Citation Nr: 21073581 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 10-35 162 DATE: December 9, 2021 ORDER Entitlement to service connection for a left eye disability, other than left eye cataracts, to include as secondary to the Veteran's service-connected hepatitis C or diabetes mellitus, is denied. FINDING OF FACT The preponderance of the evidence establishes the Veteran's left eye glaucoma was not present until more than one year following his discharge from service and is not etiologically related to his active service, to include as secondary to his service-connected hepatitis C or diabetes mellitus disabilities. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for a left eye disability, other than left eye cataracts, to include as secondary to the Veteran's service-connected hepatitis C or diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from January 1968 to December 1969 and from September 1973 to September 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2010 rating decision from a Department of Veteran's Affairs (VA) Regional Office (RO). When this case was last before the Board in February 2021, it was remanded for additional development. Specifically, the RO was instructed to obtain an addendum opinion regarding the etiology of the Veteran's left eye conditions. An appropriate addendum medical opinion was obtained. As such, the Board finds that the AOJ substantially complied with the directives in the February 2021 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially 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 may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Left Eye The Veteran is seeking service connection for a left eye disability, other than cataracts, which he claims is etiologically related to his active-duty service. In the alternative, the Veteran claims that this disability could be etiologically related to his service-connected hepatitis C or diabetes mellitus. The Board notes that the Veteran has a current diagnosis of glaucoma suspect. See February 2018 VA Eye Conditions examination. Therefore, the central issue that must be resolved is whether the Veteran's current disability originated in service or is otherwise related to service, to include as on a secondary basis. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Veteran has a currently diagnosed glaucoma suspect disability, competent medical evidence of record does not support that this disability was incurred in service or otherwise related to service. The Veteran's service treatment records (STRs) contain no complaints, treatment, or diagnosis of this condition. There are no treatment records for this condition while the Veteran was in service, and no medical examiner has given an opinion linking the Veteran's current disability to his active-duty service. However, the Board does note that the Veteran was treated for a cigarette burn to his left eye while in active-duty service. In a January 2011 correspondence, the Veteran reported that a burn to his left eye occurred while he was in service and that a purple blood clot appears on his eyelid twice a year. The Board, in a December 2017 decision, remanded the Veteran's claim in order to obtain a medical opinion with regard to the etiology of the Veteran's claimed eye disability, and to determine whether he had any current residuals of a left eye burn. In response to the Board's remand, the Veteran was provided a February 2018 VA Eye Conditions examination. The examiner diagnosed the Veteran with bilateral cataracts and indicated that the Veteran was suspicious for glaucoma. The examiner opined that the exact etiology of the Veteran's glaucoma suspicion was unknown, however, the examiner continued that there is no evidence that it is related to the Veteran's diabetes mellitus or to any history of injury. The examiner then provided an April 2019 addendum to the February 2018 examination wherein she opined that it was less likely than not (less than a 50 percent probability) that the Veteran's claimed blood clots on his left eyelid were related to his injury during service. The examiner explained that the Veteran's STR notes reveal a drawing of what seems to be the cornea/pupil and two tiny areas of punctate staining. The examiner noted the Veteran was given neosporin drops for his left eye for 3 days which were discontinued, and further noted that the Veteran's eyelid did not appear to be involved. The Board, in a December 2019 decision, again remanded the Veteran's claim in order to obtain an additional opinion regarding the Veteran's claimed left eye disabilities. In response to the Board remand, the Veteran was provided with a July 2020 Addendum to the February 2018 VA examination. In this addendum, the examiner noted that the Veteran only had two eye conditions cataracts (which are already service connected) and suspicion for glaucoma. The examiner noted that the Veteran's suspicion for glaucoma was first noted around 2010 and not during service. The examiner opined it is less likely than not (less than a 50 percent probability) that the suspicion for glaucoma was related to any superficial injury/cigarette burn to the eye during service. The rationale provided was that it was unlikely due to the nature of the injury described in the Veteran's STRs and also the presence of glaucoma in both of the Veteran's eyes. The examiner concluded that the Veteran has no other left eye disabilities. In a February 2021 decision, the Board again remanded the Veteran's claim in order to obtain an opinion regarding the etiology of the Veteran's left eye disabilities and their relationship to his service-connected hepatitis C. In response to the Board's Remand, the RO obtained a May 2021 Addendum opinion to the February 2018 VA examination. In the addendum, the examiner noted that a review of the Veteran's records revealed no specific disability unique to the Veteran's left eye. The examiner noted that the Veteran has mild cataracts in both eyes and is suspicious for glaucoma. The examiner further stated that neither of these conditions are related to the Veteran's service-connected hepatitis C. The rationale provided was that treatment for hepatitis C can cause interferon-associated retinopathy and/or neovascular glaucoma, neither of which the Veteran is diagnosed with. The Board weighs the above-mentioned VA examinations against the Veteran's lay contentions that any left eye condition other than cataracts is due to service, to include as secondary to a service-connected disability. The Veteran is competent to report symptoms he directly observed because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Veteran is not competent to offer an opinion as to the etiology of his current glaucoma suspicion due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). As such, the Board finds the VA examinations, which opined against a link between the Veteran's currently diagnosed left eye disability and his service, to include his service-connected hepatitis C and diabetes mellitus, to be of high probative value. Additionally, the Board notes that the Veteran was not diagnosed with glaucoma suspicion until around 2010, approximately 35 years after he left active-duty service. Further, no medical examiner has provided a nexus opinion which links the Veteran's condition to his active-duty service, to include as due to his service-connected disabilities. Thus, the probative evidence of record preponderates against the Veteran's claim for service connection. In light of the above discussion, there is no evidence that the Veteran sought treatment for or was diagnosed with left eye glaucoma while in service, or within a year after service, and there is no medical opinion in the record linking his current disability to his active-duty service, to include as secondary to his service-connected diabetes mellitus or hepatitis C disabilities. Therefore, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.