Citation Nr: 21068887 Decision Date: 11/15/21 Archive Date: 11/15/21 DOCKET NO. 16-15 035 DATE: November 15, 2021 ORDER Entitlement to service connection for a bilateral eye disability, including as due to service-connected hypertension, is denied. FINDING OF FACT The record evidence shows that the Veteran's current bilateral eye disability is not related to active service and was not caused or aggravated by service-connected hypertension. CONCLUSION OF LAW The criteria for service connection for a bilateral eye disability, including as due to service-connected hypertension, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1990 to July 1994, including in the southwest Asia theater of operations during the Persian Gulf War. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2017 rating decision which denied, in pertinent part, a claim of service connection for a bilateral eye disability, including as due to service-connected hypertension. A videoconference Board hearing was held in October 2018 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. In March 2019 and in April and September 2021, the Board remanded the currently appealed claim to the Agency of Original Jurisdiction (AOJ) for additional development. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. The Board directed the AOJ to obtain addendum opinions concerning the contended etiological relationships between the Veteran's bilateral eye disability and his service-connected hypertension in the most recent remand dated in September 2021. These opinions were obtained later in September 2021 and associated with the claims file. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). The Board finds that the preponderance of the evidence is against granting the Veteran's claim of service connection for a bilateral eye disability, including as due to service-connected hypertension. He essentially contends that he incurred a bilateral eye disability during active service, including as due to an in-service eye injury when paint chips fell into his eyes, and experienced continuous post-service disability. He alternatively contends that his service-connected hypertension caused or aggravated his current bilateral eye disability. The record evidence does not support his assertions regarding an etiological link between a bilateral eye disability and active service, including as due to service-connected hypertension. It shows instead that, although the Veteran complained of and sought treatment for multiple bilateral eye disabilities since his service separation, no bilateral eye disability is related to active service or was caused or aggravated by service-connected hypertension. The available service treatment records show that, at a pre-enlistment physical examination in May 1990, prior to his entry on to active service in August 1990, no relevant pre-service medical history was reported, the Veteran's eyes were normal on clinical evaluation, and his distant and near vision were 20/20. His medical history, clinical evaluation, and distant and near vision were unchanged at his separation physical examination in July 1994. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). The post-service evidence also does not support granting the Veteran's claim of service connection for a bilateral eye disability, including as due to service-connected hypertension. It shows instead that, although he complained of and sought treatment for multiple bilateral eye disabilities since his service separation, there is no bilateral eye disability which is attributable to active service or any incident of service, including as due to service-connected hypertension. For example, on VA eye conditions Disability Benefits Questionnaire (DBQ) in August 2017, the Veteran's complaints included his eyes feeling swollen with a foreign body sensation and watery 1 2 times a month. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran stated that he "was exposed to paint chips getting into his eyes. He started to wear glasses around 1996." His vision with correction was 20/25 in both eyes. Physical examination showed pupils equal, round, and reactive to light and accommodation, nasal pinguecula in the right conjunctiva/sclera, and low tear breakup time (TBUT). The diagnosis was dry eye syndrome, right eye greater than left eye. The Board acknowledges that it previously found the August 2017 VA examiner's medical nexus opinion to be inadequate for VA adjudication purposes in the March 2019 remand. Thus, this opinion was not reviewed or relied upon in adjudicating the currently appealed claim. Similarly, because the Board found that a December 2020 VA clinician's medical nexus opinion was inadequate for VA adjudication purposes in the April 2021 remand, this opinion was not reviewed or relied upon in adjudicating the currently appealed claim. The Board finally notes that, because it found that a May 2021 VA clinician's medical nexus opinion was inadequate for VA adjudication purposes in the September 2021 remand, this opinion was not reviewed or relied upon in adjudicating the currently appealed claim. The Veteran's VA outpatient treatment records show ongoing complaints of and treatment for a variety of bilateral eye disabilities. On VA eye conditions DBQ in May 2021, the Veteran's complaints included a foreign body sensation in his eyes and bilateral dry eyes. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran reported that he accidentally got paint chips in his eyes during active service "and not too long after that he started needing glasses and having dry eyes." Physical examination showed bilateral visual acuity 5/200 or worse in uncorrected vision, pupils equal, round, and reactive to light and accommodation, equal pressure, nasal pinguecula in the right eye, and bilateral dry eye syndrome treated with over-the-counter artificial tear drops. The diagnoses were bilateral dry eye syndrome and nasal pinguecula in the right eye, currently asymptomatic. In multiple opinions dated in September 2021, a VA optometrist opined that it was less likely than not that the Veteran's current multiple bilateral eye disabilities were related to active service, including as due to service-connected hypertension. This clinician specifically opined that it was less likely than not that the Veteran's not visually significant (NVS) cataracts are related to active service, including as due to service-connected hypertension. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran's reported in-service bilateral eye injury from paint chips "would not be expected to induce cataract[s] as cataract[s] are due to sun exposure and aging." The rationale further was, "There is no relationship between cataract[s] and hypertension." This clinician next opined that it was less likely than not that the Veteran's nasal pinguecula in the right eye is related to active service, including as due to service-connected hypertension. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran's reported in-service bilateral eye injury from paint chips "would not be expected to induce pinguecula as pinguecula are due to sun exposure and aging." The rationale further was, "There is no relationship between pinguecula and hypertension." The clinician next opined that it was less likely than not that the Veteran's symptomatic panus in the left eye is related to active service, including as due to service-connected hypertension. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran's reported in-service bilateral eye injury from paint chips "would not be expected to induce panus as panus are due to sun exposure/pinguecula and aging." The rationale further was, "There is no relationship between panus and hypertension." This clinician next opined that it was less likely than not that the Veteran's bilateral refractive error presbyopia is related to active service, including as due to service-connected hypertension. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran's refractive error presbyopia was a congenital defect and "consistent with the natural progression of refractive error and presbyopia." This clinician finally opined that it is less likely than not that the Veteran's bilateral dry eye syndrome and TBUT were related to active service, including as due to service-connected hypertension. The rationale for this opinion was based on a review of the claims file. The clinician stated that TBUT "is a clinical finding of dry eye syndrome and not a separate pathology." The rationale also was that the Veteran's reported in-service bilateral eye injury from paint chips "would not be expected to induce dry eye syndrome and TBUT." The rationale further was, "There is no relationship between dry eye syndrome and hypertension." Contrary to the Veteran's lay assertions and Board hearing testimony, the record evidence shows that his bilateral eye disability is not related to active service or any incident of service, including as due to service-connected hypertension. The Board acknowledges that the Veteran has been diagnosed as having and treated for a variety of bilateral eye disabilities since his service separation. The VA clinician opined in September 2021 that none of the current bilateral eye disabilities was related to active service, including as due to service-connected hypertension. All of these opinions were fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to service connection for a bilateral eye disability, including as due to service-connected hypertension. In summary, the Board finds that service connection for a bilateral eye disability, including as due to service-connected hypertension, is not warranted. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael T. Osborne, 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.