Citation Nr: 21064547 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 15-45 337 DATE: October 20, 2021 ORDER Service connection for bilateral uveitis is granted. Service connection for diabetes mellitus, as secondary to uveitis, is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, her bilateral uveitis began during active service. 2. The Veteran's diabetes mellitus is proximately due to her service-connected uveitis. CONCLUSIONS OF LAW 1. The criteria for service connection for uveitis are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for diabetes mellitus as secondary to service-connected uveitis are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1978 to February 1981. This case is before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified at a Board videoconference hearing. The transcript of the hearing has been associated with the record. The Board remanded this matter for further development in June 2019, August 2020, and April 2021. Service Connection Service connection will be granted for a current disability that resulted from an injury, disease, or aggravation while in active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may alternatively be granted on a secondary basis for a disability that is proximately due to, the result of (caused), or worsened beyond its natural progression (aggravated) by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc); 38 C.F.R. § 3.310. The Veteran is competent to report symptoms and experiences she can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102. 1. Uveitis. The Veteran contends that her bilateral vision condition had its onset in service. She argues that she was not correctly diagnosed for her eye condition in service. The Board concludes that the evidence is at least in equipoise as to whether the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The October 2019 VA examination and VA treatment records throughout the period on appeal show the Veteran has a current diagnosis of bilateral cataracts, uveitis/iritis, glaucoma, and low vision. During service, the Veteran was seen for complaints of blurred vision with headaches, pain in eye retinol, and having a sensation of a foreign body in her upper and lower eye lids. Thus, the question becomes whether the current disability is related to service. On this question, there are probative opinions in favor of and against the claim. Shortly after service in August 1981, the Veteran was diagnosed as having a detached retina and left eye retrobulbar optic neuritis. A December 1995 private treatment note stated the Veteran had a history of uveitis beginning in 1987. A January 1997 VA examiner noted the Veteran's history of uveitis as of 1981. An October 2019 VA examiner opined there is no evidence noted in the active service records that uveitis, cataracts, or glaucoma was incurred in or related to any active service event; however, the Board in April 2021 found this opinion was inadequate and had no probative value as it was based upon an inaccurate premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A May 2021 VA examiner found cataracts and glaucoma were unrelated to service as cataracts are highly likely age-related, and glaucoma is highly likely due to a genetic predisposition. Indeed, the Veteran was not diagnosed as having these conditions in service. The May 2021 VA examiner opined the Veteran's eye disabilities diagnosed in August 1981 were at least as likely as not incurred in service. The examiner noted the causes of optic neuritis are mostly unknown. Still, viral causes are listed among the possible causes, indicating a possible environmental cause for the Veteran's optic neuritis. The examiner noted retinal detachment could be related to trauma; however, the medical records show the Veteran denies any head trauma. Notably, the Veteran has not had a diagnosis for optic neuritis or retinal detachment during the period on appeal. Furthermore, although the Veteran was provided with the additional May 2021 VA examination, there has not been substantial compliance with the Board's previous remand directives regarding the issue of service connection for bilateral uveitis. The examiner did not address the nature or etiology of the Veteran's bilateral uveitis. Uveitis is defined as an inflammation of part or all of the uvea, commonly involving the other tunics of the eye (sclera, cornea, and retina). DORLAND'S ILLUSTRATED MEDICAL DICTIONARY at 1983 (33d ed. 2019). Similarly, optic neuritis is defined as the inflammation of the optic nerve. Id. at 1245. The Board acknowledges that no VA examiner has affirmatively opined that the Veteran's bilateral uveitis had its onset or is otherwise related to the Veteran's service. However, VA examiner opinions regarding the etiology of the bilateral uveitis with a notice of the adequacy requirements were solicited four times during the nearly decade-long pendency of the claim and once before in 1997. Still, no adequate opinion was rendered if rendered at all. The Veteran has described experiencing symptoms of eye inflammation since service. Those symptoms are attributed to uveitis and optic neuritis, which the May 2021 VA examiner found as likely as not incurred in active service. Furthermore, secondary medical evidence in the record stated the onset of uveitis was in 1981. Inasmuch as the sole basis for the negative nexus opinions is the lack of medical documentation, it is reasonable to assume that had the examiners considered the full evidence of the record and opined on the requested questions, they would have provided a positive nexus. Again, the Veteran perfected this appeal six years ago, and both the Board and RO have attempted on numerous occasions to have the VA examiners consider the evidence of record. The Board finds the evidence to be in equipoise as to whether the Veteran's current bilateral uveitis arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral uveitis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted. 2. Diabetes mellitus. The Veteran contends that her diabetes results from her continuous use of steroid medication to treat her uveitis since 1985. The February 2021 VA examination shows the Veteran has a current disability of diabetes mellitus. The February 2021 VA examiner opined that due to the chronic ocular steroids used for her now service-connected uveitis, she developed diabetes in the 1990s. Steroid-induced diabetes is common and is at least as likely as not the cause of the Veteran's diabetes. Accordingly, the Board finds that service connection for diabetes mellitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Costa, 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.