Citation Nr: 21065770 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 16-54 848 DATE: October 27, 2021 ORDER Entitlement to service connection for glaucoma is granted. REMANDED Entitlement to service connection for a uveitis condition (previously rated as vision loss with retinal uveitis) is remanded. Entitlement to service connection for a cataract condition is remanded. FINDING OF FACT The Veteran was diagnosed with pre-glaucoma in service, his glaucoma condition appeared within a year of service and requires continuous medication. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, the Veteran's glaucoma is related to his service. 38 U.S.C. 1110, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from March 1981 to August 2005. These matters are before the Board of Veterans' Appeals (Board) from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2021, the Veteran testified before the undersigned Veterans Law Judge; a transcript of the hearing is associated with the record. 1. Entitlement to service connection for glaucoma The Veteran contends that his glaucoma is related to service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Under 38 C.F.R. § 3.303(a), service connection requires competent evidence of: (1) a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the two. See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Glaucoma is an enumerated "chronic disease" listed under 38 C.F.R. § 3.309(a) (other organic disease of the nervous system). Enumerated "chronic disease[s]" listed under 38 C.F.R. § 3.309(a) such as glaucoma can be service connected on a presumptive basis by showing it manifested to a compensable degree within a year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). That is, under 38 C.F.R. § 3.303(b), with an enumerated "chronic disease" such as glaucoma shown in service (or within the presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. See also Groves v. Peake, 524 F.3d 1306, 1309 (2008). For a showing of chronic disease, such as glaucoma, in service requires a combination of manifestations sufficient to identify the disease, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity of symptomatology. 38 C.F.R. § 3.303(b). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49 (1991). In this case, the Board notes that it is conceded that the Veteran's has been diagnosed with glaucoma, and that it manifested in service. See January 2015 VA examination (noting early glaucoma in Service Treatment Records (STR) in February 2005 and March 2005). The Board notes that the Veteran was exposed to chemicals while inservice as part of his flight line duties, and subsequent duties testing for environmental and chemical toxins. See June 2021 Board Hearing Transcript, pg. 5. Although presumptive service connection is available because the condition appeared within a year of service, the RO denied service connection because evidence did not show that continuous medications were required. See id. In September 2021, the Veteran submitted private medical treatment records and a letter his ophthalmologist, Dr. J.B., who had been treating the Veteran's long-standing glaucoma, among other eye conditions. Private medical records from Brown Retina Institute indicate that the Veteran was on continuous medication called Dorzolamide for the treatment of glaucoma. See May 2021 Year Brown Retina Institute Records; see also Glaucoma Medications, National Eye Institute, found at https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/glaucoma-medicines. The Veteran testified that he underwent glaucoma testing in service and that the results were significant for glaucoma. See June 2021 Board Hearing Transcript, pgs. 8-9. The Board finds that the evidence is in relative equipoise; the benefit of the doubt is for application. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 49. The claim is granted. REASONS FOR REMAND 1. Service connection for retinal uveitis condition is remanded. 2. Service connection for a cataract condition is remanded. The Veteran contends that his retinal uveitis and cataract conditions are related to service. The Board notes that the Veteran's retinal uveitis condition may have pre-existed service. See February 2015 VA Examination, pg. 2 (noting entrance examination shows pre-existing iritis). The February 2015 VA examination did not provide an adequate rationale as to whether the Veteran's uveitis was aggravated beyond its natural progression because it did not address lay statements regarding exposure to chemicals, the Veteran's military occupational specialty (MOS), lay testimony regarding aggravation of eye conditions and private medical records regarding eye conditions. Furthermore, as discussed by the Veteran's representative at the hearing, and as noted by the Board, uveitis can lead to cataracts. See June 2021 Board Hearing Transcript, pgs. 11-12 (referencing a Mayo Clinic article regarding uveitis); see also UveitisSymptoms and Causes, MAYO CLINIC, found at https://www.mayoclinic.org/diseases-conditions/uveitis/symptoms-causes/syc-20378734). The 2015 VA examiner did not opine whether the Veteran's cataract condition was caused or aggravated by uveitis. For these reasons, the Board finds that the VA examination is inadequate. The Board acknowledges that the Veteran's ophthalmologist provided information regarding the Veteran's eye conditions. However, the physician did not opine whether his conditions were aggravated beyond their natural progression by service or otherwise related to service. Thus, it too is inadequate. For all these reasons, the Board finds that an addendum opinion is warranted that addresses lay statements, private medical records, aggravation of pre-existing uveitis and whether his cataract condition is secondary to uveitis. The matters are REMANDED for the following action: 1. Obtain an addendum opinion for the Veteran's uveitis and cataract disabilities. After a thorough review of the claims file, to include the Veteran's hearing testimony, lay statements of record, private records, as well as this remand, the examiner is asked to opine: a) Whether there is clear and unmistakable evidence that the Veteran's uveitis and cataract disabilities pre-existed service. Specify the condition/diagnosis that pre-existed service, the medical evidence the opinion is based on and provide a complete rationale for the opinion expressed. i. The examiner must address the Veteran's enlistment exam noting pre-existing iritis, and whether this constitutes clear and unmistakable evidence that the Veteran's uveitis pre-existed service. Provide a complete rationale. ii. The examiner is advised that "clear and unmistakable evidence" is an onerous evidentiary standard and means the evidence is undebatable. However, it does not require the absence of conflicting evidence. b) If the examiner determines that either condition clearly and unmistakably pre-existed service, the examiner is to opine whether there is clear and unmistakable evidence either condition was NOT aggravated beyond its natural progression, by service from March 1981 to August 2005. i. The examiner is asked to address the Veteran's competent lay assertions of continued eye irritation, pain, floaters, sensitivity to light, and decreased or blurred vision following service and since service. ii. The examiner is advised that "aggravation" is an increase in severity, beyond the natural progression of the disorder. Lack of aggravation must be proven with affirmative evidence of no aggravation, not simply a lack of treatment. c) If the examiner determines either uveitis or cataracts disability did not clearly and unmistakably pre-exist service, the examiner is asked to opine whether either disability is etiologically related to service. The examiner must address the Veteran's competent lay assertions regarding: i. Assigned duties involving exposure to toxic chemicals, fumes and solvents; ii. Eye pain and decreased acuity following service; iii. MOS in flight line avionics and bioenvironmental engineering technician testing pesticides, chemicals and solvents; iv. He is competent to report having eye pain, irritation, and changes in acuity. d) The examiner is asked to opine whether his cataract condition is caused or aggravated by uveitis. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. McKenzie, 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.