Citation Nr: 21042047 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 20-16 029 DATE: July 11, 2021 ORDER Service connection for an eye disability is denied. FINDING OF FACT The Veteran does not have an eye disability that was caused by his service. CONCLUSION OF LAW The criteria for service connection for an eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1974 to September 1998. In July 2020 and May 2021, the Board remanded this claim (characterized as a claim for "bilateral glaucoma") for additional development. 1. Service connection. The Veteran asserts that service connection is warranted for glaucoma. He argues that he has had glaucoma since at least 1993, or, in the alternative, that his glaucoma has been caused or aggravated by refractive error, or a brain tumor, that were incurred during service. To avoid any prejudice to the Veteran, the Board has characterized the claim broadly, as stated on the cover page of this decision. Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted on the basis of a post-service initial diagnosis of a disease, when "all of the evidence, including that pertinent to service, establishes that the disease was incurred during service." See 38 C.F.R. § 3.303 (d). Service connection may be granted, on a secondary basis, for a disability, which is caused or aggravated by a service-connected disorder. 38 C.F.R. § 3.310. Service connection is currently in effect for obstructive sleep apnea, a left shoulder disability, a thoracic spine disability, bilateral flatfoot (pes planus), tinnitus, insomnia, a cervical spine disability, hemorrhoids, headaches, and erectile dysfunction. The Board notes that in July 2018, the RO denied a claim for service connection for refractive error, and that in May 2021, the Board denied a claim for service connection for a brain tumor. The Veteran's service treatment records show that in July 1976, he was noted to complain of blurred vision OU (both eyes) "at times." There was a notation that his left eye seems weaker than his right eye. The assessment was probable congenital stationery drusen OD (right eye). See also November 1989 eye consultation. The Veteran was provided with glasses. A November 1989 report notes defective vision bilaterally that was adequate uncorrected. Reports dated in 1992 note a complaint of decreased distant vision. The Veteran was noted to have a small right eye corneal scar, good visual acuity without glasses, simple left eye hyperopia, and simple right eye myopia. A December 1993 report notes left eye astigmatism and right eye emmetropia. An undated report, apparently from about 1994 (the Veteran was noted to be age 40) (AF Form 1722), notes complaints of slow focus and minor blurred and crossed vision. The Veteran indicated that he wore glasses and that he did not have a history of glaucoma, amblyopia, or "crossed" or "wall" eye. The assessment noted myopia, hyperopia, and presbyopia, with no apparent pathology OU (both eyes). Five examination reports, dated between August 1974 and May 1994, show that his eyes, ophthalmoscopic examination, pupils, and ocular motility were clinically evaluated as normal, and that he had deficient color vision. As for the post-service medical evidence, private reports from Lusk Eye Specialists covering treatment provided between 2010 and 2017 show that in June 2010, the Veteran reported increased difficulty reading "for months." The impressions were bilateral presbyopia, bilateral astigmatism, bilateral dermatochalasis, suspected glaucoma secondary to IOP (intraocular pressure) and OU asymmetry. In 2013, the Veteran was noted to have bilateral cataracts. Other private treatment reports note a history of use of eye drops (Timolol) since November 2000. VA progress notes, and TriCare reports, show that in October 2010, the Veteran was noted to have been referred for high blood pressure in his eyes and that he was noted to have glaucoma beginning in 2013. A VA examination report, dated in May 2016, notes a history of primary open-angle glaucoma (POAG) first diagnosed in October 2010. The Veteran had been non-compliant with use of eye drops for five years, until November 2015. On examination, bilateral preoperative early nuclear cataracts were noted. The Veteran was noted to have glaucoma and cataracts/lens conditions, and a decrease in visual acuity or other visual impairment due to glaucoma. A VA medical opinion, dated in November 2020, shows that the examiner concluded that it is less likely as not that the Veteran's glaucoma was caused by an inservice disease or injury, to include treatment for blurred vision during service. The examiner explained that in June 2010 the Veteran had a diagnosis of primary open angle glaucoma that was treated with medication, and that his treatment caused a decrease in his visual acuity or other visual impairment. The Veteran's glaucoma is an "open angle" type that is most likely due to hereditary factors, or to have developed over time. The Veteran does not have angle recession glaucoma, which is usually due to trauma. A VA medical opinion, dated in October 2020, contains an opinion as to an issue not on appeal, but is remarkable for a notation that during service the Veteran had eye symptoms consistent with migraine headaches. A VA medical opinion, dated in May 2021, shows that the examiner concluded that it is less likely as not that the Veteran's glaucoma was caused by his service. The examiner explained that blurry vision is not a symptom of glaucoma, and that the Veteran's episode of blurry vision in 1976 was followed by over 30 years with no evidence of glaucoma. The Veteran was treated for eye symptoms during service as discussed supra. However, although it appears that he developed refractive error during service, congenital or developmental defects, e.g., refractive error of the eyes, as such, are not diseases or injuries within the meaning of applicable legislation and, thus, are not disabilities for which service connection may be granted. 38 C.F.R. § 3.303 (c); see also 38 C.F.R. § 4.9; Beno v. Principi, 3 Vet. App. 439 (1992). A chronic eye disability is not shown during service. 38 C.F.R. § 3.303. The earliest medical evidence of glaucoma is dated in 2010, approximately 11 years after separation from service. Beginning in 2013, the Veteran was noted to have bilateral cataracts. There is no competent opinion of record in favor of the claim on a direct basis. 38 C.F.R. § 3.303. In this regard, a June 2010 report from Lusk Eye Specialists notes that the Veteran's suspected glaucoma is secondary to IOP (intraocular pressure) and OU asymmetry. All of the VA opinions of record are shown to have been based on a review of the Veteran's records, and they weigh against the claim. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In particular the May 2021 opinion is accompanied by a sufficient explanation. Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent that the Veteran has asserted that service connection is warranted on a secondary basis, there is no competent opinion of record in favor of the claim on this basis. 38 C.F.R. § 3.310. Accordingly, the Board finds that the weight of the evidence is against the claim, and it is denied. With regard to the Veteran's contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report the presence of eye symptoms, the claimed disability is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that specific findings are needed to properly assess and diagnose this disorder, and determine its etiology. Id. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.S.E., 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.