Citation Nr: 21004007 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 16-38 484 DATE: January 25, 2021 ORDER Service connection for a chronic eye disability is denied. REMANDED Eligibility for VA outpatient dental treatment is remanded. FINDING OF FACT The preponderance of the evidence is against finding that a chronic eye disorder, including pterygium and cataracts began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a chronic eye disability have not been 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 April 1969 to April 1971. In January 2019, a videoconference Board hearing was held before a Veterans Law Judge who is no longer a member of the Board. In October 2020, the Veteran was notified and asked if he wished to schedule another hearing on appeal. No response was received within the necessary time limit and it has been assumed that he did not wish another hearing, in accordance with the notification letter furnished to the Veteran. A transcript of the January 2019 Board hearing is associated with the Veteran’s claims file. The case was remanded by the Board in May 2019 and in March 2020. While the requested development was accomplished for the issue of service connection for a chronic eye disorder, the issue of eligibility for dental treatment remains outstanding and must, once again, be remanded for requested action. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a chronic eye disability The Veteran contends that service connection should be established for a chronic eye disability. During his hearing in January 2019, he testified that he was specifically claiming service connection for a growth on the eye that he believed was the result of sun exposure he sustained while serving in the Republic of Vietnam (RVN) during service. It is noted that he has also been diagnosed with cataracts of each eye. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnoses of pterygium, cataracts and presbyopia, the preponderance of the evidence is against finding that any of these disorders began during active service, or are otherwise related to an in-service injury, event, or disease. Review of the Veteran’s service treatment records (STRs) shows no complaint or manifestation of an eye disorder during service. On examination for separation from service, the Veteran’s uncorrected visual acuity was 20/20 in each eye. He had no complaints or manifestations of an eye disorder. Post-service treatment records show that the Veteran was treated for a pterygium of the right eye in October 2012. At that time, he reported for clinical purposes that he had a 20-year history of pterygium of the right eye. He underwent an excision of the pterygium. An examination was conducted by VA in December 2019. At that time, the diagnoses were bilateral nuclear sclerotic cataracts, bilateral cortical cataracts and bilateral pterygium with the right eye being status post removal of the pterygium. After examination and review of the record, the examiner, an ophthalmologist, opined that it was less likely than not that the Veteran’s eye disorders were incurred in or caused by his claimed in-service injury, event, or illness. The rationale was that while the Veteran did have presbyopia, this was a natural process. The examiner explained that presbyopia was caused by aging of the lens and that as the lens of the eye grows it becomes inflexible; it was not known to be caused by anything else. Regarding pterygium, the examiner observed that it was only documented in the medical records in 2011, and that there was no record of this earlier in the record. It was not documented in the Veteran’s STRs and, in a treatment note dated from October 2012, the history stated that the pterygium had been present for about 20 or so years. The examiner noted that since the Veteran separated from service in 1971, the onset of the pterygium would have been after his separation from service. Therefore, the examiner opined it was less likely than not related to military service. Regarding the nuclear and cortical cataracts, the examiner noted that the Veteran’s STRs were silent for cataracts, which were typically age related and, therefore, unrelated to military service. In an addendum opinion in May 2020, the same VA examiner who had examined the Veteran in December 2019 addressed his contention that although his eye problems had their onset after service, he believed them to be due to sun exposure in service. Specifically, the examiner opined that the claimed conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran’s medical records did not support that any currently diagnosed eye condition, to include presbyopia and pterygium, was related to service, to include exposure to sun in Vietnam. The examiner explained that the cause of pterygium was unknown, and that, while sun exposure might play a role, there were other factors which could cause a pterygium to develop, such as wind, dust environmental factors, and dry eyes. The examiner noted that the Veteran’s pterygium developed years after the claimed sun exposure and with no nexus or continuation of treatment, other factors were considered more likely the cause of the development of the pterygium. The only medical opinions in the record are from the VA examiner who opined that the Veteran’s eye disorders were not at least as likely as not related to an in-service injury, event, or disease. While the Veteran believes his current eye disorders are related to his military service, he is not competent as a lay person to provide a diagnosis in this case or opine as to the etiology of his eye disorders. These issues are medically complex, as they require specialized medical education and are not capable of being resolved through lay observation alone. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for a chronic eye disorder, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Eligibility for VA outpatient dental treatment is remanded. The issue regarding eligibility for VA outpatient dental treatment has been twice remanded by the Board so that the Veteran’s claim may be adjudicated by the Veterans Health Administration (VHA) in accordance with 38 C.F.R. § 3.381, which provides that all of such claims must be first adjudicated by VHA. While the Regional Office (RO) did send the Veteran notification that he needs to submit a claim for dental treatment, the Board notes that a claim for service connection for a dental disability also includes a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 305-306 (1993). As such, he has already submitted his claim and it is incumbent on the RO to refer the case to VHA for adjudication of entitlement to VA outpatient dental treatment. Notably, although there is a September 2020 memorandum in the claims file requesting that this be completed, there are no further documents addressing this matter. Therefore, the Board is unable to discern whether the requested action has been completed. The matters are REMANDED for the following action: Refer the claim for dental treatment to the appropriate VA Medical Center (VAMC) to determine if the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph P. Gervasio 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.