Citation Nr: 21004534 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 12-24 264 DATE: January 27, 2021 ORDER Entitlement to service connection for an eye condition (cataracts, amblyopia, and exotropia), to include as secondary to service-connected diabetes mellitus type 2, is denied. FINDING OF FACT The competent and probative evidence of record fails to link the Veteran’s eye condition to his active service or to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for an eye condition, to include as secondary to service-connected diabetes mellitus type 2, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1964 to June 1967 and from April 1970 to February 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in December 2016 and January 2020, when the case was remanded for further development. The case has returned to the Board for additional appellate action. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). VA shall give the benefit of the doubt to the claimant when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. 38 U.S.C. § 5107(b). In this case, the Veteran asserts that his eye conditions, including cataracts, amblyopia and exotropia are related to his time in service, or otherwise related on a secondary basis to his service-connected diabetes mellitus type 2. The Veteran’s post-service medical records show he first reported eye-related issues in 2006. Cataracts in both eyes, noted as mild and non-visually significant, are found in 2010 VA treatment records, several decades after service. Thus, the Veteran has a current disability. The Veteran is also noted to have congenital eye conditions, including amblyopia and exotropia. In regard to the second element for service connection, the Veteran’s service treatment records (STRs) do not contain any complaints of, treatment for, or diagnosis of any eye-related condition, or any symptoms related to an eye condition. In the Veteran’s Reports of Medical History, including his entrance and separation examinations, his eyes were noted as normal. As noted above, the earliest record of any eye-related issues is decades after the Veteran’s separation from service. In regard to nexus under direct and secondary service connection, the September 2020 VA examiner opined that the Veteran’s eye conditions were less likely than not due to his active service. Regarding the Veteran’s cataracts, the examiner stated that the Veteran’s cataracts are mild and age-normal for the Veteran. In addition, the examiner further concluded that as there is no evidence of premature or dense cataract formation, which could be attributed to diabetes mellitus type 2, the Veteran’s cataracts (noted as mild) were less likely than not caused or aggravated by the Veteran’s service-connected diabetes mellitus type 2. As such, a nexus based on causation or aggravation beyond natural progression was not found for the Veteran’s mild cataracts. See 38 C.F.R. § 3.310. Moreover, the September 2020 examiner stated that the Veteran’s amblyopia and exotropia are congenital conditions and thereby not related to service on a direct or secondary basis. A VA medical opinion in March 2020 also concluded that amblyopia and exotropia are not caused nor related to diabetes mellitus type 2. Based on the March 2020 examiner’s medical records review and clinical knowledge, the examiner further explained that amblyopia and exotropia are caused by preexisting uncorrected refractive errors, and uncorrected asymmetric refractive errors cause the brain to use only one eye to see as it is unable to merge 2 different images into one, and this results in amblyopia and exotropia. The Board finds that the competent medical evidence shows that the Veteran’s amblyopia and exotropia are congenital defects, not subject to a superimposed disease or injury during service, for which service connection may not be granted. See 38 C.F.R. § 3.303(c), 4.9. The Board further finds that the Veteran’s lay statements of record are outweighed by the persuasive rationale provided in the March and September 2020 opinions. To the extent that the Veteran has been shown to be competent to opine on symptoms experienced in service and matters of personal observation, respectively, the Board finds that the opinion of the VA examiners are of greater probative weight than the lay statements of record, and the Veteran is not shown to have the training or credentials to provide a competent medical opinion on the etiology of his eye condition, as that requires medical expertise. The September and March 2020 examiners have training, knowledge, and expertise upon which was relied upon to reach the above determinations, and the opinions reflect a comprehensive, accurate, and reasoned review of the entire evidentiary record. Thus, the examiners’ opinions outweigh any lay statements of record. Ultimately, the preponderance of evidence is against a finding that the Veteran’s eye conditions, including cataracts, amblyopia and exotropia, are related to his active service on a direct or secondary basis. The Board finds that the September 2020 VA opinion and March 2020 opinion regarding amblyopia and exotropia are the most probative evidence with respect to the claim, given the examiners’ training and credentials and the claims file review incorporated. As such, the benefit-of-the-doubt doctrine does not apply in this case, and service connection for an eye condition must be denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, 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.