Citation Nr: 21041213 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 11-03 781 DATE: July 8, 2021 ORDER Entitlement to service connection for an eye disorder (other than a left eye pterygium), to include a refractive error is denied. FINDING OF FACT The preponderance of the evidence establishes that the Veteran's claimed eye disabilities were not present until more than one year following separation from service and are not etiologically related to active service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for an eye disorder (other than a left eye pterygium), to include a refractive error have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran performed a period of active duty for training (ACDUTRA) in the Army National Guard from August 1978 to February 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2012, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ). Transcripts from the hearing are associated with the claims file. The Board hearing was before a now-retired VLJ. In May 2021 correspondence, the Veteran was given the opportunity to request another hearing. The Veteran responded to this letter within thirty days and indicated that he does not want another hearing. When this case was last before the Board in November 2020 it was remanded for additional development. Specifically, the RO was instructed to forward the Veteran's January 2020 examination to a qualified ophthalmologist and obtain a medical opinion. A relevant medical opinion was obtained. As such, the Board finds that the AOJ substantially complied with the directives in the November 2020 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or causal relationship between the claimed disease or injury in service and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be established for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, reasonable doubt is resolved in favor of the claimant. To deny a claim on the merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). The Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting a decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). The Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or does not show, as to the claim. Analysis The Veteran contends that he is entitled to service connection for an eye disability, other than his already service-connected left eye pterygium, that is the result of active service. The Board notes that the Veteran is currently diagnosed with a left eye pterygium, cataracts, and a visual field loss as shown in his February 2020 VA Eye Conditions examination. Therefore, the central issue to be resolved is whether the current disabilities originated in service or are otherwise related to service. Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378 (Fed. Cir. 2000). While the Veteran has currently diagnosed disabilities, the Board finds that competent medical evidence of record does not support a finding that his eye disabilities, other than his left pterygium, were incurred in service or are otherwise related to service. During the Veteran's entrance examination, he demonstrated a mild refractive error at 20/25 bilaterally. Except for this refractive error, the Veteran's eyes were presumed to be in sound condition at the time he entered service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). The Veteran's service treatment records (STRs) do contain additional complaints of, and treatment for, left eye pain, and a left eye pterygium. Additionally, during a period of ACTDUTRA in September and October 1979, the Veteran demonstrated conjunctivitis and arcus juvenilis. However, following service, there were no treatment records for conjunctivitis and no medical examiner has provided an opinion linking any of the Veteran's current eye disabilities to his active duty service. In February 2010, the Veteran was examined by a VA optometrist to determine the nature and etiology of any eye disorder present. After a review of the Veteran's claims file, and an in-person examination, the examiner diagnosed the Veteran with senile macular degeneration and hyperopic presbyopia. As defined in Dorland's Illustrated Medical Dictionary 1691 (32d ed. 2012), senile macular changes pertain to, or are characteristic of, old age. Additionally, the examiner opined that it was "unlikely (less than [a] 50% probability)" that either of the conditions were caused by the Veteran's military service. During his November 2012 Board Hearing, the Veteran testified that in service he had red swollen eyes as a result of firing weapons. He further noted that the symptoms had been present since service and maintained that service connection was warranted for an underlying eye disorder. VA Optometry treatment notes dated throughout 2012 noted that the Veteran had a temporal pinguecula of the right eye, arcus of both eyes, hyperopic compound astigmatism, and macular degeneration. The Veteran was provided with an April 2015 VA Eye Diseases examination by a VA optometrist. The examiner diagnosed the Veteran with a left eye pterygium and ischemic optic neuropathy possibly secondary to giant cell arteritis. The examiner opined that the Veteran had no eye conditions superimposed, or record of any injury, during his ACDUTRA that resulted in a disability. Further, the VA optometrist opined that the Veteran's eye conditions (other than the left pterygium) were less likely than not (less than a 50 percent probability) etiologically related to the Veteran's active service. In response to a July 2017 Court of Appeals for Veteran's Claims (CAVC) memorandum decision, and a January 2018 Board Remand, the Veteran was provided with an August 2018 Acceptable Clinical Evidence (ACE) review regarding his claimed eye disabilities. The VA optometrist opined that the Veteran's refractive error is not the cause of his loss of vision and that a refractive error has been documented in both of the Veteran's eyes before, during, and after service. The examiner continued that there is no evidence that the Veteran's pterygium has contributed toward any loss of the Veteran's vision. The examiner noted that the Veteran's pterygium is unrelated to his optic neuritis which he credited with the loss of the Veteran's vision. After a discussion of the Veteran's in-service and post-service treatment records, the examiner noted that the Veteran's refractive error is in the reasonable, mild, range and is similar between both of his eyes. This makes it less likely than not (less than a 50 percent probability) that the Veteran's pterygium increased his refractive error. The examiner continued that the Veteran's right eye temporal pinguecula was not documented until many years after service, is a common condition in normal populations, and was less likely than not that the Veteran's eye conditions in service could cause pinguecula. The examiner noted that arcus and arcusjunvenillis are clinical findings, do not impact vision, and are less likely than not etiologically related to the Veteran's active service. The examiner opined that chronic conjunctivitis has not been formally diagnosed and that the findings of redness of the Veteran's eyes are more likely related to pterygium. The examiner concluded that ischemic optic neuropathy is credited with cause of vision loss and has no relation to the Veteran's pterygium incurred in service. Additionally, the examiner noted it was unconnected to findings of pinguecula, refractive error, senile macular degeneration, age related cataracts, or conjunctivitis. The examiner found "it is very unlikely that any of the documented eye conditions while in service, or events documented in service would contribute to recent ischemic optic neuropathy." Finally, the examiner opined that there is no eye condition present that could be incurred in, or caused by the Veteran's in-service eye treatment and opined that the claimed conditions are less likely than not (less than a 50 percent probability) incurred in or caused by the claimed in-service events, injuries, or illnesses. In response to a November 2019 Board Remand for an additional rationale, the Veteran was provided with a January 2020 VA Eye Conditions examination from an optometrist. After an in-person examination and a review of the claims file, the examiner diagnosed the Veteran with pterygium, cataracts, and a visual field loss. The examiner further noted that the Veteran's pterygium has no effect on the rate of cataract development or on visual field loss. The examiner opined that the Veteran's claimed eye disabilities were less likely than not (less than a 50 percent probability) etiologically related to his active service. The examiner explained that while the etiology of the Veteran's visual field loss is unknown, none of the arcus, conjunctivitis, or pterygium are capable of causing visual field loss, and he suspected that a language barrier was affecting the testing. Regarding the Veteran's cataracts, the examiner opined they are less likely than not (less than a 50 percent probability) related to the Veteran's active service. The examiner explained that cataracts are typically caused by normal aging and that the Veteran's degree of cataracts is consistent with his age. Additionally, none of the treatments the Veteran underwent in service are known to speed up cataract development. Commenting on the pinguecula, the examiner believed that it was the Veteran's pterygium, not a pinguecula, as they are similar conditions. Further, commenting on the arcus, the examiner noted that at the Veteran's age it is normal for some to be present, and there was not a level of arcus greater than normal for the Veteran's age. Further, the examiner noted that the Veteran was not diagnosed with chronic conjunctivitis and again related the symptoms to the Veteran's pterygium. Finally, the examiner opined that it is less likely than not (less than a 50 percent probability) that the Veteran's refractive error is related to his pterygium. The examiner explained that the pterygium is small and has very little penetration onto the cornea. The Board remanded the Veteran's claim again in November 2020 in an attempt to get an opinion from an ophthalmologist and whether they agreed with the opinion of the January 2020 VA examiner who was an optometrist. In April 2021, the Veteran was provided with an ACE review by an ophthalmologist, Dr. M.B. After a review of the claims file, including the prior VA Eye examinations, Dr. M.B. opined that the Veteran's claimed eye disabilities were less likely than not (less than a 50 percent probability) etiologically related to the Veteran's active service. Dr. M.B. noted that she agreed with the findings and rationale of the January 2020 examiner. Dr. M.B. continued, noting that the Veteran had findings of blurred vision, contracted visual field, and cataracts. She stated that the cataract finding is sufficient to cause blurred vision, is likely age related, and there is no evidence that it is a result of the Veteran's ACTDUTRA service. Dr. M.B. noted that the contracted visual field may be due to poor testing by the Veteran as the fundus exam was normal and there are no other findings that would cause a contracted visual field. The Board has considered the evidence of record. The Board notes that the VA examiners are medical professionals, competent to opine on the nature and etiology of the Veteran's claimed eye disabilities. There is no evidence that the examiners are not credible. Moreover, the examiners provided an analysis based upon both subjective and objective information to form an opinion based upon medical expertise. As such, the Board affords the VA examinations, specifically the January 2020 and April 2021 opinions, significant probative weight. The Board has weighed the VA examinations, specifically the January 2020 examination/opinion and the April 2021 ACE review, against the Veteran's lay contentions that his eye conditions other than his left eye pterygium are due to service. While the Veteran is competent to testify as to his symptoms, he is not competent to provide a medical opinion as to the etiology of the disability. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board finds the VA examinations, which opined against a link between his diagnosed eye conditions and service, to be of high probative value. Additionally, the Board notes that the Veteran was not diagnosed with cataracts, senile macular degeneration, pinguecula, or arcus until years after he left active duty service. In light of the above discussion, there is no evidence that the Veteran sought treatment for or was diagnosed with a chronic eye disability while in service, or within a year after service, and there is no medical opinion in the record linking a current disability to active duty service. Therefore, the Veteran's claim must be denied. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for an eye disability (other than left eye pterygium). Therefore, the claim must be denied. As the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.