Citation Nr: 21001005 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 17-14 508 DATE: January 6, 2021 ORDER Service connection for bilateral eye glaucoma is denied. FINDING OF FACT The preponderance of the evidence is against finding the Veteran’s bilateral eye glaucoma began during service, is related to service, to include exposure to herbicide agents, or is secondary to his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for bilateral eye glaucoma are not met. 38 U.S.C. §§ 1110, 1116, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty from November 1963 to July 1966. Service connection for bilateral eye glaucoma The Veteran contends entitlement to service connection for bilateral eye glaucoma. See August 2014 NOD. Specifically, the Veteran contended he did not have problems with eyes until the onset of his diabetes mellitus (diabetes). Id. Service connection may be granted for a disability or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish service connection for a present disability the claimant must show: (1) the existence of a present disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship or “nexus” between the present disability and the in-service injury or disease. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was 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). VA has recognized the Veteran is presumed exposed to herbicide agents during service. If a veteran was exposed to an herbicide agent during active service, the diseases set forth in 38 C.F.R. § 3.309(e) will be presumed to be related to such service if they become manifest to a degree of 10 percent or more at any time after service, with an exception not applicable to this case. 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6)(ii). Glaucoma is not a disease set forth in 38 C.F.R. § 3.309(e). However, the Board will consider whether there is evidence of actual direct causation of glaucoma due to presumed herbicide agent exposure. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The Board recognizes the Veteran is diagnosed with bilateral eye glaucoma during the appeal period. The Board also recognizes the Veteran is service connected for diabetes and presumed exposed to herbicide agents during service. Therefore, the question for the Board is whether the Veteran’s glaucoma began during service, is related to service, to include exposure to herbicide agents, or is secondary to his service-connected diabetes. The Board finds the preponderance of the evidence is against finding the Veteran’s glaucoma began during service, is related to service, or is secondary to his service-connected diabetes. The probative evidence does not show, nor has the Veteran contended, his glaucoma began during service. Service treatment records (STRs) are silent for glaucoma during service. Post-service, the first mention of glaucoma was over 40 years after service, at a December 2006 treatment visit assessing glaucoma suspect. A May 2008 VA treatment visit was positive for glaucomatous changes. A December 2008 VA treatment visit diagnosed primary open angle glaucoma. Looking to whether the Veteran’s glaucoma was otherwise related to service or his service-connected diabetes, an October 2020 VA medical opinion found the Veteran’s glaucoma is less likely as not a result of service or exposure to herbicide agents. The clinician noted glaucoma is not among the conditions that may be presumed incurred in service based upon herbicide agent exposure and there is no competent medical evidence that the Veteran's glaucoma is otherwise etiologically related to service, including herbicide agent exposure. The clinician opined the Veteran’s glaucoma is less likely as not the result of or aggravated beyond its natural progression by his diabetes. The clinician stated the Veteran's glaucoma symptoms were not a manifestation of diabetic retinopathy and were not otherwise related to his diabetes because the Veteran does not have diabetic retinopathy. The clinician noted that diabetic retinopathy can increase the incidence of glaucoma; however, the Veteran does not have diabetic retinopathy. The Board gives probative weight to the October 2020 medical opinion finding the Veteran’s glaucoma is not related to service, herbicide agent exposure, or secondary to his service-connected diabetes. The opinion is based on an accurate medical history and provided a clear conclusion and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The clinician’s finding is consistent with treatment records showing the Veteran’s diabetes was without ophthalmic manifestation or diabetic retinopathy during the appeal period. As the preponderance of the evidence is against the claim, service connection for bilateral eye glaucoma is denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Winkler, 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.