in the bottom part of his vision, the appellant went to an eye doctor and was told that his retina had detached. He was then sent to a retinal specialist. Unfortunately, both surgical attempts to reattach the retina were unsuccessful. The appellant’s vision continued to worsen and he developed a cataract. However, the retinal specialist recommended that it was better to leave alone at this point. However, he had undergone cataract surgery on the right eye. The VA examiner opined that it was less likely than not that the appellant’s left eye retinal detachment was caused by or a result of his active service. The examiner explained that it was clear that a non-traumatic retinal detachment of the left eye occurred in 2004. There was no light perception vision despite multiple repair attempts. The examiner noted that the cause of the appellant’s retinal detachment was ultimately unknown as there are no records from the time of diagnosis. The appellant did not suffer any type of trauma and the onset appeared to be spontaneous. It was noted that the most common cause of spontaneous retinal detachment in adults is due to a posterior vitreous detachment (PVD). PVD is very common after the age of 60, occurring in up to 75 percent of people by the age of 65. PVD is an age-related shrinkage of the gel-like fluid which fills the back of the eye, which can result in a peripheral retinal tear. This can subsequently lead to a retinal detachment in about 10 to 15 percent of cases. The risk of retinal tears and detachment associated with PVD is higher in patients with myopic retinal degeneration, lattice degeneration, and a familial or personal history of previous retinal tears of detachment. Notably, the appellant was a known myope even prior to his active service. The examiner concluded that it was highly unlikely that the concussive blasts in Vietnam could have contributed to the retinal detachment, although anything is possible. Notably, the vast majority of traumatic retinal detachments occur at the time of injury. Here, the retinal detachment occurred more than 30 years after the reported incident. No medical literature supports a retinal detachment being caused by a decades-old injury. The most likely cause of the appellant’s retinal detachment was a posterior vitreous detachment that resulted in a retinal tear and subsequent retinal detachment. Notably, the appellant was 62 years of age when the detachment occurred, with PVD being more common after age 60. In May 2020, the appellant reported that he contacted his optometrist’s office and was informed that additional records from his 2004 visits were not available as the office does not keep records for more than ten years. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. “To establish a right to compensation for a present disability, a Veteran must show: ‘(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service’—the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Applying the facts in this case to the criteria set forth above, the Board finds that entitlement to service connection for detached retina, left eye, is not warranted. It is well established that congenital or developmental defects and refractive error of the eyes are not considered diseases or injuries within the meaning of applicable legislation governing the awards of VA compensation benefits. See 38 C.F.R. §§ 3.303(c), 4.9; McNeely v. Principi, 3 Vet. App. 357, 364 (1992). However, retinal detachment is not refractive error of the eye. Rather, the appellant’s eyes were found to be normal, aside from myopic refractive error, during his February 1968 pre-induction examination and again at entrance during a January 1969 physical inspection. The appellant does not contend otherwise. He contends that concussive blasts incurred during combat were the cause of his 2004 left eye retinal detachment. As noted supra, the appellant served in the Republic of Vietnam during the period from January 9, 1962, to May 7, 1975, and is thus presumed to have been exposed to herbicide agents. 38 C.F.R. § 3.307(a)(6)(iii). While there is no presumption of service connection for retinal detachment, a claimant may establish service connection based on exposure to Agent Orange with proof of actual direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Here, however, there is no indication or contention that the appellant’s retinal detachment was caused by presumed exposure to herbicide agents. Rather, the appellant contends that concussive blasts incurred during combat were the cause of his 2004 left eye retinal detachment. The appellant in this case is a combat Veteran, as reflected by his awards and decorations indicative of combat service, including the Combat Infantryman Badge (CIB), and his military occupational specialty of Infantryman. Under 38 U.S.C. § 1154(b), in the case of any veteran who engaged in combat with the enemy in active service, the Secretary shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. In this case, the Board finds that the appellant has provided satisfactory lay evidence of an in-service concussive injury which is consistent with the circumstances, conditions, and hardships of his service. He has also provided competent and credible lay evidence that an optometrist told him that his post-service left eye retinal detachment could be the result of old concussive trauma. However, despite the existence of an in-service injury and a current disability, a nexus must still be present in order to award a grant of service connection. Here, the Board affords great probative weight to the etiological opinion of the January 2020 VA examiner. The medical opinion was based upon an examination of the appellant and a review of the claims file. The opinion was accompanied by a detailed rationale and references the relevant evidence of record and medical knowledge. Further, the opinion is consistent with the evidence of record. The Board notes the argument of the appellant’s representative that the VA medical opinion was too speculative because the medical literature did not definitively rule out a causal connection between the retinal detachment and remote concussive blasts, and that a grant of the benefit sought was warranted because the examiner conceded that “anything is possible.” However, a VA opinion need not be definitive but must simply comply with the as likely as not (greater than 50 percent) probability standard. The VA examiner indeed used the requisite probability standard. The Board has considered the appellant’s reports that his private optometrist told him in 2004 that his left eye problems, including retinal detachment, could be the result of concussive trauma in Vietnam but assigns it less probative weight than the January 2020 VA medical opinion. It is well established that medical opinions that are inconclusive in nature do not provide a sufficient basis upon which to support a claim. See e.g. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (finding doctor’s opinion that “it is possible” and “it is within the realm of medical possibility” too speculative to establish medical nexus); Goss v. Brown, 9 Vet. App. 109, 114 (1996) (using the words “could not rule out” was too speculative to establish medical nexus); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (holding that a physician’s statement that a service-connected disorder “may or may not” have prevented medical personnel from averting a Veteran’s death was not sufficient). Given the applicable standard of proof, the Board finds that this opinion of the appellant’s private optometrist is insufficient to support an award of service connection and certainly does not outweigh the VA medical opinion cited above. The Board has considered the appellant’s lay history of symptomatology related to his claimed disorder throughout the appeal period. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through an individual’s senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The appellant in this case is not competent to determine the cause of his symptoms because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the appellant in this case, who has not been shown by the evidence of record to have medical training or skills. The Board finds the VA examination report to be of greater probative weight than the appellant’s lay assertions. In sum, the most probative evidence establishes that it is less likely than not that the appellant’s current left eye retinal detachment is causally related to his in-service concussive trauma. The Board emphasizes that the appellant’s in-service injury of concussive trauma is not disputed. However, as the evidence preponderates against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Behlen, 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.