Citation Nr: 21004492 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 15-01 280 DATE: January 27, 2021 ORDER Entitlement to service connection for residuals of left eye surgery is denied. FINDING OF FACT The Veteran’s residuals of left eye surgery is was not incurred in service and is not otherwise causally or etiologically related to service. CONCLUSION OF LAW The criteria for establishing service connection for residuals of left eye surgery 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 in the United States Air Force from February 1966 to November 1968. This matter is on appeal from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Board remanded the instant matter to identify and obtain any outstanding treatment records and to obtain an etiology opinion. Such an etiology opinion was obtained in March 2019 and a February 2019 letter to the Veteran requested that he complete an appropriate authorization form to allow VA to obtain records from any private providers on this behalf. In September 2019, the Board again remanded the instant matter for additional development. Specifically, the Board instructed that a VA addendum opinion was to be obtained. Such an addendum opinion was obtained in October 2020. The Board therefore finds that there has been substantial compliance with its previous remands. Stegall v. West, 11 Vet. App. 268 (1998). In order to establish service connection, the following must be shown: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for residuals of left eye surgery. The Veteran contends that his current eye condition is the result of an in-service trauma, specifically a corneal abrasion to his left eye. In a September 2013 notice of disagreement, the Veteran stated that he suffered from eye symptoms such as sensitivity to light and difficulty reading since his in-service eye injury. Service treatment records show that the Veteran suffered a blunt trauma to the left eye in 1966. The Veteran reported that he struck his eyebrow against his bed and that he complained of eye pain in July 1966. A July 1966 right orbit X-ray found no evidence of fracture or space occupying lesion. Post-service treatment records show that the Veteran began treatment for eye conditions in 2001. Such included treatment for intraocular lens in the left eye in March 2016 and a diagnosis of chronic angle closure glaucoma of both eyes and noted the Veteran’s history of trauma to the left eye. The record also shows treatment at a private facility for eye conditions, to include corneal edema, nerve pain, and intraocular lens. The Veteran was also treated for glaucoma at VA in January 2002. The Veteran was afforded a VA examination in March 2019. The examiner diagnosed the Veteran with bilateral eye glaucoma and bilateral pseudophakia. The March 2019 examiner opined that it was less likely than not that the Veteran's left eye conditions were incurred in or caused by the claimed in-service injury, event or illness as the Veteran suffered a blunt trauma to the left eye in 1966 which resolved with treatment and that the Veteran later developed cataracts and glaucoma in the early 2000s. The examiner further opined that the Veteran had both cataracts removed, that he now had pseudophakic in both eyes, that he had been treated for progressive glaucoma with topical drops and laser surgery both eyes and that his had glaucoma related optic atrophy in the left eye with visual field constriction. The examiner reasoned that cataracts are more likely than not age related and not secondary to 1966 eye surgery, that he has progressive open angle glaucoma since 2001 and that this is a separate condition not related to 1966 eye injury. An addendum VA opinion was obtained in October 2020. The October 2020 VA examiner opined that the Veteran’s current eye conditions are not related to his corneal abrasion in 1966 which resolved quickly. The examiner further opined that the corneal abrasion of 1966 would likely not have any bearing on his glaucoma which is bilateral in nature and equal in severity in both eyes. The eye trauma of 1966 would also likely not have any bearing on the Veteran’s diabetes which manifested currently without diabetic retinopathy, and neither would it have any bearing on his macular degeneration which is mild and affecting both eyes equally. The examiner opined that the Veteran’s eye condition were bilateral in nature and affecting both eyes equally, which would not be characteristic of a unilateral eye trauma to one eye in 1966. Rather, the Veteran’s eye conditions were characteristic of his age and race, and being equal in the right and left eye, do not show the left eye being affected more than the right eye, as should be the case if due to a singular eye trauma to one eye. The Board finds the March 2019 opinion and October 2020 addendum opinion to be highly probative as the examiner reviewed the claims file, interviewed the Veteran, and provided an opinion supported by a clear rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There is no contrary opinion of record. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to" and a mere conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran's service and his left eye condition to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, the Board accords the statements regarding the etiology of the Veteran's left eye condition little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issued. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinion of the Veteran is nonprobative evidence. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for residuals of a left eye injury. As such, that doctrine is not applicable in the instant claim, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, 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.