Citation Nr: 21013742 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 06-39 406 DATE: March 10, 2021 ORDER Entitlement to service connection for glaucoma is denied. FINDING OF FACT The Veteran’s glaucoma did not have its onset during the Veteran’s active service, and is not otherwise etiologically related to such service; and, was not caused or chronically worsened by service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for glaucoma are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from July 1966 to July 1969. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2018. A transcript of that hearing has been added to the record. This case was previously before the Board, most recently in August 2020, at which time the issue currently before the Board was remanded for additional development. The case has now been returned to the Board for further appellate action. Service Connection – Glaucoma At the outset, the Board notes that the Veteran has not alleged, and the evidence does not suggest, that his glaucoma is directly related to his active service. Further, there is no indication from the record that the Veteran was treated for, or diagnosed with glaucoma during service, or received treatment for symptoms which could reasonably be associated with a later diagnosis of glaucoma while in active service. Additionally, there is no post-service medical evidence of record linking the Veteran’s glaucoma to his active service. Rather, the Veteran has asserted that his glaucoma was caused or chronically worsened by a service-connected disability, namely his service-connected diabetes mellitus. Specifically, the Veteran has reported that he believes his glaucoma had increased in severity since his diagnosis of diabetes mellitus. He has also reported that in approximately 2010, he was told that his glaucoma could be related to diabetes. The Board notes that service connection is in effect for diabetes mellitus and associated diagnosed complications of such. Further, the Veteran has a current diagnosis of glaucoma. As such, the question remaining for the Board is whether the Veteran’s glaucoma was caused or aggravated by his service-connected diabetes mellitus. In Jun 2010, the Veteran was afforded a VA examination. At that time, the Veteran reported that he believed he had glaucoma that was secondary to his diabetes mellitus, which had been diagnosed three years prior. The examiner diagnosed open angle glaucoma at that time. The examiner found that the glaucoma was unlikely to be related to his diabetes mellitus as it was controlled with one eye drop, and had not resulted in visual field defect. In November 2015, an addendum VA medical opinion was obtained. At that time, the VA examiner opined that it was less likely as not that the Veteran’s glaucoma was incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the VA examiner noted that there was no evidence of in-service treatment for glaucoma, and the first evidence of glaucoma was an April 1998 private eye examination report showing the Veteran to be glaucoma suspect. Further, the VA examiner found that the Veteran’s diabetes mellitus did not result in his development of glaucoma. In for finding, the VA examiner noted that at the time of his diagnosis of glaucoma, there was no sign of diabetic retinopathy. In May 2016, the Veteran was afforded another VA eye examination. at that time, the examiner confirmed the diagnosis of glaucoma, and noted it was stable. At that time, the VA examiner opined that the Veteran’s glaucoma was less likely as not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner noted that the Veteran did not develop open angle glaucoma until 2006, and the June 2010 VA examination showed normal visual field, and normal eye pressure on one drop daily. The examiner also opined that it was less likely as not that the Veteran’s glaucoma was proximately due to, or the result of his service-connected diabetes mellitus. In so finding, the examiner noted that the Veteran had primary open angle glaucoma, which was not caused by diabetes mellitus. Further, the Veteran had mild diabetes mellitus, without evidence of diabetic retinopathy. Further, the examiner noted that there was no evidence of neurovascular glaucoma present, and there was no evidence to support a finding that mild diabetes mellitus aggravated primary open angle glaucoma. In September 2019, the Veteran was afforded another VA eye examination. At that time, the VA examiner opined that it was less likely as not that the Veteran’s glaucoma was incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the VA examiner noted that the Veteran’s glaucoma was not diagnosed until 2006. Further the examiner noted that the most common identifiable cause of glaucoma was inherited. It was noted that glaucoma was generally caused by high eye pressures which damaged the optic nerve and then led to loss of vision. The examiner noted that the loss of vision may not develop until years later. Further, the examiner noted that the Veteran was noted as being glaucoma suspect as early as 1998, but was not diagnosed with glaucoma until years later; and, there was no history of trauma, or other risk factors, for glaucoma development during the Veteran’s time in service. The VA examiner also opined that it was less likely as not that the Veteran’s glaucoma was proximately due to or the result of his diabetes mellitus. In so finding, the VA examiner noted that the type of glaucoma that would be related to diabetes mellitus would be neovascular glaucoma, that was often associated with proliferative diabetic retinopathy, neither of which are noted in the Veteran’s medical record. Further, the examiner noted that the Veteran was diagnosed as glaucoma suspect in April 1998, which pre-dated the Veteran’s diabetes mellitus diagnosis, and so, concluded that the Veteran’s diagnosis of diabetes mellitus did not result in the development of glaucoma. An addendum VA medical opinion was obtained in October 2020. At that time, the VA examiner conducted a thorough review of the claims file, and specifically noted the pertinent medical evidence of record. At that time, the VA examiner opined that it was less likely as not that the Veteran’s glaucoma was caused or aggravated by a service-connected disability. In so finding, the examiner noted that the Veteran’s glaucoma was primary open angle glaucoma, which is not aggravated by diabetes mellitus. Further, the examiner noted that there was not evidence that the Veteran had diabetes retinopathy or neovascular glaucoma, which was the type of glaucoma caused by diabetes. The examiner reiterated that the most common cause of glaucoma was inherited, and it formed due to high eye pressures causing damage to the optic nerve over time. The examiner also cited to the prior medical opinions of record showing no evidence of diabetes retinopathy or visual field defect after the Veteran’s diagnosis of diabetes mellitus, and the notation that primary open angle glaucoma was not caused or worsened by diabetes mellitus. The Board finds that the VA medical opinions, when read in conjunction with each other, are adequate. In this regard, the examiners thoroughly reviewed and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, there are no medical opinions of record to the contrary. As such, the VA medical opinions of record are the most probative evidence of record. While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current glaucoma to his active service or to his diabetes mellitus, as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for glaucoma either on a direct or secondary basis is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Andrew Ledman II 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.