Citation Nr: 21065735 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 15-20 216 DATE: October 27, 2021 ORDER Entitlement to service connection for a bilateral eye disability is denied. FINDING OF FACT The preponderance of the evidence does not demonstrate that the Veteran's bilateral eye disability, including bilateral primary open angle glaucoma, nuclear sclerotic cataract, and peripheral corneal degeneration were incurred in service or are attributable to any in-service event, injury, or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral eye disability, including bilateral primary open angle glaucoma, nuclear sclerotic cataract, and peripheral corneal degeneration, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1963 to October 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision. The Veteran's claim for service connection was remanded by the Board for further development in May 2018, March 2021, and July 2021. That development having been completed; the Veteran's claim has returned to the Board for adjudication. 1. Entitlement to service connection for a bilateral eye disability is denied. The Veteran maintains that service connection is warranted for his bilateral eye disability. However, for the reasons discussed below, the Board finds that service connection is not warranted. Service connection means that a Veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when the evidence shows that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish a right to compensation for a present disability, the claimant must provide competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). The United States Court of Appeals for the Federal Circuit found that pain alone can constitute a "disability" under § 1110, because pain can cause functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim, or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The first and second elements for service connection, namely a current disability and an in-service incurrence, have been met. 38 C.F.R. § 3.303(a); see Holton, 557 F.3d at 1366; Shedden, 381 F.3d at 1166-67; Saunders, 886 F.3d at 1367-68. Concerning the requirement that the Veteran have a current disability, an April 2021 Eye Conditions Disability Benefits Questionnaire demonstrates that the Veteran has diagnoses of bilateral primary open angle glaucoma, nuclear sclerotic cataract, and peripheral corneal degeneration. The Veteran's private treatment records during the pendency of his appeal reflect similar diagnoses of primary open-angle glaucoma, cataracts, and nuclear sclerosis. Regarding an in-service incurrence, a November 1972 service treatment record states that the Veteran has a foreign object in his left eye. In particular, the Veteran had dirt in his right eye for one hour and on physical examination small specks of dirt were found. Later in November 1972, the Veteran had a patch removed from his eye and it was noted that his eye remained slightly red. An October 1973 service treatment record states that the Veteran sustained a right eye abrasion that was treated and re-patched. His right eye abrasion healed one day later with full vision and range of motion. A December 1974 service treatment records notes left eye rule out conjunctivitis. In February 1982, the Veteran complained of severe eye irritation after experiencing a feeling of a sandy object in both eyes and was assessed with conjunctivitis. Lastly, the Veteran's claims folder contains an August 2021 medical opinion addressing the relationship between his current bilateral eye disability and his active service. The examiner concluded that the Veteran's bilateral eye disability is less likely than not related to his active service. In support, the medical opinion provides that the Veteran's service treatment records are silent on any eye injury in 1972 or 1973. Subsequent service treatment records, including Reports of Medical Examination in January 1976 and August 1983 indicate that the Veteran does not have eye conditions, which are after the Veteran's service treatment records showing that he reported dirt in his eye and eye abrasion. In particular, concerning glaucoma, the medical opinion provides that it is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye. Glaucoma is one of the leading causes of blindness for people over the age of 60. The risk factors for glaucoma including having high internal eye pressure (intraocular pressure); age over 60; Black, Asian, or Hispanic heritage; a family history of glaucoma; certain medical conditions, such as diabetes, heart disease, high blood pressure; and sickle cell anemia. The Veteran's in-service incurrences of dirt in his eye or corneal abrasions are not established risk factors for glaucoma, therefore the claimed disability is less likely than not related to any in-service event, injury, or illness. Regarding cataracts, a cataract is a cloudy or opaque area in the normally clear lens of the eye per the medical opinion. Depending upon its size and location, it can interfere with normal vision. Most cataracts develop in people over the age of 55. As the Veteran is 78 years old, his cataracts were found to occur during the time which is usually associated with the natural aging of the lens and is therefore less likely than not the result of any in-service event, injury, or illness. According to the medical opinion, the Veteran also has bilateral peripheral corneal thinning. This disability is associated with degenerative, autoimmune, or infective causes. Corneal thinning can subsequently affect the visual acuity either by inducing severe astigmatism or by progressive involvement of the central cornea. Age is a significant factor in corneal thinning. The Veteran's peripheral corneal thinning is found to occur during the time which is usually associated with the natural aging of the eye and is therefore less likely than not the result of any in-service event, injury, or illness. The medical opinion states that concerning the Veteran's dry eye syndrome, his service treatment records are silent for any diagnosis or treatment for dry eye. The July 2019 Eye Conditions Disability Benefits Questionnaire diagnosed the Veteran with dry eye syndrome. This diagnosis occurred 36 years after the Veteran separated from active service. Dry eye syndrome is a disease of the ocular surface and tear film that is prevalent in older adults. Even though the degree of visual acuity loss in individuals with dry eye is commonly mild-to-moderate, in the aging population. A healthy ocular surface is maintained by appropriate tear production and tear drainage, and deficiencies in this delicate balance can lead to dryness. The Veteran was about 75 years old when he had onset of dry eyes. Therefore, the Veteran's dry eye syndrome is less likely than not related to any in-service event, injury, or illness. The Board finds that the determination of the April 2021 medical opinion concerning the relationship between the Veteran's bilateral eye disability and his active service to be especially probative. This finding is underpinned by sufficient rationale, including a review of the Veteran's medical and service history, medical literature and principles, and the lay evidence of record. See 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."); see also Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992) (reflecting that the Board is free to assess medical evidence and is not obligated to accept a physician's opinion). Related, a July 2019 medical opinion that concludes the Veteran's claimed condition is at least as likely as not related to his active service. However, the rationale in support of that conclusion provides that the Veteran's cataracts are not caused by his active service as they are natural age-related disabilities. There is no direct service connection that would have caused his cataracts per the medical opinion. Further, while the Veteran has advanced glaucoma, it is also age-related as his active service ended in 1983 and that is too remote in time to have been a cause of the glaucoma. Therefore, the above conclusion is not adequate to support a finding of service connection. In sum, the preponderance of the evidence weighs in favor of service connection for the Veteran's current bilateral eye disability. The evidence contained in the Veteran's claims folder demonstrates that he has a current bilateral eye disability, and his service treatment records demonstrate in-service incurrences relating to his eyes. However, there is no competent evidence linking his current bilateral eye disability and his active service. Consequently, the benefit-of-the-doubt rule does not apply, and service connection is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.