Citation Nr: 21006327 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-07 754 DATE: February 3, 2021 ORDER Entitlement to service connection for traumatic glaucoma of the right eye is denied. FINDING OF FACT The preponderance of the evidence is against finding that traumatic glaucoma of the right eye is related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for traumatic glaucoma of the right eye are not 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 1984 to June 1987. In July 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed. This case was previously remanded for additional development in October 2020. 1. Entitlement to service connection for traumatic glaucoma of the right eye Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). The Veteran contends that glaucoma of the right eye is related to an assault in service. He asserts that the assault resulted in damage of the optic nerve. A May 1987 service treatment record shows that the Veteran reported a laceration of the right eye and possible loss of consciousness and hematoma of the right eye. The record noted a contusion of the right eyelid, swelling of the right eye globe, and contusions of both right eyelids. The Veteran complained of decreased vision and diplopia. A May 1987 record shows a diagnosis of right infraorbital fracture status post open reduction. VA treatment records dated in November 2012 and February 2013 show diagnoses of glaucoma suspect. In December 2019, a VA examiner diagnosed corneal scar post infection right eye, primary open angle glaucoma of both eyes, and cataracts of both eyes. The examiner noted a history of orbital blow out fracture of the right eye in 1987. The Veteran reported that he was beaten with a baseball bat, which caused a right orbital fracture. He reported that the injury caused problems with his vision. He reported that he could not see out of his right eye, and glasses did not help very much. The examiner opined that the service treatment records indicate that the injury resolved without complication and the Veteran had normal acuity and no visual impairment after resolution. The examiner opined that the current visual problems result from other unrelated eye conditions. In December 2019, the examiner also opined that the claimed eye condition is less likely than not related to service. The examiner noted that while this type of injury may cause glaucoma years (or decades) later, the etiology of such glaucoma is due to angle recession. The examiner noted that angle recession has never been diagnosed, and thus, the disability is unlikely to be related to trauma. The examiner opined that, if the Veteran had glaucoma only in his right eye, a trauma etiology would be more likely. The examiner opined that the Veteran’s right eye corneal scar is related to an injury that occurred in 2014. In October 2020, the case was remanded for an additional medical opinion. The examiner was asked to address material submitted by the Veteran from his private treatment provider, indicating that blunt injuries that cause bleeding in the eye can cause glaucoma. A VA medical opinion was obtained in December 2020. The examiner opined that the Veteran’s right eye primary angle glaucoma is less likely than not related to the right eye trauma with swelling of the right eye globe that occurred during service. The examiner explained that the Veteran has a diagnosis of traumatic glaucoma of both eyes, for which treatment with Cosopt is being administered bilaterally. The examiner noted that the Veteran has bilateral optic nerve cupping that is normal physiologic cupping and slightly larger in the left eye. The examiner noted that, in glaucomatous-related cupping, the vertical cupping is typically larger than the horizontal cupping. The examiner indicated that this vertical cupping is not found in the Veteran. In addition, the records indicate that the Veteran has normal anterior chamber angles with the ciliary body visible 360 degrees, and no angle recession and no synechia, which are all inconsistent with evidence of residual, traumatic glaucoma. The examiner indicated that an eye examination in November 2012 (25 years after the injury in May 1987) revealed best correctable vision of 20/20 in both eyes. The examiner explained that records indicate that the laceration, swelling, and hematoma cleared without sequelae. The examiner opined that “the diagnosis of BILATERAL Primary Open Angle Glaucoma (POAG) is not consistent with a traumatic etiology since the eye records do not indicate any anatomic residuals from the injury to the right eye. In addition, the diagnosis of POAG occurred approximately 30 years after the right eyelid and eye injury.” The medical information about traumatic glaucoma is not sufficient to establish a nexus to service. Medical treatise evidence can provide probative support for a VA claim in certain instances. Mattern v. West, 12 Vet. App. 222, 228 (1999). A medical article or treatise can provide support for a claim, but must be combined with an opinion of a medical professional and be reflective of the specific facts of a case as opposed to a discussion of generic relationships. Sacks v. West, 11 Vet. App. 314, 317 (1998). In this case, the article is not combined with an opinion from a medical professional, and thus, it has low probative value. The VA examiner considered the information pamphlet about traumatic glaucoma and found that the Veteran’s right eye disability is not consistent with residual traumatic glaucoma, while providing a detailed rationale and reviewing the Veteran’s claims file and lay statements. Therefore, the Board places high probative weight on the December 2020 VA examiner’s medical opinion. On review, the Board finds that there is a preponderance of the evidence against a finding that glaucoma of the right eye is related to an in-service injury or disease. As there is a preponderance of the evidence against the claim, the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherine Cykowski 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.