Citation Nr: 21066088 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 10-18 494 DATE: October 28, 2021 ORDER Entitlement to service connection for a right eye disability is denied. FINDING OF FACT A chronic right eye disability did not have its onset during active service and is not otherwise due to active service. CONCLUSION OF LAW The criteria for service connection for a right eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1974 to August 1976, with additional subsequent service in the Army National Guard of Alabama from September 1979 to June 1986. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at an October 2020 hearing, and a transcript of the hearing has been associated with the claims file. This matter was previously reopened by the Board of Veterans Appeals (Board) in February 2021, at which time the underlying claim for service connection was remanded for further development, including a relevant VA examination and adjudication on the merits. The matter was again remanded by the Board in in June 2021 for issuance of a Supplemental Statement of the Case (SSOC), which was subsequently issued in September 2021. As such, the matter is properly returned to the Board for adjudication. Entitlement to service connection for a right eye disability. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. To establish a right to compensation for a disability, a Veteran must show: (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. VA regulations specifically prohibit service connection for congenital or developmental defects, such as vision loss due to refractive error of the eyes, unless such defect was subjected to a superimposed disease or injury during active service which created additional disability. The Veteran asserts that a right eye disability is related to his active service. At the October 2020 Board hearing, the Veteran testified that his eye socket was fractured while playing football during active service and that he was told by a doctor that it could not be treated and would heal on its own, and that eventually he would go blind. He clarified that he was not claiming a visual acuity issue but more so his additional ongoing symptoms including dry socket, an eye that "sticks a lot of time," pain, and nerve damage, all of which had required treatment with ointment and eye drops. Following a careful review of the evidence of record, and as discussed further below, the Board finds that the preponderance of the evidence weighs against the Veteran's claim for a right eye disability. The reasons for this decision follow. As to the first element of a service-connection claim, a current disability, an April 2021 VA eye examination report documents diagnoses of bilateral cortical cataracts and bilateral dry eye syndrome. Given the above, the first element of the Veteran's claim is met. As to the second element of an in-service disease or injury, the Board notes that service treatment records show that in April 1976, the Veteran reported that he was struck by a knee to the right side of his face while playing football, resulting in pain and swelling to his right jaw and facial area. The injury was initially assessed as a possible fracture to the facial bones or zygomatic arch, and a subsequent x-ray showed an undisplaced zygomatic arch fracture. Thus, the service treatment records document an in-service incurrence of a right eye injury sufficient to meet the in-service element of the Veteran's claim. However, the Board finds that the preponderance of the evidence of record weighs against a finding that the Veteran's current right eye disability is related to his active service, including his isolated April 1976 undisplaced zygomatic arch fracture. Following the injury, the Veteran's eye was examined approximately four months later and found to be normal in multiple aspects. For example, an August 1976 Report of Medical Examination at separation documents normal clinical evaluations of the eyes, ophthalmoscopic, pupils, and ocular motility. His visual acuity in the right eye was documented to be 20/20. Based upon the Veteran's normal clinical evaluations at separation involving the eye, the Board finds that the evidence of record does not support the finding that the Veteran developed a chronic right eye disability following the April 1976 injury, which is evidence against a nexus between the post-service right eye disability and service. Post-service treatment records including an April 1991 VA General Examination report, which documents that a physical examination of the Veteran's head, face, and neck were within normal limits. Similarly, the Veteran's eyes were also within normal limits, with 20/20 vision in the right eye, although it was noted that his right eye was smaller than the left. Subsequent VA treatment records from February 2000 document that the Veteran needed to have his eyes examined due to headaches and eye strain. The following month, he reported seasonal allergies including watery eyes. Private treatment records from Franklin Primary Health Center, Inc., in April 2000 document the Veteran's decreased visual acuity test results, including presbyopia, myopia, and astigmatism. A July 2000 VA examination report documents the Veteran's old right zygoma fracture, but a physical examination did not reveal current findings regarding the Veteran's eyes. Subsequent private treatment records from June 2005 document the Veteran's report of left eye pain and blurred vision after he was hit during a fight, and a facial CT showed a comminuted depressed fracture of the left anterior sinus with left facial soft tissue swelling. In March 2008, the Veteran complained of watery, irritated eyes off and on for years, including an old left eye injury, and he was diagnosed with allergic conjunctivitis and prescribed tobramycin ophthalmic drops. Upon follow up in May 2008, the Veteran's eyes were normal, with no abnormalities, although he continued to be prescribed Optive eye drops for dry eyes. In June 2008, he again experienced running eyes related to allergies and acute sinusitis, but upon follow up in October 2008, his eyes were again normal, with no abnormalities. VA treatment records from June 2009 document that he continued to experience dry eye syndrome, although his eyes were normal upon follow up in May 2015. In March 2018, the Veteran again reported allergic conjunctivitis, with symptoms of dry eyes, eye drainage, and pruritis of his eyes. A July 2018 VA glasses examination revealed bilateral refractive error and presbyopia. Upon follow up in November 2018, the Veteran denied visual changes, visual loss, discharge, or photophobia and he was prescribed artificial tears for his dry eyes. Additionally, in an April 2021 VA examination report, the examiner documented the Veteran's current diagnoses of bilateral cortical cataracts and bilateral dry eye syndrome. The examiner acknowledged the Veteran's history of an in-service orbital fracture of the right eye in 1976 after he was hit on the right side of his face while playing football. The examiner concluded that this condition resolved with no current symptoms. Regarding the Veteran's current condition of bilateral cortical cataracts, the examiner stated that it had its onset in 2008, when it was diagnosed on a routine eye exam, and that the condition had gotten worse since that time and resulted in blurry vision and reduced visual acuity. The examiner stated that the Veteran's bilateral dry eye syndrome was diagnosed in 2012, with symptoms of dryness, eye pain, watery eyes, and irritation, and that the condition required artificial tears for treatment, and had stayed the same. In sum, the VA examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Specifically, the examiner stated that the Veteran's conditions of cataracts and dry eye syndrome are less likely than not related to the orbital fracture in service, as such conditions are age-related, and there were no residuals found from the right orbital fracture in service. The Board finds that this opinion is well-supported by a reasoned rationale, including a review of the Veteran's medical history, and medical principles; therefore, it is probative evidence that weighs against the Veteran's claim for service connection for a right eye disability. Moreover, there is no countervailing positive nexus opinion to weigh against the April 2021 VA opinion. Notably, at the present time, there is no competent evidence of record that the Veteran's post-service right eye complaints are related to his active service, including his documented in-service right zygomatic fracture. The Board notes that the onset of the Veteran's complaints occurred decades after his discharge from active service in 1976. Such length of time between service and the earliest post-service clinical documentation of a right eye disability is of itself a factor for consideration against a finding that the disability is related to service. While the Veteran's lay statements of observable symptomatology are probative evidence, to the extent that the Veteran has asserted that a current right eye disability is related to his active service, such statements lack probative value as the Veteran has not been shown to possess medical or optometric expertise to render a nexus opinion regarding a complex and internal disease process such as a right eye disability. Additionally, to the extent that the Veteran has asserted that he has right eye nerve damage and that his right eye symptoms have been continuous from the time of his in-service injury, the Board finds that such statements lack credibility, as they are inconsistent with the additional evidence of record, including service treatment records which document that the Veteran's separation examination was normal, without ongoing right eye symptoms, and post-service private and VA treatment record which do not document subjective reports or objective findings of right eye nerve damage related to active service. For all the reasons laid out above, the Board finds that the preponderance of evidence weighs against the Veteran's claim of entitlement to service connection for a right eye disability. As such, there is no reasonable doubt to be resolved, and the claim for service connection for a right eye disability is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Chad Johnson, 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.