Citation Nr: 21041048 Decision Date: 07/08/21 Archive Date: 07/07/21 DOCKET NO. 16-53 589 DATE: July 8, 2021 ORDER Entitlement to service connection for glaucoma, to include as due to toxic herbicide exposure is denied. REMANDED Entitlement to service connection for thrombocythemia, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. FINDING OF FACT The Veteran's glaucoma was not manifested in service or for many years thereafter and is not a result of toxic herbicide exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for glaucoma, to include as due to toxic herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Air Force from October 1968 to October 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In his VA Form 9 (Appeal to the Board of Veterans' Appeals), the Veteran requested a hearing via live videoconference. A hearing was scheduled for September 2019, and notice sent to the Veteran and his representative. Unfortunately, the Veteran failed to appear for that hearing. To date, neither the Veteran nor his representative have provided good cause for missing the hearing or requested a new hearing be scheduled. Service Connection The law provides that 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). VA regulations state that a veteran who served in the Republic of Vietnam during the period from January 9, 1962 to May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent containing dioxin, 2,4-Dichlorophenoxyacetic acid or 2,4,5-Trichlorophenoxyacetic acid, and may be presumed to have been exposed during such service to any other chemical compound in an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). Notably, these were the key compounds found in the tactical herbicides used during that time, with "Agent Orange" being the most common. Service connection is warranted for a veteran who has been exposed to toxic herbicide agent during active military service (subject to the requirements of 38 C.F.R. § 3.307(a)) for diseases such as chloracne or other acneform diseases consistent with chloracne, Type 2 diabetes, Hodgkin's disease, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, multiple myeloma, respiratory cancers (cancer of the lungs, bronchus, larynx, or trachea), soft-tissue sarcomas, ischemic heart disease, Parkinson's disease, B-cell leukemias and prostate cancer. Moreover, service connection is warranted even if these disorders were not shown during active duty. 38 C.F.R. § 3.309 (e). In addition, several statutory presumptions operate in connection with section 1110. Of particular relevance, 38 U.S.C. § 1116 provides that, if a veteran was exposed to Agent Orange during service, certain listed diseases are presumptively service-connected, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 ; 38 C.F.R. § 3.307 (d) are also satisfied. 38 U.S.C. § 1116 (a)(1), (a)(2); 38 C.F.R. § 3.309 (e). The Board notes that the list of diseases associated with exposure to certain herbicide agents does not include glaucoma. 38 C.F.R. § 3.309 (e). Nonetheless, service connection may still be granted if a medical nexus between herbicide exposure and the disability in question is established by the evidence. In addition, certain chronic diseases, including other organic disorder of the nervous system such as glaucoma, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). 1. Entitlement to service connection for glaucoma, to include as due to toxic herbicide exposure The Veteran contends that his glaucoma is a result of his military service. Specifically, he contends that it is a result of his exposure to toxic herbicides. The Board concludes that, while the Veteran has a current diagnosis of glaucoma, and VA has conceded his in-service exposure to herbicide agents, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of glaucoma began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records are silent for any complaints, treatments, or manifestations of glaucoma. At the time of the Veteran's June 1972 separation examination, his eyes were noted as clinically normal. Post-service treatment records reflect a diagnosis of glaucoma in 1993. The Board notes that the Veteran's diagnosis was approximately 21 years after he left active service, and the Veteran has not asserted that his glaucoma was diagnosed in service or any time earlier than 1993. There is no evidence of symptoms from the time of service through 1993. Therefore, continuity is not established based on the clinical evidence, and service connection on a presumptive basis is not established. Next, service connection may also be granted when the evidence establishes a medical nexus between his claimed disorder and either his active duty or his service-connected disability. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's claimed disorder to active duty, to include herbicide exposure, despite his contentions to the contrary. The only evidence in support of the Veteran's claim are his own lay statements, in which he contends that his glaucoma is related to herbicide exposure. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires medical training and knowledge of the interaction between multiple organ systems in the body and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Veteran underwent a VA examination in September 2016. The examiner noted by history the Veteran was diagnosed with glaucoma around 1993 and cataracts in 2014. Further, the examiner noted that the Veteran is pseudophakic and has mild to moderate glaucomatous changes characterized by optic nerve cupping and mild visual fields changes to automated static visual fields. The examiner opined that the Veteran's glaucoma is not a result of his exposure to toxic herbicides. In support of his opinion, he stated that there is no known association between herbicide exposure or agent orange exposure and the development of glaucoma. Additionally, he stated that there exists nothing in the ophthalmic literature that supports any association between glaucoma and exposure to herbicides. So "at least as likely as not" is not the correct term, the correct term is that there is no accepted association between glaucoma and exposure to herbicide. The Board finds the conclusions and reasoning of the September 2016 VA examiner is entitled to significant probative value, as it is based upon a review of the Veteran's medical history and an in-person examination of the Veteran. Furthermore, the VA examiners cite to specific medical examinations in support of their conclusions, which are fully supported by the Veteran's medical history and objective findings. In adjudicating these claims, the Board has specifically considered the statements made by the Veteran relating his claimed disorder to service. The Veteran has stated that his glaucoma is a result of his exposure to toxic herbicides. Lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a veteran's particular disability is the type of disability for which lay evidence is competent. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011). In the instant case, the question of the cause of an eye disorder is not something that can be determined by mere observation. Nor is this question simple. While the Veteran is competent to report problems with vision, the question of its cause is not an observable fact. It requires clinical testing to assess and diagnose the underlying condition and training to make the appropriate interpretations and conclusions about what the testing demonstrates in conjunction with the symptoms reported to determine the cause. In other words, mere observable symptomatology is insufficient. As such, the Board finds that the Veteran's statements as to how his glaucoma was caused are not competent evidence as to a nexus. Therefore, after weighing all the evidence, the Board finds that the preponderance of the evidence is against a finding of entitlement to service connection for glaucoma. 38 U.S.C.§ 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Entitlement to service connection for thrombocythemia, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. In a June 2021 brief, the Veterans representative contends that the Veterans thrombocythemia is secondary to his service-connected PTSD. The representative cited to studies that declared that chronic PTSD is associated with clinically elevated T-cells, hypersensitive immune responses, and the presence of biological markers and that PTSD is consistent with a wide range of inflammatory disease some of which may be thrombocytosis. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for thrombocythemia because no VA examiner has opined whether the Veterans thrombocythemia is secondary to his PTSD. Therefore, a remand is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's thrombocythemia is at least as likely as not related to his PTSD/proximately due to service-connected disability/aggravated beyond its natural progression by service-connected disability. M. Pryce Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Vample, Erica 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.