Citation Nr: 21001899 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 11-00 184A DATE: January 12, 2021 ORDER Entitlement to service connection for glaucoma is granted, subject to the laws and regulations governing the award of monetary benefits. FINDING OF FACT The evidence is at least in equipoise that the Veteran’s current glaucoma was at least as likely as not incurred in and is related to active service. CONCLUSION OF LAW The criteria for service connection for glaucoma are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1973 to April 1978. In May 2012, the Veteran testified at a Board hearing before a Veterans Law Judge who is no longer available to adjudicate this appeal. In November 2019, the Board sent the Veteran a letter offering him another Board hearing. The Veteran did not respond to the letter, and thus the Board presumes that he does not want another hearing. This appeal has a long procedural history and has been before the Board previously. Most recently, in January 2020, the Board remanded the appeal for development. The Board finds that the Agency of Original Jurisdiction (AOJ) substantially complied with the Board’s remand instructions and an additional remand to comply with the Board’s directives is not required. See Stegall v. West, 11 Vet. App. 268 (1998). The record contains additional evidence that the AOJ has not yet considered. However, since this decision is wholly favorable to the Veteran, neither a waiver of the Veteran’s right to initial AOJ review of such evidence nor a remand of this appeal for the issuance of a Supplemental Statement of the Case (SSOC) is necessary. See 38 C.F.R. § 20.1305(c). The Veteran seeks to establish service connection for glaucoma. He contends that he has a current eye disability that was incurred in and is related to active service, namely various injuries sustained during his in-service boxing career. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). A layperson is generally incapable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff’d sub nom., Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or, (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it pertains to the readily observable features or symptoms of injury or illness and “may provide sufficient support for a claim of service connection.” Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2). A determination as to whether medical evidence is needed to demonstrate that a Veteran presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran’s present condition (e.g., whether the Veteran’s present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology; rather, such may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C. § 1154(a). See Davidson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In this case, the evidence of record summarized below is at least in equipoise that the Veteran has a current glaucoma disability that was incurred in and is related to active service. First, the evidence is at least in equipoise that the Veteran has a current glaucoma disability. During a July 2014 VA examination, he reported a history of glaucoma. However, the examiner noted that the examination did not show a diagnosis of glaucoma; rather, the examiner diagnosed the Veteran as a glaucoma suspect based on slight assymetry in his cup-to-disc ratios. July 2015 VA treatment notes show the Veteran had no suspicion of glaucoma at the time; however, monitoring was recommended. During a May 2019 VA examination, the examiner noted there was no diagnosis of glaucoma because the Veteran did not exhibit glaucoma during the examination; however, the examiner noted the Veteran should be followed as a low-risk glaucoma suspect. In a November 2019 Eye Conditions Disability Benefits Questionnaire, the private optometry examiner diagnosed ocular hypertension secondary to trauma sustained while a boxer in the military, as well as glaucoma. Although there were multiple times the Veteran was examined and found not to have glaucoma, those clinicians also noted concerns for the risk of future glaucoma development. The most recent examination in November 2019 shows the Veteran was diagnosed with glaucoma. In summary, resolving all reasonable doubt in the Veteran’s favor, the Board finds the evidence is at least in equipoise that he has a current diagnosis of glaucoma. Second, the weight of the evidence shows that the Veteran incurred various eye injuries during active service. He has competently, credibly, and consistently reported that he engaged in boxing as part of his military service. Specifically, he reported that from around 1974 through 1977, he fought in more than one hundred boxing bouts, many of which resulted in several traumatic blows to the eyes. See e.g., December 2009 VA optometry consult note; August 2010 statement; May 2012 hearing testimony. This lay testimony is generally consistent with the verified circumstances of the Veteran’s active service. See service personnel records, April 1978 performance evaluation (noting that prior to his current assignment, the Veteran had spent the majority of Army career as a boxer). Finally, the evidence is at least in equipoise that the Veteran’s current glaucoma is related to active service, namely eye injuries incurred as a boxer. The Board affords great probative value to the following medical findings competently and persuasively linking the Veteran’s current glaucoma to traumatic eye injuries sustained during active service. The July 2014 found that the Veteran’s history of blunt trauma with boxing made him more at risk for developing glaucoma. Likewise, the May 2019 VA examiner explained that any traumatic blows to the eye can lead to glaucoma because this can cause damage to the small structures that help to drain the aqueous humor inside of the eye. The examiner noted that any time someone has had a blow to the eye, especially in the form of blunt trauma, his or her risk for developing glaucoma will always be higher, and glaucoma can develop at any time in the future after the traumatic event. Similarly, the November 2019 private optometry examiner diagnosed the Veteran with glaucoma, as well as ocular hypertension secondary to trauma sustained while a boxer in the military. In conclusion, the competent, credible, and probative evidence summarized above is at least in equipoise that the Veteran’s current glaucoma disability was incurred in and is related to active service. Resolving all reasonable doubt in the Veteran’s favor, the appeal is granted. R. JANOFSKY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, 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.