Citation Nr: 21022600 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 17-10 769 DATE: April 16, 2021 ORDER Entitlement to service connection for loss of vision is denied. FINDING OF FACT The Veteran’s current vision disability of the right eye did not manifest in service and is not otherwise attributable to service. CONCLUSION OF LAW A vision disability of the right eye was not incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1983 to March 1986. This matter comes before the Board of Veterans Appeals (Board) on appeal from a March 2014 rating decision by the VA regional office (RO). In March 2019 and October 2020, the Board remanded this matter. Service Connection Veterans are entitled to compensation from VA if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present 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”-the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Loss of vision The Veteran seeks service connection for loss of vision, specifically for the right eye. The Veteran has indicated that he has loss of vision due to his service. See January 2011 Claim for service connection. The Veteran has been diagnosed with anatomically narrow angles of the bilateral eyes, refractive error with presbyopia of the eye and dry eye syndrome. See December 2019 VA Examination Report. With regard to an in-service injury, the Board notes that the Veteran was treated in November 1985 for partial loss of vision and eye irritation of the right eye for 24 hours. The Veteran stated he was holding the branch of a tree while fellow soldiers moved a tent, and the branch slipped and struck the Veteran in the eye. At the time, the Veteran stated that his vision in the right eye was fuzzy and his right eye itched. See November 1985 service treatment record (STR). The examiner diagnosed the Veteran with a corneal abrasion of the right eye and prescribed ointment into the right eye for two days. He instructed the Veteran to return if his eye pain persisted. The Veteran’s February 1986 separation examination did not reflect any abnormalities or diagnoses of either eye. See February 1986 STR separation examination. In December 2019 the Veteran was afforded a VA examination for his loss of vision. The examiner, after diagnosing the Veteran with the above vision conditions, found that the Veteran’s decreased vision was due to evaporative dry eye, which was less likely as not related to service. The examiner found that the Veteran also had anatomically narrow angles without evidence of glaucomatous nerve damage and no history of angle closure. See December 2019 VA Examination Report. Thereafter, the Veteran submitted a July 2020 private medical report into record. The physician, who stated that he had reviewed the evidence of record including the Veteran’s STRs, stated that the Veteran’s loss of vision in his right eye was related to his ative duty service, based on the in service corneal abrasion to the Veteran’s right eye. The Board notes that the July 2020 private physician did not indicate that he had performed any examination of the Veteran or indicate any specific knowledge regarding the Veteran’s eyes. As such, the Board remanded the matter again in October 2020 for a VA examiner to address the Veteran’s in-service right eye corneal abrasion. Subsequent to the Board remand, the Veteran was afforded another VA addendum opinion in January 2021, for the examiner to address the November 1985 in service eye injury. The examiner noted that the Veteran sustained an eye injury in service which resulted in partial loss of vision and eye irritation. He noted that the corneal abrasion the Veteran sustained was not the cause of sustained decrease of vision in the Veteran’s right eye. He explained that when an abrasion occurs on the cornea, the vision will worsen, and the eye will be irritated and painful. Depending on the size the abrasion, it will heal within 1-3 days, and vision will return to baseline. The examiner further explained that if the abrasion is deep, it may leave a scar on the cornea which can affect vision. Also, rarely, the cornea can heal abnormally and cause issues with recurrent corneal abrasions which can affect vision. However, both of these conditions would have shown evidence of their presence upon clinical examination, and the Veteran’s December 2019 examination was normal. See January 2021 VA Opinion. The January 2021 opinion was provided by the attending physician of ophthalmology. The Board affords the January 2021 VA opinion the greatest probative value because the examiner based his findings on a review of the Veteran’s STRs and post-service treatment records, in addition to the examination of the Veteran in December 2019. He concluded that due to the nature of the Veteran’s current diagnosis, it was less likely as not that the injury in service led to such. This opinion is consistent with the Board’s review of the evidence of record. Consideration has been given to the Veteran’s testimony that his military duties led to his current vision loss. Although the Veteran is competent to report having blurred vision while in the military, he is not competent to state that his military duties caused his current vision disabilities. 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. West, 12 Vet. App. 460, 465 (1999). In this regard, the question of causation of such a disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence alone, and the Veteran’s own opinion on this matter is nonprobative evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Accordingly, the Board finds that a preponderance of the evidence is against a finding that the Veteran’s vision loss disability is etiologically related to his period of active service, specifically to his November 1985 in service injury. As the preponderance of the evidence is against the claim, the benefit of reasonable doubt doctrine is not applicable, and service connection for vision loss must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). T. V. CASEY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Nadia Kamal, 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.