Citation Nr: 21015252 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 16-05 771 DATE: March 17, 2021 ORDER Entitlement to service connection for a bilateral eye disorder, to include as secondary to service connected hypertension and tension headaches, is denied. FINDING OF FACT 1. Refractive errors are not disabilities for VA compensation purposes. 2. The Veteran’s bilateral eye disorder manifested as blurry vision was not incurred in service, is not otherwise causally or etiologically related to service and is not caused or aggravated by a service connected hypertension and/or tension headaches. CONCLUSION OF LAW The criteria for establishing service connection for a bilateral eye disorder, to include hypertension and/or tension headaches, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.9. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1981 to July 1984, from November 1990 to May 1991, and from August 2009 to August 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision issued by a Department of Veterans Affairs Regional Office (RO). In August 2019, the Board remanded the matter to allow for additional development, to include obtaining an addendum opinion to address the etiology of the Veteran’s current eye disorder. The Veteran has provided an addendum opinion by a VA examiner in June 2020. The Board finds that there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A July 2020 rating decision granted the Veteran's claim for service connection for gout and assigned an initial rating. As this decision represents a full grant of the benefits sought with respect to this claim for service connection, such issue is no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For purposes of entitlement to benefits, the law provides that refractive errors of the eyes are developmental defects and not disease or injury within the meaning of applicable legislation. See 38 C.F.R. §§ 3.303(c), 4.9. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9. Thus, VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury during service which created additional disability. See VAOPGCPREC 82-90 (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for a bilateral eye disorder. The Veteran contends that his eye disorder manifested as blurry vision is a result of his service. Specifically, he alleges that his condition is the result of chronic eye irritation caused by exposure to sand, wind, and dust blowing in the Kuwaiti desert, where he was deployed in 1991. The Veteran reports that he has been suffering from blurred vision in both eyes since that time and that his condition has progressively worsened over the years. He now has dry irritated eyes and a small growth on the inside corner of his left eye which at times becomes irritated. Service treatment records are silent for any complaints, treatment, or diagnoses related to a vision disorder. Post-service treatment records reflect diagnoses for minor refractive error in August 2013, bilateral cataracts and right eye pterygium in April 2019, and dry eye syndrome in June 2020. Turning to the question of whether there is an etiological relationship between the Veteran's claimed eye disorder and service, the Board notes that the record contains several etiology opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (stating that the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board will consider each of these opinions below. The Veteran has been provided several examinations for his eyes. Upon VA examination in December 2012, the Veteran was found to have myopic eyesight at 20/50 visual acuity. Trace nuclear cataracts were also noted. The examiner diagnosed the Veteran with minor refractive error, cataracts, pinguecula, and mild blepharitis. The examiner opined that the Veteran’s eye conditions were not related to headaches. The examiner did not opine on whether the conditions were related to the Veteran’s service, citing a lack of records upon which to base his determination. The examiner was then subsequently provided the Veteran’s entire claims file and asked to offer an addendum opinion. The examiner reviewed the Veteran’s claims file but stated that he saw “no changes or deletions that need to be made to the previously given opinion or examination done in December 2012”. The Board found this opinion to be inadequate in its September 2018 remand as the examiner did not review the Veteran’s claims file and did not discuss whether the Veteran’s eye disorder was related to an in-service head injury or the service-connected hypertension. The Veteran was subsequently provided another VA examination for his eyes in April 2019. The examiner diagnosed the Veteran with bilateral cataracts and right eye pterygium. Myopia at 20/40 visual acuity and nuclear sclerosis were noted as well. The examiner then opined that it was less likely than not that the Veteran’s eye conditions were related to service. The Board found this opinion to be inadequate in its August 2019 remand as it failed to render an opinion on causation and aggravation of the eye disabilities, was not responsive to the inquiries in the Board's September 2018 remand and failed to consider or address statements of the Veteran and his spouse. A June 2020 VA examiner diagnosed the Veteran with pterygium, cataracts and dry eye syndrome. The examiner opined that the Veteran's eye disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness and was not caused or aggravated by the Veteran’s service connected disabilities to include hypertension and tension headaches as the Veteran's blurred vision in each eye is the direct result of age-related nuclear cataracts in each eye. The examiner noted that nuclear cataracts are caused solely by age and genetic factors (some individuals develop them earlier than others) but are in no way related to headaches or hypertension. The examiner explained that there were no eye conditions found in either eye that are the result of hypertension or headaches, that the pterygium OS is the direct result of exposure to sunlight/UV and wind over the Veteran's lifetime, that the dry eye syndrome is the result of meibomian gland dysfunction in which the tiny oil glands that line each eyelid become inflamed leading to increased tear evaporation and that neither of these conditions are in anyway related to tension headaches or hypertension as all conditions share a different etiology. The June 2020 VA examiner further opined that it was less likely than not (50 percent probability or greater) that the Veteran's refractive error is due to an injury or disease in service that resulted in an additional disability of the eye as any mild refractive error that the Veteran exhibits is not attributable to any current eye condition. The examiner noted that none of the Veteran's eye conditions would be expected to lead to a marked increase in refractive error and that in some cases nuclear cataracts can change an individual's refractive error. however, the examiner noted that the Veteran's cataracts are mild to moderate in nature and typically cataracts must be substantially more progressed to cause valid changes in refractive status. The examiner reviewed the Veteran’s claims file, interviewed the Veteran, considered the Veteran’s statements and provided an opinion supported by a clear rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There is no contrary opinion of record. The Board has considered the Veteran’s lay assertions, specifically that his condition stemmed from his deployment to Kuwait and the harsh desert conditions experienced there. However, the Board finds the question regarding the potential relationship between the Veteran's condition and any instance of his service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran is competent to describe his current symptoms, the Board accords his statements regarding the etiology of such a disorder little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinion of the Veteran is nonprobative evidence. The Board has also considered the argument of the Veteran’s representative citing 38 U.S.C. § 1154(b), as relied upon in Chipego v. Brown, 4 Vet. App. 102 (1993), which provides that “[Veterans] engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, campaign, or expedition” may establish sufficient proof of service-connection on the basis of lay evidence, even in the absence of official record of incurrence or aggravation in such service (i.e. medical treatment, complaints, etc.). Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. In the present matter, the evidence does not indicate that the Veteran engaged in combat with the enemy and the Veteran has not alleged incurring an eye injury as a result of combat with the enemy. As such, the provisions of 38 U.S.C. § 1154(b) are not for application. Additionally, the Board finds that the Veteran’s lay assertions are rebutted by clear and convincing medical evidence to the contrary, i.e. through the VA medical opinion evidence which clearly opines a negative nexus opinion and offers alternate etiologies for the Veteran’s eye conditions. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a bilateral eye disorder. As such, that doctrine is not applicable in the instant claim, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, 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.