Citation Nr: 21029289 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-07 718 DATE: May 13, 2021 ORDER Service connection for a left eye disability, diagnosed as central vein occlusion, to include as due to presumed exposure to herbicide agents is denied. FINDING OF FACT The Veteran's left eye disability was not incurred in service and is not causally or etiologically related to service, to include as due to in-service exposure to herbicides. CONCLUSION OF LAW The criteria for service connection for a left eye disability, to include as due to herbicide exposure have not been met. 38 U.S.C. §§ 1101, 1110, 11112, 5107(b). 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1967 to December 1972. This case comes to the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision. In August 2019, a travel Board hearing was held before a Veterans Law Judge. In October 2019 the Veteran was notified by letter that the Board was unable to produce a full transcript of the hearing due to audio malfunctions, The Veteran was provided an opportunity to present for another hearing; however, he responded that he did not wish to appear at an additional hearing and requested that his case be considered on the evidence of record. In September 2020, the Board remanded the matter for a VA examiner's opinion regarding the etiology of the Veteran's claimed left eye condition. The matter has returned for adjudication. Entitlement to service connection for a left eye disorder, to include as due to herbicide exposure. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Next, service connection may be granted on a presumptive basis for certain diseases associated with exposure to herbicides if a veteran (1) served in the Republic of Vietnam between January 1962 and May 1975, (2) served April 1968 and August 1971 in or near the Korean Demilitarized Zone, (3) served near the base perimeter of certain Thailand Air Force Bases during the Vietnam War era, or (4) regularly and repeatedly operated, maintained, or served aboard aircraft known to have been used to spray a herbicide agent during the Vietnam War Era. 38 C.F.R. § 3.307(a)(6). As to presumptive service connection based on herbicide exposure, the Veteran served in Vietnam and his exposure to Agent Orange is presumed; however, the Veteran's eye disorder is not a disability for which service connection is warranted on a presumptive basis due to herbicide exposure under 38 C.F.R. § 3.309(e). Therefore, the medical evidence does not support service connection for an eye disorder on the basis of presumed exposure to herbicide agents. Notwithstanding the inapplicability of the Agent Orange presumptive service connection regulations, the Board has considered the claim on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Here, the Veteran claims that his eye disorder is the result of his service, to include exposure to herbicides. As noted above, presumptive service connection is not warranted. The Board will next address the Veteran's contentions that his eye disorder is the result of service. However, the evidence does not show a causal relationship between the Veteran's eye disorder and in-service herbicide exposure or any other incident of active service. The Veteran contends his currently diagnosed left eye disability is due to his presumed exposure to herbicides. The Veteran has a current diagnosis of central vein occlusion; thus, the first Holton element of service connection, that of a current disability, is met. Furthermore, the Veteran's service treatment records noted evidence of in-country service in Vietnam at Phu Cat Base in 1970. Herbicide exposure is conceded pursuant to 38 C.F.R. § 3.307(a)(6)(iii). Therefore, the second Holton element of service connection, that of an in-service incurrence, is also met. The Board now turns to the question of nexus. The Veteran's service treatment records are devoid of any instance of treatment for any eye problems. In fact, an October 1972 separation examination reflected a normal clinical evaluation of his eyes. In a report of medical history completed at that time the Veteran denied any eye related issues. In support of his contention, the Veteran supplied a medical article noting an Institute of Medicine report linking Agent Orange exposure to stroke. The conclusion of the paper reported the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides had voted to move stroke to the "limited and suggestive" category. The Veteran also supplied articles related to the use of herbicides, specifically dioxin, in proximity to his service. Following the Board's September 2020 remand, the Veteran was afforded a December 2020 VA examination to assess the nature and etiology of his claimed eye disorder, specifically his contention that the disorder was a result of presumed herbicide exposure. The examiner noted that the Veteran had a left central retinal vein occlusion (CRVO), and not central retinal artery occlusion (CRAO). Nevertheless, the examiner opined the Veteran's medical records do not show a direct connection between his CRVO and service, noting that research that led to the development of the Agent Orange presumptive list did not demonstrate a clear link between the condition and Agent Orange. Turning to the paper provided by the Veteran from a 2010 Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides, the examiner noted that the paper states that it added the category of stroke as there is now limited or suggestive evidence of an association. However, the examiner noted that a firm conclusion is limited due to chance, bias, and confounding. Moreover, the examiner opined the Veteran does not have a majority of risk factors of CRVO which include hypertension, hyperlipidemia, diabetes, cardiovascular disease, or raised intraocular pressure. However, the examiner noted that a risk factor the Veteran did have was an age over 55 when his CRVO occurred at the age of 68. Accordingly, the examiner concluded that the Veteran's CRVO was less likely than not incurred in or caused by active military service, to include presumed in-service exposure to herbicide agents. The Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no evidence that may serve as a medical nexus between the Veteran's service and his eye disorder. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of his CRVO, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In any event, the probative value of the contentions of the Veteran is outweighed by the medical opinions of record. The Board affords the VA examiner's opinion greater probative weight as it is based on a review of the Veteran's claims file and specific medical history, to include his presumed exposure to herbicides. The Board has considered the probative value of the articles submitted by the Veteran. The Court has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discussed generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated lay opinion. Wallin v. West, 11 Vet. App. 509 (1998) (medical treatise evidence discussed generic relationships with a degree of certainty to establish a plausible causality of nexus). The Board places little probative value on the articles the Veteran submitted, however, as they were written to explain only general medical principles, and do not address the specific facts in this case. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.N. Bush, 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.