Citation Nr: 21063474 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 15-44 317 DATE: October 14, 2021 ORDER Entitlement to service connection for eye disorder, to include dry eye syndrome, is granted. Entitlement to service connection for prostate disorder, to include benign prostatic hypertrophy (BPH) with residual urinary dysfunction, is granted. FINDINGS OF FACT 1. The Veteran's eye disorder, to include dry eye syndrome, is presumed to be etiologically related to the Veteran's service in Southwest Asia. 2. The evidence of record demonstrates the Veteran's BPH with residual urinary dysfunction is related to the Veteran's active-duty service in Southwest Asia. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for eye disorder, to include dry eye syndrome, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 2. The criteria for entitlement to service connection for prostate disorder, to include BPH with residual urinary dysfunction have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army on active duty from January 1991 to September 1991 and September 2004 to February 2006, with additional service in the National Guard. The issues come before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The above issues were previously before the Board in November 2018. The Board remanded to provide further development. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be warranted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection for chronic, undiagnosed illness or a medically unexplained chronic multi-symptom illness arising from service in Southwest Asia during the Gulf War era may be established under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Service connection may be established for objective indications of a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illnesses, provided that such disability (1) became manifest in service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2026; and (2) by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. 1. Entitlement to service connection for eye disorder, to include dry eye syndrome The Veteran contends that his current dry eye syndrome is the result of environmental exposures while serving in the Southwest Asia theater of operations during the Gulf War. The evidence of record shows the Veteran served in Southwest Asia, including service in Saudi Arabia, Kuwait, and Iraq. Pursuant to the Board remand, the Veteran underwent a VA examination in August 2019 to address his dry eye disability. The VA examiner diagnosed the Veteran with dry eye syndrome, and noted the date of onset as July 2010. The VA examiner noted the Veteran's symptoms as dryness, blurred vision, and eye pain, which remained the same severity since onset. The VA examiner concluded that the Veteran's eye condition was a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology. The Board notes that private treatment records show the Veteran was treated for eye pain and symptoms thought to be conjunctivitis in August 2010. The private physician prescribed antibiotic drops. The Veteran's was treated for lipid deficient dry eye in September 2012. The private treatment plan involved prescribed artificial tears, omega 3 supplements and warm compresses. The Veteran testified in a hearing before a VA Decision Review Officer in August 2015. The Veteran stated that he first experienced symptoms of his dry eye syndrome in 1991, during his service in the Persian Gulf War. He noted the symptoms continued during his service in Operation Iraqi Freedom. Resolving the evidence in a light most favorable to the Veteran, the Board finds the evidence of record establishes symptoms of the Veteran's dry eye syndrome manifested in service on active duty in Southwest Asia during the Persian Gulf War. The Veteran, as a lay person, is competent to provide opinions on certain subjective medical issues and of observable symptomatology. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Accordingly, as the Veteran has met the criteria under 38 C.F.R. § 3.317, entitlement to service connection for the Veteran's dry eye condition as a medically unexplained chronic multi-symptom illness is warranted. 2. Entitlement to service connection for prostate disorder, to include BPH, with residual urinary dysfunction The Veteran contends his current BPH with urinary dysfunction is the result of exposure to various chemicals while serving in Southwest Asia. The Veteran asserted that he was exposed to many different chemicals during his active service in Southwest Asia. Additionally, the Veteran stated that he began experiencing increased urinary frequency during service. The Veteran reported in his January 2006 post-deployment evaluation that during his service in Iraq he was exposed to pesticide strips, smoke from burning trash or feces, vehicle or truck exhaust, solvents, paints radar/microwaves, loud noises, and sand and dust. The Veteran underwent a VA examination in August 2019 to address his claimed prostate gland condition and urinary dysfunction condition. The VA examiner reported the Veteran's diagnoses of urinary dysfunction and BPH. The examination noted the Veteran's voiding dysfunction was etiologically related to the Veteran's BPH. The VA examiner noted the Veteran's BPH and urinary dysfunction are diseases with clear and specific etiology and diagnoses. The VA examiner provided the medical opinion that it was at least as likely as not that the Veteran's BPH with residual urinary dysfunction was related to a specific exposure event experienced by the veteran during service in Southwest Asia. The VA examiner noted specific chemicals, including Phthalates, Triclosan, and BPA, are known to cause BPH and its residuals, which the Veteran may have been exposed to while in active service. As the August 2019 VA examiner addressed the Veteran's urinary dysfunction as a residual condition related to the Veteran's BPH, and VA compensates both conditions as voiding dysfunction related to the predominant condition; the Board characterizes the Veteran's claim as entitlement to service connection for BPH with residual urinary dysfunction. Resolving all reasonable doubt in favor of the Veteran, the Board finds that the probative lay and medical evidence of record supports a finding that the Veteran's current BPH with residual urinary dysfunction is related to his active-duty service. Here, the Board finds the Veteran's August 2019 VA medical opinion is probative evidence of a nexus relationship between the Veteran's current disability and his exposure to environmental hazards in service. Thus, the evidence of record supports finding in favor of service connection, and the Veteran's claim is granted. M. Mills Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.V. Bona, 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.