Citation Nr: 21072063 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-04 998 DATE: December 2, 2021 ORDER Entitlement to service connection for right eye vision loss, other than refractive error, to include as secondary to service connected coronary artery disease (CAD), or secondary to service connected stroke, is denied. FINDING OF FACT The Veteran's right eye vision loss did not have its onset in service, was not caused or aggravated by his service connected stroke or CAD, and is not otherwise related to service. CONCLUSION OF LAW The criteria for service connection for right eye vision loss, to include as secondary to service connected stroke and CAD, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1961 to February 1969, and from July 1990 to January 1991. The Veteran also had periods of Active Duty for Training (ACDUTRA). This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which, inter alia, denied service connection for right eye vision loss. In July 2016, the Veteran filed his notice of disagreement, was issued a statement of the case in December 2016, and in January 2017 perfected his appeal to the Board. On November 20, 2018, the Veteran appeared at a videoconference Board hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record. In August 2019, the Board, among other things, remanded the Veteran's claim for service connection for right eye vision loss for a VA examination to address the etiology of his right eye vision loss. In February 2021 and March 2021, the RO continued its denial of, among one other thing, the Veteran's claim for service connection for right eye vision loss, notifying the Veteran in a supplemental statement of the case. In May 2021, the Board again remanded the Veteran's claim for service connection for right eye vision loss, among one other thing, for a new medical opinion. In October 2021, the RO continued its denial of the Veteran's claim for service connection for right eye vision loss, notifying the Veteran in a supplemental statement of the case. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (b). Refractive error of the eye is not a disease or injury within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). The Board will address the Veteran's vision loss assuming that it is not due to refractive error. Vision Loss, Right Eye The Veteran contends that his right eye vision loss is due to his stroke which occurred during a period of ACDUTRA. February 1965 service treatment records reflect that the Veteran was treated for eye problems including sensitivity to light, and May 1966 service treatment records indicate that the Veteran was treated for itching eye lids and watering eyes. The Veteran's January 1969 medical examination report upon discharge from service is normal, and his January 1969 report of medical history does not indicate that he suffers from eye trouble. The Veteran's September 1992 medical history report reflects that the Veteran reported good health, with no medications and vision in both eyes, and his September 1992 medical examination report is normal. In a December 2019 disability benefits questionnaire (DBQ), the examining optometrist opined that the Veteran's right eye vision loss was less likely than not (less than a 50 percent probability) proximately due to, or the result of his service connected CAD. The optometrist explained that the Veteran's decrease of vision in his right eye is due to diabetic retinopathy bilateral with macular edema and pseudophakia of the right eye, and not due to his CAD. The optometrist additionally noted that he could not determine a baseline level of severity of his right eye vision loss based upon the medical evidence available prior to aggravation, or the earliest medical evidence following aggravation of his right eye vision loss, stating that the Veteran's right eye vision loss was not at least as likely as not aggravated beyond its natural progression by a service connected condition. The optometrist noted diagnoses of bilateral dry eye syndrome, glaucoma suspect bilaterally, left eye cataract, diabetic retinopathy with macular edema, and pseudophakia of the right eye, and reported a decrease of vision in the right eye due to macular edema from diabetes. A June 2021 DBQ reflects that the ophthalmologist, after a review of the claims file, opined that the Veteran's right eye vision loss is less likely than not (less than a 50 percent probability) proximately due to or the result of the Veteran's service connected disability, but stated that his vision loss of the right eye is at least as likely as not proximately due to, or aggravated by his service connected stroke, and most likely due to diabetic macular edema due to diabetic retinopathy, type 2. She reported that she was unable to determine a baseline of severity of the Veteran's right eye vision loss based upon medical evidence available prior to aggravation, or the earliest medical evidence following aggravation by his service connected stroke, but reported that regardless of an established baseline, the Veteran's right eye vision loss was not at least as likely as not aggravated beyond its natural progression by his service connected stroke. In a separate June 2021 DBQ, the ophthalmologist opined that the Veteran's right eye vision loss is not proximately due to, or aggravated by his service connected CAD, stating that his vision loss is due to retinopathy with macular edema which is due to his type 2 diabetes. She indicated that she could not determine a baseline of severity of right eye vision loss based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by CAD, stating that the medical evidence was not sufficient to support a determination of a baseline level of severity. She concluded that regardless of an established baseline, the Veteran's right eye vision loss was not at least as likely as not aggravated beyond its natural progression by his service connected CAD. In an August 2021 addendum, the ophthalmologist reported that the Veteran's vision loss in the right eye is at least as likely as not (at least a 50 percent probability) proximately due to or aggravated by his service connected stroke, and is most likely due to diabetic macular edema due to the diabetic retinopathy type 2, as the condition is related to the Veteran's diabetes and not from the stroke as diabetes causes leaky retinal vessels that contributes to the macular edema. In a September 2021 addendum, the ophthalmologist reported that the Veteran's right eye vision loss was from diabetes and diabetic retinopathy with macular edema and not due to or aggravated by the CAD as they are separate conditions. She stated that the stroke was not a direct cause of the Veteran's right eye vision loss as the vision loss was from the diabetic retinopathy with macular edema. She additionally reported in a September 2021 addendum that the Veteran's retinopathy is due to diabetes and was not aggravated by the stroke, stating that there is no nexus between the claimants retinopathy and stroke as per service treatment records review. Considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for right eye vision loss. In this regard, the December 2019 DBQ indicates that the Veteran has decreased vision in his right eye, however, the previously discussed medical opinions reflect that the loss of vision in his right eye is less likely than not (less than a 50 percent probability) caused or aggravated by his service connected CAD or stroke. While the June 2021 ophthalmologist provided opinions which are worded in a manner which would indicate that the Veteran's right eye vision loss was at least as likely as not proximately due to, or aggravated by his service connected stroke, the Board affords more weight to her explanations provided in her addendum opinions which specify why the Veteran's eye disability is not aggravated beyond its natural progression by his service connected stroke than to the erroneous notations. The ophthalmologist specifically explained that the Veteran's right eye vision loss was not due to or aggravated by his service connected CAD or stroke, stating that his vision loss was due to diabetic retinopathy with macular edema, providing a thorough rationale to support her opinion based on an accurate characterization of the evidence of record. Therefore, the ophthalmologist's opinions are afforded significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). While the Veteran's service treatment records reflect treatment for sensitivity to light and itching and watery eyes, the Veteran's medical examination report and medical history reports upon discharge indicate that the eye issues had resolved with no additional sequela. Additionally, the Veteran does not contend, and the evidence of record does not otherwise indicate that he suffered from an eye disability during service which has continued since service, or which caused his right eye vision loss. There are no contrary medical opinions in the evidence of record as to the etiology of the Veteran's right eye vision loss, and the evidence does not otherwise indicate that the Veteran's right eye vision loss is related to his service connected CAD, stroke, or otherwise related to service. The Board acknowledges the Veteran's contention that his right eye vision loss is related to his service connected stroke or CAD. However, while the Veteran is competent to provide testimony or statements relating to symptoms or facts of events that he has observed and are within the realm of his personal knowledge, he is not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The record does not show, nor does the Veteran contend, that he has specialized education, training, or experience that would qualify him to render a diagnosis or render a medical opinion on this matter. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the issue in this case is outside the realm of common knowledge of a lay person because it involves a complex medical issue that goes beyond a simple and immediately observable cause-and-effect relationship. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Thus, the Veteran's statements in this regard are not competent and are afforded no probative weight. For the above stated reasons, the preponderance of the evidence weighs against a finding that the Veteran's right eye vision loss had its onset in service, is otherwise related to service, or was caused or aggravated by his service connected CAD or stroke. The benefit-of-the-doubt doctrine is therefore not for application, and service connection for right eye vision loss is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Maddox, 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.