Citation Nr: 21064031 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 19-38 931 DATE: October 18, 2021 ORDER Service connection for keratoconus is granted. FINDING OF FACT By providing the Veteran the benefit of the doubt, it is at least as likely as not that the Veteran's keratoconus developed during his active military service. CONCLUSION OF LAW The criteria for service connection for keratoconus have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from September 2003 to December 2003. The matter is on appeal before the Board from a November 2018 rating decision. The Veteran provided testimony at a February 2021 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In April 2021 the Board remanded the issue for further development. Service Connection Keratoconus The Veteran asserts that his keratoconus is related to his active military service. At the February 2021 Board hearing, the Veteran reported that prior to his service he did not have any problems with his eyes other than wearing glasses and contacts. He relayed that about two to three weeks after he had begun boot camp, he had started developing what seemed to be a shadow on everything. He stated that he spoke with someone, and that they were going to give him a new pair of glasses, but that he should wear his civilian glasses for the time being. He noted that he went for an exam in November 2003 during his military service, at which he was told he had an astigmatism and given a prescription. He relayed that he got contacts after he got out of service, but that they did not work well. He then went to see a private doctor after he got out of the service, and was diagnosed with keratoconus. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A review of the Veteran's service treatment records (STRs) reflects that the Veteran reported wearing contacts in his March 2003 medical prescreen of medical history, however, no other eye disorders were noted. At the Veteran's March 2003 enlistment examination, the Veteran's near and distance vision was noted in the section pertaining to defects and diagnoses, however, it was reported as not disqualifying. In November 2003, the Veteran was seen for an eye examination for glasses. The Veteran was assessed with a compound myopic astigmatism and simple myopia. He was given a prescription for glasses. The Veteran submitted a private opinion from an optometrist in April 2019, in which the Veteran was reported to have a diagnosis of keratoconus. The optometrist relayed that they had reviewed the Veteran's medical history from 2005 to present, and that they had reviewed the circumstances and events of the Veteran's military service. Additionally, it was reported that the Veteran had been a patient under the optometrist's care since 2016. The Veterans optometrist concluded that it was at least as likely as not that the Veteran's pre-existing eye condition was worsened beyond natural progression due to his military service. The Board finds probative value in the opinion, but only to the limited extent that the opinion suggests that the Veteran's keratoconus may be related to his active military service. The Veteran's optometrist did not provide in their opinion an explanation, a link between the Veteran's active military service and his keratoconus. Additionally, the opinion provided by the optometrist pertained only to aggravation of a "pre-existing eye condition." Based upon the foregoing evidence the Board remanded the issue in April 2021 to provide the Veteran with a VA examination. The Veteran underwent the VA examination in July 2021. The VA examiner found the Veteran to have an eye condition that is other than congenital or developmental errors of refraction. The diagnosis was bilateral keratoconus. The examiner opined that the Veteran's keratoconus was less likely than not (less than 50 percent probability) incurred in or caused by his active military service. The examiner explained that the Veteran was diagnosed with myopia OU and a small amount of astigmatism in the OD in November 2003. Keratometry readings of the cornea were flat and showed just a minimal amount of astigmatism. The findings did not show keratoconus or the beginning of keratoconus. The Veteran's keratoconus was not diagnosed until 2005. The Board finds probative value in the VA examiner's opinion. However, it is limited as the VA examiner did not address and discuss the optometrist's opinion or the Veteran's testimony provided at the February 2021 Board hearing, as was instructed in the April 2021 Board remand. The Veteran submitted an additional private medical opinion from his ophthalmologist in August 2021. The ophthalmologist noted that the Veteran had been in her care since 2004, and that she had reviewed the Veteran's eye examinations prior to, during, and after his 2003 military service. The doctor opined that it was at least as likely as not that the Veteran's keratoconus developed during his time in the military. It was explained that one of the main focuses in the medical community as to the root cause of keratoconus is environmental factors. Prolonged exposure to dust, dirt, chemicals, and UV light is a major contributor to the development of keratoconus. As the Veteran does not have a family history of keratoconus and his MOS in the Air Force consisted of working on the gun range, at the armory, on outside patrol, and guarding entry gates, it is relevant that this contributed to his eye disability. When you compare the Veteran's eye examination in service with the eye examination post service, you see a two to three step prescription jump in a short period of time. Also, the Veteran's double vision is a key factor in determining this rare disease. Many optometrists contribute double vision with an astigmatism, and while this may be true, one must factor in the jump in prescriptions as a key sign that the cornea has been compromised and is thinning. The thinning of the external tissue is when the eye loses its shape and makes more of a football shape. Light cannot enter the eye in one single beam when this happens, and this is why double vision occurs and refracting is difficult to impossible. The Board finds the most probative value in the ophthalmologist's well-reasoned opinion. Accordingly, service connection for keratoconus is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, 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.