Citation Nr: 21063147 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 20-18 187 DATE: October 13, 2021 ORDER Service connection for a left eye disorder is denied. Service connection for a right eye disorder is denied. FINDINGS OF FACT 1. A refractive error of the left eye was not subjected to a superimposed disease or injury during service that resulted in additional disability, and a left eye disorder other than a refractive error is not shown to be causally or etiologically related to any disease, injury, or incident during service. 2. A refractive error of the right eye was not subjected to a superimposed disease or injury during service that resulted in additional disability, and a right eye disorder other than a refractive error is not shown to be causally or etiologically related to any disease, injury, or incident during service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left eye disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.9. 2. The criteria for service connection for a right eye disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.9. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1960 to August 1963. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in August 2018 by a Department of Veterans Affairs (VA) Regional Office. While the Veteran requested a Board hearing in connection with his April 2020 substantive appeal, he subsequently withdrew such request in October 2020. 38 C.F.R. § 20.704(e). In February 2021, the Board remanded the issues on appeal, as well as claims for service connection for bilateral ankle, left shoulder, and cervical spine disorders, for additional development. While on remand, an August 2021 rating decision awarded service connection for right and left lateral collateral ligament sprains, left shoulder impingement syndrome, and degenerative arthritis of the cervical spine. As such are full grants of the benefits sought on appeal with respect to these issues, they are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). The remaining claims now return for further appellate review. 1. Entitlement to service connection for a left eye disorder. 2. Entitlement to service connection for a right eye disorder. The Veteran contends that he has a current bilateral eye disorder related to his military service. In this regard, he alleges that his visual acuity worsened during his military service, to include as a result of treatment for a foreign body in his left eye and conjunctivitis, and/or as a result of his duties as an electrician when he was exposed to the glare from the arc of welding by machinists in the engine room. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Generally, service connection may not be granted for congenital or developmental defects, such as refractive error of the eyes, as these are not considered a disease or injury for the purpose of determining service connection. 38 C.F.R. §§ 3.303(c), 4.9; VAOPGCPREC 82-90 (July 18, 1990). However, service connection may be granted if a congenital defect is subject to a superimposed disease or injury during service which results in additional disability. Id. As an initial matter, the Board observes that the Veteran has current left and right eye disorders, to include age-related nuclear cataracts in both eyes, posterior vitreous detachment in both eyes, and choroidal nevus in the left eye, as evidenced by a June 2021 VA examination. Additionally, the Veteran's service treatment records (STRs) reflect that, upon his June 1960 entrance examination, his distant visual acuity was 20/20 in the right eye and 20/40 in the left eye, which corrected to 20/20 bilaterally. The summary of defects and diagnoses included defective vision. In October 1960, the Veteran had a foreign body removed from his left eye and, in January 1961 he was treated for conjunctivitis of the bilateral eyes, which was noted be probably secondary to exposure. A July 1961 examination reflected that his distant visual acuity was 20/40 bilaterally, which corrected to 20/20 bilaterally. A June 1963 examination reflects the Veteran's report of trouble seeing distance, and his distant visual acuity was 20/40 in the right eye and 20/50 in the left eye. Upon his July 1963 separation examination, his distant visual acuity was 30/20 in the right eye and 40/20 in the left eye, which corrected to 20/20 bilaterally. In July 2018, a VA examiner reviewed the record and opined that the Veteran's had an isolated event of a likely viral conjunctivitis, which began in one eye and ultimately affected both eyes, based on the pattern of red eyes, serous discharge, pain, and an inability to open eyes, as well as the self-limiting nature of the condition and the complete resolution of the complaints. She further found that the Veteran had no ocular problems or reduction in vision upon his separation examination. However, in the February 2021 remand, the Board determined that such opinion was inadequate to adjudicate the Veteran's claims as it was unclear as to the nature of his current bilateral eye disorders, did not consider his lay statements as to the onset and continuity of his vision problems, and was based on an inaccurate factual premise as his vision did worsen from his entrance examination to his separation examination. Thus, the Board remanded the claim in order to afford the Veteran a VA examination so as to determine the nature and etiology of his bilateral eye disorders. Thereafter, the Veteran underwent a VA examination in June 2021, at which time the aforementioned bilateral eye disorders were diagnosed and, following a review of the record, an interview with the Veteran, and a physical examination, the examiner opined that such bilateral eye disorders were less likely than not incurred in or caused by an in-service injury, event, or illness. In this regard, she noted that welding without eye protection or being around welding without a face/eye shield has the potential to cause a condition called welder's retinopathy, which may decrease vision quality or cause central scotoma; however, no macular changes or scotoma were noted on examination in either eye. The examiner further observed that exposure to ultraviolet (UV) radiation from welding may speed the formation of cataracts; however, the cataracts present on examination, which were the likely cause of the Veteran's reduced vision, were mild and normal for his age. The examiner also found that the Veteran's in-service treatment for removal of a foreign body from the left eye and conjunctivitis in the bilateral eyes had no effect or significance in regard to reduced vision or his currently diagnosed disorders. Specifically, she noted that the foreign body was removed safely and the conjunctivitis was viral in nature, and it was less likely than not that his current defective vision is related to either event. The examiner further indicated that the Veteran's mild cataracts are due to age-related clouding of the lens in both eyes, his posterior vitreous detachment is a natural age-related process of the liquefaction of the vitreous, and choroidal nevus of the left eye is a benign finding. Additionally, the examiner found that the Veteran's refractive error, identified as astigmatism and/or myopia, likely worsened during his military service as demonstrated by the decrease in his visual acuity from his entrance examination to his separation examination. In this regard, she indicated that such likely occurred naturally as his eyes matured, but could have been influenced by his exposure to intense UV light with welding without face/eye protection. Nonetheless, as indicated previously, service connection for refractive errors, as a congenital defect, is prohibited. Furthermore, she did not find that a disease or injury superimposed upon such refractive error during service resulted in additional disability. Rather, as noted previously, the examiner found that the Veteran's current bilateral eye disorders were unrelated to any aspect of his military service. The Board affords great probative weight to the June 2021 VA examiner's opinion as such considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's assertions as to the etiology of his left and right eye disorders; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Specifically, such requires knowledge of the ocular system and the impact that removal of a foreign body, a past episode of conjunctivitis, and exposure to glare from the arc of welding has on the eyes. Consequently, such matter may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the etiology of his left and right eye disorders is not competent evidence and, consequently, is afforded no probative weight. Therefore, the Board finds that a refractive error of the left and/or right eye was not subjected to a superimposed disease or injury during service that resulted in additional disability, and a left and/or right eye disorder other than a refractive error is not shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for such disorders is not warranted. In reaching such 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 claims of entitlement to service connection for left and right eye disorders. As such, that doctrine is not applicable in the instant appeal, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Spielmann, Jill F. 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.