Citation Nr: 21061719 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 14-10 949 DATE: October 5, 2021 ISSUE Entitlement to service connection for an eye disability, to include as secondary to service-connected hypertension. ORDER Entitlement to service connection for an eye disability, to include as secondary to service-connected hypertension is denied. FINDINGS OF FACT The Veteran's eye disability was not manifest in service, is not caused or aggravated by a service-connected disability and is not otherwise attributable to service. CONCLUSIONS OF LAW The Veteran's eye disability was not incurred in or aggravated by service and is not proximately due to, the result of or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.159, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1978 to August 1989. This matter comes before the Board of Veteran's Appeals from a November 2012 rating decision of the Department of Veteran's Affairs (VA) Regional Office (RO) in Denver, Colorado. In March 2020, the Veteran was afforded a Videoconference Board Hearing before the undersigned Veterans Law Judge. A transcript of that Hearing has been associated with the Veteran's record. This matter was previously before the Board in April 2020. In that decision, the Board, in pertinent part, remanded the Veteran's service connection claim for the purpose of obtaining an addendum medical opinion to address whether the Veteran's eye condition was aggravated by his service-connected hypertension. The matter has been properly returned for to the Board for appellate consideration and the Board is satisfied that there has been substantial compliance with the Board remand. Thus, no further action is required. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for an eye disability, to include as secondary to service-connected hypertension. The Veteran contends that he is entitled to service connection for his eye disabilities, to include as secondary to his service-connected hypertension. See May 7, 2012, VA Form 21-526B re: assertion that his glaucoma suspect is secondary to his existing service-connected disabilities. See also, March 11, 2020 Board Hearing transcript, pgs. 10-11; September 7, 2021, Informal Hearing Presentation, pgs. 1-2 re: strong belief his eye disabilities are due to his military service and/or secondary to his hypertension. For the reasons explained below, the Board finds that entitlement to service connection is not warranted. In order to obtain service connection under 38 U.S.C. §§ 1110, 1131 and 38 C.F.R. § 3.303 (a) a Veteran must satisfy a three-element test: (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 - the so- called 'nexus' requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Secondary service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Secondary service connection is also possible for the increase in severity of a nonservice connected disability that is caused (aggravated) by a service-connected disability. 38 C.F.R. § 3.310 (b). In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, with regard to the Veteran's claims. The Board's discussion and analysis below will focus on the Veteran's claim to entitlement to service connection for an eye disability on a secondary basis but will also address the Veteran's claim on a direct service basis. The Board now turns to the evidence of record in the evaluation of this Veteran's claim. Direct Service There is evidence that the Veteran has a current disability. In a June 26, 2012 Eye Conditions examination (dated October 16, 2012) a VA examiner noted the Veteran's diagnosis of glaucoma suspect April 22, 2011, as well as diagnoses for pinguecula, unknown re: onset; cataract, March 19, 2012; and myelinated nerve fibers, unknown re: onset. See June 26, 2012 Eye Conditions examination, dated October 16, 2012, pgs. 2-3. To the extent that the Veteran has alleged that his eye disabilities are directly related to service, the Board finds that there is no evidence linking these conditions to his military service. Service treatment records are negative for any documentation of complaint, relevant findings, treatment for, or diagnosis for an eye disability. See July 28, 1989 Report of Medical Examination; See also, July 8, 1988 Report of Medical Examination (Annual physical) re: eyes normal on clinical evaluation. Review of the Veteran's VA and private medical treatment records indicates that the earliest diagnosis for an eye disability was in April 2011 for glaucoma suspect. See also, November 2, 2020 Eye Condition's Examination, pgs. 1-2. The probative medical evidence does not contain a VA or private medical opinion indicating that the Veteran's eye disabilities were incurred during or caused by his period of active service. Accordingly, entitlement to service connection on a direct basis is not warranted. See 38 C.F.R. § 3.303. Secondary Service As indicated earlier in this decision, the Veteran primarily contends that his glaucoma suspect was caused or aggravated by his hypertension. See May 7, 2012, VA Form 21-526B re: assertion that his glaucoma suspect is secondary to his existing service-connected disabilities. Because the Veteran has a service-connected disability, which he alleges caused his or aggravated his eye disability, the Board finds that based on the evidence of record, the Veteran has satisfied the first two prongs of service connection on a secondary basis: 1) evidence of a current disability and 2) evidence of a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Turning to the "medical nexus" requirement: The Veteran was afforded a VA Eye Conditions examination in June 2012 to determine the nature and etiology of his sleep apnea. The June 2012 VA examiner indicated reviewed the Veteran's medical history, noted that the Veteran was diagnosed with high blood pressure in 1989. The Veteran reported that he was diagnosed with glaucoma in 2009. As referenced above, the VA examiner noted the Veteran's diagnosis of glaucoma suspect April 22, 2011, as well as diagnoses for pinguecula, unknown re: onset; cataract, March 19, 2012; and myelinated nerve fibers, unknown re: onset. See June 26, 2012 Eye Conditions examination, dated October 16, 2012, pgs. 2-3. After physical examination of the Veteran, applicable testing and review of the Veteran's claims file, the examiner rendered a negative linkage to the Veteran's service-connected disability. The June 2012 examiner opined that the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected condition. The examiner provided the following rationale to support this opinion: His intraocular pressures from December 18, 2007, until March 19, 2012, ranged between 19 and 21 for his right eye and 19 and 20 for his left eye. He has been diagnosed as a glaucoma suspect in the past. He has no family history of glaucoma. The amount of optic disc cupping of his eyes has not changed over the past 4 plus years. He has never been diagnosed with glaucoma. Hypertension does not cause glaucoma, pre-glaucoma or cause a patient to become a glaucoma suspect. Id. at pg. 25. Because the June 2012 examiner did not address whether the Veteran's glaucoma suspect eye condition was aggravated by his service-connected hypertension, his claim was remanded by the Board in April 2020 for an addendum medical opinion, to include an additional examination if deemed necessary by the examiner. See April 27, 2020 Board Remand, pgs. 8-11. Pursuant to the Board's April 2020 Remand, the Veteran was afforded a November 2020 Eye Conditions examination and medical opinion. In this November 2020 Eye Conditions examination, the VA examiner indicated that the Veteran's medical records were reviewed, including but not limited to the Veteran's in-service and post-service treatment records and a recent September 3, 2020 VA eye examination. See November 2, 2020 Eye Condition's Examination, pg. 1. The November 2020 examiner confirmed the Veteran's diagnosis of glaucoma suspect both eyes, pinguecula both eyes and cataracts of both eyes. The examiner also reported a diagnosis of meibomian gland dysfunction, both eyes and conjunctivitis, chronic allergic, in both eyes. Id. at pg. 2. After review of the Veteran's medical records, including the recent September 2020 VA eye examination, the examiner rendered a negative nexus opinion to service. The November 2020 examiner first opined that the Veteran's claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner provided the following rationale to support this opinion. Service treatment records are silent for any ocular pathology (nor even any complaints, injuries, infection, etc. There is no evidence to support a direct service connection between the Veteran's current eye conditions and his service. See November 2, 2020 Medical Opinion, pgs. 1-2. Addressing secondary service connection, the November 2020 VA examiner rendered a negative linkage opinion to the Veteran's service-connected disability. The examiner opined that the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected condition. The examiner reasoned that the Veteran "has no ocular disability that would be secondary in nature to his hypertension." The examiner explained that "the Veteran's ocular conditions are unrelated to any service-connected disabilities as to include hypertension. They are separate and independent conditions." Id. at pg. 3. The examiner also determined that the Veteran's eye disabilities were not aggravated by the Veteran's service-connected hypertension. Specifically addressing the Veteran claim that his glaucoma suspect is related to or aggravated by his hypertension, the examiner explained that the "Veteran has remained stable as a suspect only. He does not have glaucoma; therefore, this is not a disability. The suspicion of glaucoma is not related to hypertension." Addressing his cataract condition, the examiner explained that the Veteran's cataracts are "age related and not aggravated by any additional disability as to include hypertension." Addressing his pinguecula ocular condition, the examiner opined that this condition is "unrelated to hypertension, is not aggravated by hypertension." Addressing his meibomian gland dysfunction, the examiner opined that this condition is "unrelated to hypertension, is not aggravated by hypertension." Addressing his allergic conjunctivitis, the examiner opined that this condition was "unrelated to hypertension, is not aggravated by hypertension. Id. at pg. 3. Analysis In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The Board finds the November 2020 Eye Conditions examination and medical opinion probative for the following reasons: First, the examiner noted review of the pertinent evidence of record, including review of the Veteran's medical records, including but not limited to his in-service and post-service treatment records. Second, the examiner provided sound reasoning for the conclusions reached, addressing each of the Veteran's ocular conditions. Third, the examiner provided an explanation as to why the Veteran's ocular condition was not caused or aggravated by his service-connected hypertension. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board also notes that to the extent that the June 2012 Eye Conditions examination addresses whether the Veteran's glaucoma suspect was proximately caused by his hypertension, the Board also finds this examination probative. Hence, the Board finds the November 2020 examination, taken together with the June 2012 examination adequate for adjudication purposes. Lay statements The Board does not assign any probative value to the Veteran's statements which purport to relate his glaucoma suspect to his service-connected hypertension. Moreover, the Board does not assign any probative value to his belief that his eye disabilities are related to military service and/or his service-connected hypertension. See September 7, 2021, Informal Hearing Presentation, pgs. 1-2 re: strong belief his eye disabilities are due to his military service and/or secondary to his hypertension. While the Veteran is certainly competent to report symptoms he experiences, he has not demonstrated that his is competent to provide an opinion regarding the nature and etiology of his eye disabilities. Nor has the Veteran demonstrated that his is competent to provide an opinion on the etiological "nexus" between his glaucoma suspect (or any eye disability) and his service-connected hypertension. Therefore, the Board finds the Veteran's statements and beliefs that relate his eye disabilities to his service-connected hypertension unpersuasive. It follows that the Board finds the November 2020 examination and medical opinion, together with the June 2012 examination and medical opinion to be the most probative and persuasive evidence of record as to the nature and etiology of this Veteran's eye disabilities. The June 2012 Eye Conditions examiner determined that hypertension does not cause glaucoma, pre-glaucoma or cause a patient to become a glaucoma suspect. See June 26, 2012 Eye Conditions examination pg. 25. The November 2020 VA examiner determined that the Veteran did not have any ocular disability that would be secondary in nature to his hypertension. The examiner found that the Veteran's ocular conditions are unrelated to any service-connected disabilities as to include hypertension. The basis for this determination was that they are separate and independent conditions. Specifically addressing whether the Veteran's glaucoma suspect was aggravated by hypertension, the examiner explained that the Veteran has remained stable as a glaucoma suspect only. He does not have glaucoma; therefore, this is not a disability. The suspicion of glaucoma is not related to hypertension. See November 2020 Eye Conditions Medical Opinion, pg. 3. Addressing all of the Veteran's contentions, the Board underscores that this November 2020 Eye Conditions' examiner also determined that there is no evidence to support a direct service connection between the Veteran's current eye conditions and his service. See November 2020 Eye Conditions Medical Opinion, pg. 2. See also, July 28, 1989 Report of Medical Examination; July 8, 1988 Report of Medical Examination (Annual physical) re: eyes normal on clinical evaluation. There is no contrary competent medical opinion of record. In summary, the Board finds that the Veteran's eye disability was not manifest in service, is not caused or aggravated by a service-connected disability and is not otherwise attributable to service. Given that the Board has found the unfavorable November 2020 VA examination and medical opinion, together with the June 2012 VA examination and medical opinion to the most probative evidence of record, the preponderance of the evidence is against the Veteran's claim for service connection, and the claim must be denied. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.