Citation Nr: 21005392 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 13-32 231 DATE: February 1, 2021 ORDER Entitlement to service connection for a vision disorder, to include open angle glaucoma is denied. FINDING OF FACT 1. The Veteran’s glaucoma was not chronic or otherwise present during service, was not manifest within one year of separation from service and has not been productive of symptoms continuously since service. 2. There is no in-service event, injury, or disease, to which Veteran’s glaucoma may be related. CONCLUSION OF LAW The criteria for entitlement to service connection for an eye disorder, to include open angle glaucoma, are not met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 4.79, Diagnostic Code 6013 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1973 to November 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision (RD) of a Regional Office (RO) of the Department of Veterans Affairs (VA) in San Juan, Puerto Rico. The Board remanded the case in September 2017 for development including a medical opinion. The case was remanded a second time in March 2019 for an additional medical opinion. The RO issued a September 2020 supplemental statement of case (SSOC) and the case has returned to the Board. Entitlement to service connection for a vision disorder, to include open angle glaucoma The Veteran is seeking entitlement to service connection for a vision disorder, to include open angle glaucoma (glaucoma). The Veteran contends that his glaucoma is due to an in-service injury in 1974 where gasoline spilled into his eyes. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Board will also address presumptive service connection as applicable. 1. Current Disability The Board finds that the Veteran has a current disability of glaucoma. During an April 2011 eye examination, the physician indicated the Veteran needed a glaucoma work up. In a February 2012 medical note for eye glaucoma, the physician notes the Veteran’s glaucoma is currently controlled. See December 2012 VA Medical Treatment Records. In addition, the May 2018 and December 2019 VA examinations indicate the Veteran has a current diagnosis of glaucoma. 2. Presumptions of In-Service Incurrence or Aggravation VA considers glaucoma, as an organic disease of the nervous system, a chronic disease subject to presumptive service connection. 38 C.F.R. § 3.309(a); see also VA Adjudication Manual M21-1 III.iv.4.N.1.d. Such chronic diseases may be service connected on a presumptive basis if shown as “chronic” during service, manifested to a compensable degree in a specified period after service, or productive of continuous symptomatology since service. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 38 C.F.R. § 3.303(b), 3.307, 3.309. A. Chronicity in Service For the showing of chronic disease in service there is a required combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. See 38 C.F.R. § 3.303(b). The Board finds that the Veteran’s glaucoma was not “chronic” in service. The Veteran contends that his glaucoma is due to an injury in service in which gasoline spilled into his eyes and further asserts that one of his treating VA medical center physicians told him that his glaucoma was due to that incident. See February 2013 Notice of Disagreement (NOD). The Veteran’s service treatment records (STR’s) during his period of service are absent for any complaint or diagnosis of glaucoma or any other eye disorder. There is no indication from the November 1973 enlistment examination that the Veteran mentioned a history of eye trouble or complained of symptoms of an eye condition, and his eye examination was normal. See July 2016 STRs. In February 1974, the Veteran spilled gasoline into his eyes; his face was cleaned, and his eyes rinsed with a saline solution. Id. His eye examination was normal except for a mild case of conjunctivitis and he was returned to light duty. Id. The Veteran’s September 1976 separation examination was absent for any indication that the Veteran had any type of eye trouble or symptoms of any eye condition and he indicated he was in good health. Id. The Board finds there is not a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. Service connection is not warranted based on a chronic disease noted as such in service. 38 C.F.R. § 3.303(b). B. Presumptions Regarding Post-Service Manifestations Service connection may also be granted on presumptive bases based on post-service manifestations. First, service connection may be awarded if the chronic disease not preexisting service is productive of symptoms continuously since service. 38 C.F.R. § 3.303(b). Second, service connection may be awarded if a disability is manifested to a compensable degree within one year of separation from service. 38 C.F.R. § 3.307(a)(3). The Veteran’s glaucoma did not manifest to a compensable degree within one year of service separation. There is no evidence of record regarding the diagnosis, symptoms or treatment of glaucoma from the Veteran’s November 1975 separation from service to November 1976. The Board concludes service connection is not warranted on this basis. Next, the Board finds that glaucoma has not been productive of symptoms continuously since service. Although the Veteran contends that he was verbally told by a VA medical center physician that his glaucoma was caused by the injury in service where gasoline spilled into his eyes, the record is absent of diagnosis, symptoms or treatment for the condition until approximately April 2011 when his physician indicated the need for a glaucoma work up. See December 2012 VA treatment records. In a February 2012 medical treatment note, the assessment includes controlled glaucoma and is the first indication of record that the Veteran has a diagnosis of glaucoma. Id. Thus, service connection is not warranted on this basis. 38 C.F.R. § 3.303(b). In the absence of any other evidence, the Board finds the preponderance of the evidence demonstrates that the Veteran’s glaucoma was not symptomatic during service or continuously since separation. There being no other presumptions available in this appeal, the Board resumes consideration of in-service incurrence or aggravation on direct service connection. See Shedden, supra. 3. Nexus to an In-service Incurrence or Aggravation of a Disease or Injury The Veteran is seeking entitlement to service connection for an eye disorder, to include glaucoma, and asserts that the condition was caused by gasoline spilling into his eyes during service. As stated above, the Veteran asserts that his physician at the VA medical center told him that the gasoline in his eyes was the cause of his glaucoma; however, there is no additional evidence in the Veteran’s VA treatment records to support this contention. See December 2012 VA Treatment Records. Although the Veteran is competent to report what his doctor has told him, the Veteran has not provided the underlying rationale for his doctor’s opinion. In light of the competing medical opinions discussed below, the Board must afford his statement little probative value. The Veteran’s service treatment records are negative for complaints, treatment or diagnosis of any eye condition including glaucoma. See July 2016 STRs. The Veteran’s November 1973 enlistment examination and September 1976 separation examination indicate the Veteran was in good health and did not note any eye condition or a diagnosis of glaucoma. Id. Finally, regarding the February 1974 incident where gasoline spilled into the Veteran’s eyes, he was treated for mild conjunctivitis, his eye examination was normal, and he was returned to light duty. Id. During a May 2018 VA examination, the examiner opined that the Veteran’s bilateral open angle glaucoma was less likely than not related to military service. The VA examiner noted the Veteran has two female siblings with a positive diagnosis of glaucoma and glaucoma runs in families. Id. He reasoned that as there is a strong familial tendency in primary open-angle glaucoma, the Veteran’s glaucoma was not due to military service but was a congenital condition. Id. Aside from noting the Veteran has two siblings diagnosed with glaucoma, the VA examiner failed to provide any rationale in support of his opinion that the Veteran’s glaucoma was a congenital condition. Lastly, the examiner stated that although the Veteran had gasoline spilled onto his eyes in February 1974, one occasion would not cause his current condition of glaucoma. Id. During a December 2019 VA examination, the Veteran stated that gasoline fell into his eye while pumping gas into a vehicle in 1974 and that he had a second eye injury with a nail in 1994, but could not remember which eye was injured and he did not seek medical care. Id. The Veteran also stated that he had a sibling that used eye drops but could not confirm they had glaucoma. The examiner diagnosed the Veteran with mild bilateral open angle glaucoma (glaucoma), incipient bilateral senile cataracts (cataracts) and bilateral nasal small pterygia (pterygia). Id. The VA examiner opined that the Veteran’s bilateral open angle glaucoma was less likely than not (less than 50 percent) caused by the February 1974 injury or otherwise related to military service. In support of his opinion the examiner noted the Veteran’s medical records indicated his eyes were irrigated with saline, and his examination was normal except for mild conjunctivitis. There was no additional record of treatment for any eye condition in the Veteran’s STRs and the Veteran was not diagnosed with glaucoma until 35 years after the incident. Further, he opined the Veteran’s bilateral chemical conjunctivitis was a transient condition of the ocular surface, and the incident did not affect the inner structures of the eye or drainage system and thus induce glaucoma. Id. The VA examiner explained that the Veteran had several risk factors for glaucoma including age, family history, ethnicity and thinned central corneal thickness. Id. Although the examiner noted that family history is a risk factor for glaucoma, he stated it is an acquired disease and not a congenital defect or disease. Id. The examiner further clarified that congenital glaucoma is seen in infants and usually diagnosed in the first year of life. Id. Lastly, the examiner opined that the Veteran’s cataracts were an age-expected acquired disease and his pterygia was acquired due to sun exposure. Further, neither condition was incurred in or caused by the Veteran’s military service, including the incident in which gasoline spilled in the Veteran’s eyes. Id. The Veteran’s STRs are absent any diagnosis, symptoms or treatment for glaucoma, cataracts, or pterygia while in service. Both the May 2018 and December 2019 VA examiners opined that the Veteran’s glaucoma was not related to service. See May 2018 and December 2019 VA examination. However, the May 2018 VA examiner based this opinion on the conclusion that the Veteran’s glaucoma was a congenital disease. He provided no rationale for this conclusion outside noting the Veteran’s statement that he has two siblings with the condition. See May 2018 VA Examination. Therefore, the Board finds this opinion is entitled to little probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (most of the probative value of a medical opinion comes from its reasoning). The December 2019 VA examiner provided a detailed analysis in support of his opinion that the Veteran’s glaucoma, cataracts and pterygia were not related to military service, including the incident with the gasoline. See December 2019 VA Examination. In addition, the examiner explains the nature and etiology of the Veteran’s eye condition in support of his conclusion that it is not a congenital defect or disease, but rather an acquired disease. Id. The Board finds that the December 2019 VA examiner’s opinion is entitled to more probative value than the May 2018 VA examiner’s opinion. Therefore, the Board finds that the evidence of record does not demonstrate the presence of an in-service injury. The Board finds that the preponderance of the evidence shows the Veteran’s eye condition, to include bilateral open angle glaucoma, incipient bilateral senile cataracts and bilateral nasal small pterygia, was neither caused nor aggravated by an event, injury or illness during active service, nor is it etiologically related to service. The detailed rationale of the December 2019 medical opinion simply outweighs the Veteran’s account of his doctor’s statement. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against an in-service incurrence or aggravation of the disease or injury, and therefore, the claim. The doctrine is not applicable, and (Continued on the next page)   the claim for entitlement to service connection for an eye condition, to include glaucoma, must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Aubee, 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.