Citation Nr: 21027838 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 12-07 591 DATE: May 7, 2021 ORDER Entitlement to service connection for a disability manifested by vision impairment, and diagnosed as bilateral posterior chamber intraocular lens implant, bilateral dry eye syndrome, and left vessel tortuosity, is granted. FINDING OF FACT It is at least as likely as not that the Veteran's bilateral eye conditions are related to active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for bilateral eye conditions have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1965 to December 1968. This case comes before the Board of Veterans' Appeals (Board) on appeal from a November 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in June 2015 and January 2018, when it was remanded for additional development. It is noted that claims of service connection of peripheral neuropathy, hypertension, and erectile dysfunction were also a part of the prior remands. During the pendency of the ordered development, those claims were granted in full and therefore are no longer part of this appeal. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. Entitlement to service connection for bilateral eye conditions The Veteran asserts that his bilateral eye conditions are a result of his military service, to include herbicide exposure during service in Thailand. In the alternative, he contends that his eye conditions have worsened due to his service-connected diabetes mellitus, type II. The Board finds the claim should be granted. As an initial matter, the evidence of record shows current eye diagnoses of bilateral posterior chamber intraocular lens implant (status-post cataract surgery), bilateral dry eye syndrome, and left vessel tortuosity, as confirmed in the most recent VA examination. The Board further observes that the Veteran is service-connected for peripheral neuropathy of the extremities, erectile dysfunction, diabetes mellitus, type II, and hypertension all secondary to herbicide exposure. The objective medical evidence of record reflects that his eye conditions have been aggravated by his service-connected disabilities. In January 2018, the Board granted service connection of diabetes mellitus, type II, as a presumptive disability associated with herbicide exposure in Thailand. The Board subsequently remanded the appeal for an examination an opinion which assessed any possible etiology between his eye conditions and either service (to include herbicide exposure) or his now service-connected diabetes mellitus. The Veteran was afforded a VA examination in February 2021. While the examiner opined that it was less likely than not that his eye conditions were directly related to service, or directly caused by his diabetes, the examiner concluded that his service-connected disabilities (particularly his diabetes mellitus) aggravated his bilateral eye conditions beyond their natural progression. In support of this conclusion, the examiner provided a detailed discussion of the baseline of the Veteran's various eye conditions, and the status of those eye conditions in light of his diabetes. It also applied the facts of the case to known medical principles. The Board also notes that during the pendency of the previously ordered development, the RO issued a February 2021 rating decision which, among other things, granted service connection of hypertension. Upon review, the evidence of record also includes an August 2008 VA examination, before the Veteran was granted service connection of hypertension, that etiologically connects his vessel tortuosity with hypertension. The Board finds these opinions to be persuasive. They were given by VA specialists in light of the Veteran's complete medical history. They applied the facts of the case to known medical principles in support of the conclusions reached. In assessing the evidence, the Board acknowledges that the evidence includes negative opinions from the August 2008 and May 2016 VA examiners. However, those opinions are of less persuasive value in this matter. Although the May 2016 examiner opined against a link between retinal vessel tortuosity and diabetes mellitus, that opinion only addressed causation, and not aggravation of the eye condition, and did not address the complete aray of visual disabilities in question. Likewise, the August 2008 opinion only stated that mild-dry eye, cataract, retinopathy, and macular edema were not secondary to diabetes, but did not provide any discussion or rationale as to how that opinion was reached. Thus they are less persuasive in this appeal. In sum, after careful consideration of the evidence of record, the Board finds that the evidence is at least in relative equipoise to support service connection of the Veteran's posterior chamber intraocular lens implant, dry eyes and vessel tortuosity as secondary to diabetes mellitus and/or hypertension. As such, service-connection is warranted. M. Pryce Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. McDonald 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.