Citation Nr: 21029976 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 12-01 689 DATE: May 17, 2021 ORDER Entitlement to service connection for a glaucoma disability is denied. FINDING OF FACT The Veteran's eye disability was not first shown until many years following discharge from service, and not otherwise due to, or aggravated by, an in-service injury or disease, including his service-connected diabetes mellitus and/or hypertension. CONCLUSION OF LAW The criteria for service connection for an eye disability, to include glaucoma, have not 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 had active service from May 1963 to April 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision of a Department of Veterans' Affairs (VA) Regional Office (RO). This case has been before the Board on three prior occasions: May 2018, January 2020, and October 2020. Each time, the Board issued a remand of the instant issue for further development. It is noted that in the initial appeal to the Board resulting in the May 2018 remand order, the Veteran had originally requested a hearing before a Veterans Law Judge. That request was duly withdrawn prior to the scheduled date. See November 2017, VA Form 21-4138; see also 38 C.F.R. § 20.704(e). Specifically, in the Veteran's request, he stated the following: "Please cancel my BVA hearing scheduled for February 2018. The only issue to be addressed at the hearing is glaucoma and I do not have glaucoma." Accordingly, the Veteran's request for a hearing was withdrawn. Upon completion of the prior remand directives, this matter has now been returned to the Board for further appellate action. Service Connection Glaucoma Despite the Veteran's signed communication from November 2017 acquiescing that he did not, at that time, have a diagnosis of glaucoma, it has been otherwise contended that he has a present disability of glaucoma related to his active military service, secondary to his service-connected diabetes mellitus, type II (DM) or hypertension disabilities, or aggravated beyond it natural progression due to such service-connected disabilities. The Board notes that after the Veteran's signed communication in November 2017 conveying that he did not, in fact, at that time have a diagnosis of glaucoma, later private treatment records from November 2017, demonstrate an initial diagnosis of the disability. Accordingly, the Veteran has established the first element of service connection. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. § 3.303(a); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); see November 28, 2017, Private Treatment Records. Service treatment records (STRs) are silent for any evidence or report of an eye disability while on active service. The Veteran's eyes were noted as "normal" upon both enlistment and separation examinations, with 20/20 vision. See May 1963 and February 1967, STRs (respectively). The Veteran was initially diagnosed with glaucoma, and concedes as much, in November 2017, approximately 50 years after separation from service. Indeed, treatment notes as well as VA examinations following the Veteran's initial claim for service connection in 2009, confirm that the Veteran was diagnosed with diabetes mellitus, type II without ocular complications. See February 2010, VA Examination; April 2011, VA Treatment Records; July 2015, VA Examination Report (confirming diagnosis of DM since 1995 and diabetic retinopathy, but no finding of glaucoma). Despite later proffered arguments, until November 2017, the Veteran's record demonstrated that the Veteran was not diagnosed with the disability but merely suspected of the disability. Based on the probative evidence of record, the Board finds that the Veteran's glaucoma was not caused by his active service or any incidents therein. The evidence shows no complaints or diagnosis in service. The separation physical noted no eye condition, including glaucoma. Moreover, it was not until November 2017, approximately 50 years after service, that there was a diagnosis of glaucoma. Thus, service connection on a direct basis must be denied. Regarding secondary service connection, the Veteran was afforded a VA examination in September 2019. The examiner confirmed that the Veteran is diagnosed with bilateral intermittent angle-closure glaucoma, explaining that it is the result of an abnormal anatomical structure of the eye and therefore not the result of military service and is also independent from the Veteran's service-connected DM and hypertension. However, the examiner did not provide further explanation or rationale for the medical conclusions provided. An additional examination was conducted in April 2020. Again, the examiner confirmed a diagnosis of bilateral glaucoma. An opinion was provided that the disability is less likely than not incurred in or caused by an in-service incident, to include exposure to herbicides (as previously conceded during the adjudication of the Veteran's claim for service connection of DM (see February 2002, Rating Decision)) as the form of glaucoma that the Veteran is diagnosed with is not medically related to herbicide exposure or DM, but is as a result of the anatomical shape of the Veteran's eyes. The examiner also explained that the condition is not a result of the Veteran's service-connected hypertension because of the variety of glaucoma diagnosed which is not medically associated with hypertension as supported by the fact that the anatomical shape of the eyes was corrected by surgery. Finally, in March 2021, the Veteran was afforded additional VA examinations based upon review of the Veteran's claims file. These examination reports reflect opinions that the Veteran's glaucoma disability is less likely than not aggravated beyond its natural progression by diabetes because diabetes causes and aggravates neovascular glaucoma, a condition which the Veteran does not have. Likewise, the examiner further opined that the disability is less likely than not aggravated or caused by the service-connected hypertension as there is no medical correlation between glaucoma and systemic hypertension. Overall, the examiner opined that there is no medical nexus between the diagnosed disability of angle-closure glaucoma and hypertension or DM. The Board finds that the uncontradicted cumulative evidence of VA examination reports provide thorough and reasoned rationales for the opinions expressed therein and represent the most probative evidence of record. In sum, there is no competent medical evidence of record in support of a link between the Veteran's glaucoma and service or his service-connected DM or hypertension. While treatment records reflect notations of advising the Veteran of the concerns of glaucoma and DM, the medical opinions of record explain that the Veteran's specific diagnosis of glaucoma is not medically related to such conditions as it is the result of the anatomical shape of the eye, a condition that is not resultant from DM. The Board notes that the Veteran is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). The specific issue in this case, whether his glaucoma is etiologically related to service or his service-connected diabetes mellitus or hypertension, falls outside the realm of common knowledge of this Veteran. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Determining the etiology of the Veteran's glaucoma requires medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of a layperson. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for glaucoma is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Sutherell, 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.