Citation Nr: 21011693 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-31 752 DATE: March 2, 2021 ORDER Entitlement to service connection for a left eye disorder is denied. Entitlement to service connection for a right eye disorder is denied. FINDINGS OF FACT 1. A left eye disorder was not manifest during active service and the preponderance of the evidence fails to establish that a present left eye disability is etiologically related to service. 2. A right eye disorder, amblyopia caused by esotropia, was manifest during active service; however, the preponderance of the evidence fails to establish that a present right eye disability for VA purposes is etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left eye disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for entitlement to service connection for a right eye disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from September 1967 to September 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision by the Philadelphia, Pennsylvania, Regional Office (RO) of the Department of Veterans Affairs (VA). In February 2019, the Veteran testified at a personal hearing before the undersigned Veterans Law Judge. The transcript of that hearing is of record. The case was remanded for additional development in June 2019. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Congenital or developmental defects, such as refractive error of the eye, are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). VA General Counsel Precedent Opinion has held that service connection may be granted for disease, but not defects, which are congenital, developmental, or familial in origin when the evidence establishes the disorder was incurred in or aggravated by active service. With regard to congenital or developmental defects, service connection may be granted for disability which is shown to have resulted from a defect which was subject to a superimposed disease or injury during service. VAOGCPREC 82-90 (Jul. 18, 1990). A Veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence (obvious or manifest) establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Noted means “[o]nly such conditions as are recorded in examination reports.” 38 C.F.R. § 3.304(b). “Clear and unmistakable evidence” is an “onerous” evidentiary standard requiring that the conclusion be “undebatable.” Cotant v. Principi, 17 Vet. App. 116 (2003). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. The Veteran contends that he has left and right eye disorders as a result of active service. At his February 2019 hearing he testified that his duties during active service required that he review aerial photography and that during service he began to experience blind spots. He described having performed such duties eight out of 10 hours per day, six days per week during service in the Republic of Vietnam. He denied any recollection of having sustained a direct blow to the eyes during service. Service treatment records show the Veteran’s August 1967 enlistment examination revealed a normal clinical evaluation of the eyes. Records dated in May 1969 noted a history of dizziness, not vertigo, that usually occurred during exertion. A physical examination was normal except for persistent nystagmus on right gaze with fast component to the right. An ear, nose, and throat (ENT) consultation noted the Veteran reported a six-week history of becoming light-headed with blurred vision after playing basketball for about five minutes. No diagnosis was provided, but upon evaluation of the eyes the examiner commented that it was not believed to be due to any spontaneous nystagmus. A September 1970 report noted the Veteran had lightheadedness and diplopia with exertion. It was noted a neurologic examination was within normal limits expect for nystagmus to lateral gaze, bilaterally. The examiner’s impression was lightheadedness of unknown etiology. Reports dated in March 1972 report noted mild photophobia to the right eye, eye strain, and spots on the right eye. A provisional diagnosis of rule out glaucoma was provided. A March 1972 ophthalmologic consultation revealed far vision without correction of 20/20, to the right and left eyes. Visual fields were normal. The examiner noted that no treatment was indicated. The Veteran’s August 1972 separation examination revealed a normal clinical evaluation of the eyes. Distant and near vision was 20/20, bilaterally. Field of vision and intraocular pressure were normal. VA treatment records dated in August 1977 noted the Veteran reported a seven-year history of chronic right eye blurred vision. A diagnosis of undiagnosed visual disturbance was provided. An April 1978 report noted a diagnosis of blurred vision. VA examination in March 1998 included diagnoses of congenital right esotropia and hyperopia with amblyopia. It was noted the Veteran reported a history of blurred right eye vision since the 1970’s. Private medical records show the Veteran underwent treatment for nuclear cataracts to the left and right eyes in May 2010. No opinions as to etiology were provided. VA examination in November 2019 included diagnoses of bilateral hypertensive retinopathy with a date of onset in 2019, bilateral pseudophakia with a date of onset in 2008, and strabismic amblyopia that was first noted clearly in 1998. It was noted that strabismic amblyopia was responsible for a visual impairment. Based upon a review of the evidence of record and examination, the examiner determined that it was less likely that right or left eye disabilities were incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted there was no pertinent examination prior to 1972, but that upon ophthalmologic examination in 1972 muscle balance was marked as normal. It was first noted to be abnormal in 1978. The examiner acknowledged that decreased right eye vision was present at least as far back as 1972 and that hypertensive retinopathy of the degree shown and pseudophakia did not cause changes in vision. The examiner noted the Veteran had strabismus amblyopia to the right eye and that records dated from 1972 indicated esotropia as the cause of the amblyopia. It was noted that esotropia was typically congenital, but that it could be acquired. The examiner stated it could not be determined whether the Veteran’s esotropia was congenital or acquired as there was no record of an eye examination prior to 1972. The examiner found that the Veteran’s strabismus amblyopia, pseudophakia, and hypertensive retinopathy were less likely related to reviewing aerial photography. As rationale for the amblyopia opinion, it was noted that it was a condition which arises due to deprivation of stimulation and that reviewing photographs would not cause this type of deprivation. Esotropia is a form of strabismus (eye misalignment) characterized by an inwards turn of one or both eyes. See https://aapos.org/glossary/esotropia (last visited Feb. 23, 2021). Amblyopia, or “lazy eye,” is the most common cause of visual impairment in children. See https://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&v%3Asources=medlineplus-bundle&query=amblyopia&_ga=2.240956227.1712445055.1614087259-664718489.1587489727 (last visited Feb. 23, 2021). Based upon the evidence of record, the Board finds that a left eye disorder was not manifest during active service and that the preponderance of the evidence fails to establish that a present disability is etiologically related to service. There is no evidence of a specific left eye disorder during active service and the November 2019 examiner’s opinion is persuasive that the Veteran’s bilateral hypertensive retinopathy and bilateral pseudophakia were not likely related to an in-service event, injury, or illness. There is no competent medical opinion to the contrary. As to the right eye disorder claim, the evidence of record clearly demonstrates the onset of right eye blurry vision problems during active service, and that the Veteran had amblyopia caused by esotropia that was manifest in service. The Veteran’s right eye is presumed to have been sound upon service enlistment. Although the March 1998 VA examiner found his right esotropia was a congenital disorder, the November 2019 examiner noted that esotropia, while typically congenital, could be acquired. The November 2019 examiner further stated it could not be determined whether the Veteran’s esotropia was congenital or acquired as there was no record of an eye examination prior to 1972. The examiner, however, specifically found that the Veteran’s strabismus amblyopia, pseudophakia, and hypertensive retinopathy of the right eye were less likely incurred in or caused by the claimed in-service injury, event, or illness and were not likely related to his having reviewed aerial photography. As rationale for the opinion, the examiner noted that upon ophthalmologic examination in 1972 muscle balance was marked as normal and it was only first noted to be abnormal in 1978. It was further noted that amblyopia was a condition which arises due to deprivation of stimulation and that reviewing photographs would not cause this type of deprivation. The Board finds that the preponderance of the evidence fails to establish that the Veteran’s esotropia or amblyopia of the right eye are disabilities for VA purposes that are etiologically related to service. There is no evidence indicating that his esotropia or amblyopia developed as a result of disease nor are they shown to have resulted from a superimposed disease or injury during service. The March 1998 and November 2019 VA findings are persuasive and based upon adequate rationale. The examiners are shown to have reviewed the evidence of record and to have adequately considered the credible lay statements and reported symptom manifestation history of record. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). There is no competent evidence to the contrary. Consideration must be given to the Veteran’s personal assertion that he has present left and right eye disabilities as a result of service. Lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The specific issues in this case, however, fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The claimed disabilities are not conditions that are readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran is competent to report observable symptoms. However, he is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in as to such disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value.   When all the evidence is assembled VA is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim in which case the claim is denied. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). The preponderance of the evidence is against the Veteran’s claims. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Douglas 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.