Citation Nr: 21062508 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 16-16 678 DATE: October 7, 2021 ORDER Entitlement to service connection for an eye disability, to include myopia, presbyopia, astigmatism, photophobia, and myopic astigmatism with presbyopia and photophobia, and to include as secondary to service-connected migraine headaches and/or service-connected diabetes mellitus type 2 with vertigo is denied. FINDING OF FACT The Veteran's diagnoses of myopia, presbyopia, astigmatism, photophobia, myopic astigmatism with presbyopia and photophobia are not subject to service connection. The Veteran's eye disability, to include myopia, presbyopia, astigmatism, photophobia, and myopic astigmatism with presbyopia and photophobia, is not caused or aggravated by service-connected migraine headaches and/or service-connected diabetes mellitus type 2 with vertigo. CONCLUSION OF LAW The criteria for service connection for an eye disability, to include myopia, presbyopia, astigmatism, photophobia, and myopic astigmatism with presbyopia and photophobia, and to include as secondary to service-connected migraine headaches and/or service-connected diabetes mellitus type 2 with vertigo, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.9. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from August 1984 to August 1990. Service Connection 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). When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability. Id. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Entitlement to service connection for an eye disability, to include myopia, presbyopia, astigmatism, photophobia, and myopic astigmatism with presbyopia and photophobia, and to include as secondary to service-connected migraine headaches and/or service-connected diabetes mellitus type 2 with vertigo. In a July 2013 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, the Veteran claimed entitlement to service connection for blurred vision secondary to service-connected anxiety disorder not otherwise specified. In a VA Form 21-0820, Report of General Information, the Veteran stated his claim for blurred vision is secondary to either service-connected migraine headaches or service-connected diabetes mellitus type 2. As the Veteran has claimed entitlement to service connection on a secondary basis, the Board shall only consider this theory of entitlement. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for an eye disability on a secondary basis. The reasons follow. The question for the Board in this case 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 or is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order for service connection to be established, there needs to be competent evidence of a current disability. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran has a current diagnosis of an eye disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). Throughout the pendency of the claim, the Veteran has been variably diagnosed myopia, presbyopia, astigmatism, photophobia, myopic astigmatism with presbyopia and photophobia The Board notes that in the December 2019 VA examination, the Veteran was diagnosed with ophthalmoplegia migraine. However, the Board finds that this diagnosis is attributed to the Veteran's service-connected migraine headaches and is not a separate diagnosis of an eye disability. For example, the American Academy of Ophthalmology states that "Ophthalmoplegic migraine (OM), more recently renamed recurrent ophthalmoplegic neuropathy (RPON) by the International Headache Society, is an uncommon and poorly understood condition with an incidence of 0.7 per million. This rare condition manifests as episodes of ipsilateral headache followed by palsy of one or more ocular cranial nerves that begins immediately or up to 14 days after onset of headache." See https://eyewiki.aao.org/Ophthalmoplegic_Migraine/Recurrent_Painful_Ophthalmoplegic_Neuropathy For purposes of entitlement to benefits, the law provides that refractive errors of the eyes are developmental defects and not disease or injury within the meaning of applicable legislation. See 38 C.F.R. §§ 3.303(c), 4.9. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9. Thus, VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury during service which created additional disability. See VAOPGCPREC 82-90 (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). Thus, the Veteran's diagnosed myopia, astigmatism, and presbyopia with related symptoms are not eligible for service connection. The Board concludes that the preponderance of the evidence is against a finding that the Veteran has current eye disability, to include pain or similar symptom, that causes functional impairment that affects earning capacity and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). For example, of record are medical records from December 1999 to August 2021, and the preponderance of the evidence during this time period is against a finding that the Veteran has a current eye disability, to include pain or similar symptom, that causes functional impairment that affects earning capacity. These records cover a 22-year period, and the lack of documentation of an eligible eye disability, to include pain or similar symptom, is evidence against the claim for service connection for an eye disability. However, even if the Veteran was found to have an eye disability subject to service connection, the preponderance of the evidence is against a finding that such an eye disability is caused or aggravated by the service-connected diabetes mellitus type 2 with vertigo. For example, in the December 2019 VA examination report, the examiner opined that the Veteran's eye disability is less likely than not proximately due to diabetes mellitus type 2 with vertigo. The examiner explained that the Veteran is diagnosed with congenital refractive errors of myopia, astigmatism, and presbyopia. The examiner stated that myopia affects nearly 30 percent of the U.S. population. The examiner also explained that while the exact cause of myopia is unknown, there is significant evidence that many people inherit myopia, or at least the tendency to develop myopia. The examiner stated that if one or both parents are nearsighted, there is an increased chance their children will be nearsighted; and even though the tendency to develop myopia may be inherited, its actual development may be affected by how a person uses his or his eyes. The examiner stated that individuals who spend considerable time reading, working at a computer, or doing other intense close visual work may be more likely to develop myopia. The examiner stated that the Veteran has marked glaucoma well beyond any possible development of this condition. The examiner concluded that since diabetes is not a risk factor for myopia and this condition pre-existed as a congenital refractive error, it is less likely than not due to or the result of diabetes. The examiner also opined that for the same reasons, since diabetes is not a risk factor for myopia and this condition pre-existed as a congenital refractive error it is less likely than not aggravated by diabetes. The examiner stated that astigmatism is a common vision condition and that it frequently occurs with other vision conditions like myopia and hyperopia. The examiner stated that there are many causes to astigmatism, noting that it can be hereditary and is usually present from birth. The examiner concluded that since diabetes is not a risk factor for astigmatism and this condition pre-existed as a congenital refractive error, it is less likely than not due to or the result of diabetes. Based on the same rationale, the examiner also opined that since diabetes is not a risk factor for astigmatism and this condition pre-existed as a congenital refractive error it is less likely than not aggravated by diabetes. The examiner explained that presbyopia is a separate and independent condition from astigmatism and myopia, and that presbyopia is a natural part of the aging process of the eye. The examiner stated that presbyopia is not a disease, and it cannot be prevented. Finally, the examiner concluded that since diabetes is not a risk factor for presbyopia and this condition is a developmental refractive error, it is less likely than not due to or the result of diabetes. The examiner also provided the same rationale for the opinion that since diabetes is not a risk factor for presbyopia and this condition is a developmental refractive error, it is less likely than not aggravated by diabetes. This opinion establishes that an eye disability is not caused or aggravated by service-connected diabetes mellitus type 2 with vertigo. As the examiner reviewed the claims file, physically examined the Veteran, and provided a detailed rationale for the conclusions reached, which included the examiner discussing the characteristics of each component of the claimed eye disability, reviewing the frequency of each diagnosis within the general population, providing an analysis of likely causes, and discussing whether the Veteran's individual diagnoses could be attributed to either congenital causes or the Veteran's service-connected diabetes mellitus, the Board affords this opinion high probative value. In a November 2014 Disability and Benefits Questionnaire, the Veteran's private physician, Dr. Alan Marcus, opined that the Veteran did not have an eye disability that was due to his service-connected diabetes mellitus, but it was at least as likely as not that the Veteran had an eye disability other than neuropathy that was permanently aggravated by his diabetes. Dr. Marcus did not provide a rationale for his opinion and, therefore, the Board affords it no probative value. A medical opinion without a rationale has no probative value. The preponderance of the evidence is also against a finding that such an eye disability is caused or aggravated by the service-connected migraine headaches. In the July 2021 VA examination report, the examiner opined that the Veteran's eye disability is less likely than not proximately due to service. The examiner stated that while the exact cause of myopia is unknown, there is significant evidence that many people inherit myopia, or at least the tendency to develop myopia. The examiner also explained that presbyopia may seem to occur suddenly, but sight reduction occurs over several years. Astigmatism, the examiner explained, is an irregularly shaped cornea or lens that prevents light from focusing properly on the retina, the light-sensitive surface at the back of the eye. The examiner also noted that these conditions are not pathological in nature but rather are congenital or developmental errors of refraction. The examiner concluded that because migraine headaches are not a risk factor for the Veteran's diagnoses, the claimed disability is less likely than not proximately due to service-connected migraine headaches. The examiner concluded by opining that since diabetes is not a risk factor for the Veteran's eye diagnoses, and they are found to be developmental refractive errors, the Veteran's eye disability is less likely than not aggravated by service-connected migraine headaches. This opinion establishes that an eye disability is not caused or aggravated by service-connected migraine headaches. As the examiner reviewed the claims file, physically examined the Veteran, and provided a detailed rationale for the conclusions reached, which included the examiner discussing the Veteran's eye disability within the context of current medical knowledge, how each aspect of the disability manifests in the populace, whether the diagnoses can be attributed to pathological or developmental causes and discussing the relationship between the Veteran's eye disability and the service-connected migraine headaches, the Board affords this opinion probative value. Although the Veteran claims that the eye disability is caused or aggravated by a service-connected disability or service-connected disabilities, he is not competent to directly link the eye disability to a service connected disability, as medical expertise is required. 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. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinions are nonprobative evidence. At the present time, there is no competent and probative evidence of a nexus between the current eye disability and a service-connected disability that can be weighed against the VA negative opinions. In sum, for all the reasons laid out above, the Board concludes that the preponderance of the evidence of record is against the Veteran's claim for service connection for eye disability, to include myopia, presbyopia, astigmatism, photophobia, and myopic astigmatism with presbyopia and photophobia, and to include as secondary to service-connected migraine headaches and/or service-connected diabetes mellitus type 2 with vertigo. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Husain, 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.