Citation Nr: 22012116 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 12-08 010A DATE: March 2, 2022 ORDER Entitlement to service connection for an eye condition is denied. Entitlement to compensation benefits under 38 U.S.C. § 1151 for vision loss, claimed as a visual field defect, is denied. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that an eye condition began during active service or is otherwise related to an in-service injury or disease. 2. The Veteran does not have additional disability, to include vision loss, as a result of the scar revision surgeries performed at a VA medical facility in April 2010 and April 2011. CONCLUSIONS OF LAW 1. The criteria for service connection for an eye condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for compensation under 38 U.S.C. § 1151 for vision loss have not been met. 38 U.S.C. §§ 1151, 5107; 38 C.F.R. § 3.361. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1977 to February 1981. These matters come to the Board of Veterans' Appeals (Board) on appeal from a December 2011 rating decision. In June 2016, the Veteran testified before the undersigned Veterans Law Judge at a Board videoconference hearing. A copy of the transcript is of record. In August 2016, August 2020, and October 2021, the Board remanded the matters to obtain VA examinations and medical opinions and outstanding treatment records. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The U.S. Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability, there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). 1. Entitlement to service connection for an eye condition. The Veteran contends that service connection is warranted for an eye condition. Specifically, he contends that he was exposed to fuel and fumes during service and that this exposure caused his eye conditions. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has currently diagnosed eye conditions, including macular degeneration, drusen, suspected glaucoma, cataracts, loss of and/or poor visual field, and vitreous degeneration, the evidence of record persuasively weighs against finding that the Veteran's eye conditions began during service or are otherwise related to an in-service injury, event, or disease. Initially, the Board notes that congenital or developmental defects, such as refractive error of the eyes, 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. Refractive errors are defined to include astigmatism, myopia, hyperopia, and presbyopia. As such, service connection is not available for vision problems attributable to refractive errors. Absent superimposed disease or injury, service connection may not be allowed for a congenital or developmental defect of the eyes, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. Parker v. Derwinski, 1 Vet. App. 522 (1991); McNeely v. Principi, 3 Vet. App. 357, 364 (1992). Turning to the evidence of record, the Veteran's service treatment records reflect that defective vision was noted on the Veteran's August 1977 entrance examination, with 20/20 distant vision in the right eye and 20/100 distant vision in the left. A September 1977 vision examination revealed 20/60 vision in the right eye and 20/100 vision in the left eye. The Veteran was prescribed glasses. Astigmatism and anisometropia were noted on an August 1978 examination and the Veteran was prescribed glasses. A November 1980 examination and January 1981 separation examination continued to note defective vision. In February 1982, the Veteran claimed service connection for an eye condition. A March 1982 VA examination report reflects the Veteran reported blurry vision in his left eye since December 1980 which was worse at distance and at night. He had 20/25+2 vision in his right eye and 20/25-2 vision in his left eye with intact motility and full visual fields. A fundus examination revealed normal disc, maculae, vessels, and peripheral retina, and a trial frame cleared up his vision. The diagnosis was bilateral myopic anisometropia with good vision. A September 1983 VA treatment record reflects the Veteran complained of blurred vision. An October 1984 VA treatment record reflects the Veteran felt as if his vision was inadequate and that he had been told he had a lazy left eye. After examining the Veteran, the clinician diagnosed bilateral refractive error (myopia and astigmatism) and anisometropia with mild amblyopia in the left eye. May 2002 and November 2004 VA treatment record reflect the Veteran reported a history of macular degeneration which was being treated by an outside clinician. VA treatment records from June 2005 to February 2008 reflect the Veteran reported blurriness. The diagnoses included mild macular drusen and suspected open-angle glaucoma. An October 2007 VA treatment record revealed bilateral tilted optic disks with cup-to-disc ratios of 0.75 in the right eye and 0.7 in the left, with normal macula, periphery, and vessels bilaterally. The impression was mild open-angle glaucoma suspected based on enlarged optic cups. In August 2008, he reported a recent fall on his nose without eye trauma. In May 2009, the Veteran was diagnosed with bilateral cataracts. In February 2010, the Veteran reported floaters in his left eye that were getting worse over the last six months. He reported seeing flashes, pain, and headaches. The diagnoses were suspected open-angle glaucoma based on the cup-to-disc ratio, degenerative drusen bilaterally, and bilateral dry eyes. April 2010 VA treatment records reflect the Veteran underwent a scar revision surgery without complication. An April 2010 VA eye clinic note reflects that the Veteran reported his glasses were taken and he had been using an old pair. He was issued a new pair of glasses. In March 2011, he reported that his eyes were doing good but were still dry. Diagnoses included bilateral mild macular degeneration, cataracts, and dry eye. April 2011 VA treatment records reflect that the Veteran underwent an excision of the nasal scar and nasal valvoplasty and was discharged the same day. An April 2011 VA eye clinic treatment record reflects the Veteran requested a visual field examination because it felt like he had on blinders and his eyes felt strained after reading. A May 2011 eye clinic record reflects the Veteran reported his side vision was blacked out and had been that way for years. The clinician diagnosed the Veteran with suspected open-angle glaucoma and constricted visual field in the left eye with history of sinus symptoms. A June 2011 VA eye clinic record reflects the Veteran reported experiencing headaches for about 8 weeks since nasal surgery and that he felt like he had blinders on. He reported decreased visual acuity for six months but that he had had vision problems since the military after exposure to exhaust and fumes. The clinician noted that tunnel vision with the visual field was the same at near distance and at six feet. The clinician noted the Veteran had a history of suspected bilateral open angle glaucoma based on the cup-to-disc ratio and normal light perception. The clinician noted that old records showed the same cup-to-disc ratio with no visual field loss and referred the Veteran to a neuro-ophthalmologist. In a January 2012 statement, the Veteran reported that his tunnel vision started after a nasal surgery in 2011. He felt the surgeon was negligent in the surgery, which he thought was supported by June 2011 VA treatment records. A January 2012 VA ophthalmology consult reflects the Veteran reported constant headaches since a scar revision on his nose in 2009 which had worsened after a second scar revision in 2010. He reported floaters and loss of peripheral vision since the second scar revision. A February 2012 VA neurology consult reflects the Veteran reported onset of vision changes, specifically, central vision loss in the eyes bilaterally, which he first noticed after a scar revision from his sinus surgery three years earlier. On examination, optic disks were flat, and the visual field revealed tunnel vision that was the same constriction at two feet and 8 feet. Extraocular eye movements were intact, pupils were equal and reactive, and there was no nystagmus. The clinician noted a functional type of defect but that the examination revealed a peripheral vision defect rather than a central vision defect as reported. An April 2012 neurology note continued to note a functional type visual field constriction. A May 2012 VA neurology consult reflects the Veteran complained of headaches and loss of peripheral vision after a nasal surgery and scar revision. The Veteran reported an episode in the past of trauma to the left eye with a sharp wire. On examination, the clinician noted internal inconsistencies during the examination, such as the Veteran not being able to move his eyes laterally while on the examination table, and difficulty with peripheral vision when located six feet from the clinician but was able to ascertain movement in the periphery when seated one foot from the examiner. The clinician reported the Veteran had mild asymmetric smile on the left side and multiple surgical changes on his note. Based on the Veteran's use of NSAIDs and report of snoring, the clinician diagnosed rebound headaches suggested a sleep study to rule out sleep apnea. A May 2012 private ophthalmology treatment record reflects the Veteran reported loss of peripheral vision since his sinus surgery that he needed to document. After examining the Veteran, the clinician diagnosed bilateral macular scars of the retina, nuclear sclerotic cataracts, dermatochalasis, and unspecified visual disturbances. A June 2012 VA treatment record noted that the Veteran's visual field defect seemed very functional and was unchanged. An October 2013 VA neurology treatment record noted that visual fields were intact despite previous reports and subsequent VA neurology records noted that the Veteran's history was inconsistent, with visual field loss in the periphery and then in the central field. A May 2016 private vision record reflects the Veteran complained of blurriness at a distance and near vision bilaterally for several years. After examining the Veteran, the clinician provided diagnoses of age-related macular degeneration and nuclear cataracts, presbyopia, myopia. Visual acuity was noted to be 20/20 in each eye with glasses. During the June 2016 Board hearing, the Veteran testified that his eye conditions began in service after exposure to fuel and fumes. He denied eye problems before service. A December 2019 private vision record reflects the Veteran reported blurry vision. Confrontational visual field testing was full, and the Veteran was diagnosed with bilateral pinguecula, age-related nuclear cataracts, and vitreous degeneration. During a December 2019 VA eye examination by Dr. E.R., the Veteran reported he was exposed to various chemicals and fluids during service and sometimes would get poked in the eye from loose wires. Since then, he had had intermittent blurry vision. He denied tunnel vision during the examination and indicated that he believed his current blurry vision was due to his psychiatric medications. Upon examination, the Veteran was found to have very mild dry age-related macular degeneration in his right eye and bilateral mild age-related cataracts. The Veteran had visual field loss consistent with functional visual loss in his left eye, but no objective findings to support a true visual field defect. Due to disc cupping, the examiner suspected glaucoma. Finally, the examiner noted myopia and presbyopia and recommended glasses. In January 2020, after reviewing the December 2019 VA examination report by Dr. E.R. and the record, Dr. G.B. noted that the Veteran was not treated for glaucoma during service and that his visual field defect did not present until 2012. Furthermore, the visual field defect was thought to be functional in nature. As the field defect could not be explained by fuel or fume exposure during service, the examiner opined that it was less likely than not that the Veteran's vision disability was incurred in or caused by service. Dr. G.B. indicated, however, that there were several references to eye examinations in the record, but that few were available to him as part of the record. In August 2020, the Board remanded the matter so that the outstanding eye examinations could be obtained and associated with the record and addendum medical opinions obtained. A December 2020 VA examination report reflects a diagnosis of cataracts. The Veteran's vision was corrected to 20/20 bilaterally. After examining the Veteran and reviewing the claims file, the examiner indicated that the Veteran did not have tunnel vision or glaucoma. As to the cataracts, the examiner opined that the Veteran's cataracts less likely than not began during or were otherwise related to service, as his cataracts were due to the normal aging process. Outstanding ophthalmology records dated from 2005 through 2019 were obtained and associated with the record in March 2021 and are summarized above. In October 2021, the Board remanded the matter for an addendum opinion, noting that the December 2020 examiner was unable to consider the ophthalmology records dated from 2005 through 2019, to include diagnoses of macular degeneration, drusen, suspected glaucoma, cataracts, loss of and/or poor visual field, and vitreous degeneration, as the ophthalmology records were not associated with the record until March 2021. In a December 2021 VA medical opinion, the examiner noted that the Veteran's January 1981 discharge examination was consistent with refractive error and a March 1982 VA examination revealed normal disc, maculae, vessels, and peripheral retina, with findings of a refractive error only. The examiner noted the nasal surgeries and the Veteran's contentions regarding exposure to fumes during service and loss of vision after his nasal surgeries. The examiner explained that the Veteran's macular degeneration, drusen, suspected glaucoma, cataracts, loss of and/or poor visual field, and vitreous degeneration all had their onset after military service. Furthermore, onset of these conditions was consistent with normal aging or were pathologies that developed with age and had no apparent relationship to the Veteran's refractive error during service or exposure to fumes 20 to 30 years earlier. Thus, the examiner opined that the Veteran's eye disability was less likely than not incurred in or caused by service. Upon review of the evidence of record, the Board finds that the Veteran does not have an eye condition that was incurred in or is otherwise related to service. Rather, the Veteran's diagnosed eye conditions, including macular degeneration, drusen, suspected glaucoma, cataracts, loss of and/or poor visual field, and vitreous degeneration, have been attributed to the aging process rather than any incident of service. The Board finds that the December 2021 VA examiner's opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his eye conditions are related to an in-service injury, event, or disease, including exposure to exhaust and fumes. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. 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). Consequently, the Board gives more probative weight to the December 2021 VA examiner's opinion as discussed above, which relates the Veteran's current eye conditions to the aging process rather than to service. For these reasons, the Board finds that the preponderance of evidence weighs against the claim of service connection for an eye condition and the benefit of the doubt doctrine is not for application. Consequently, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Compensation under 38 U.S.C. § 1151 Compensation benefits are awarded under 38 U.S.C. § 1151 for a qualifying additional disability in the same manner as if the additional disability were service connected. A disability is a qualifying additional disability if: (1) it was not the result of the veteran's willful misconduct, (2) it was caused by hospital care, medical or surgical treatment, or examination furnished by VA, and (3) was proximately caused by (a) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA or (b) an event not reasonably foreseeable. 38 U.S.C. § 1151. Regarding the second element, merely showing that a veteran received care, treatment, or examination and that the veteran has an additional disability or died does not establish cause. 38 C.F.R. § 3.361(c)(1). Further, hospital care, medical or surgical treatment, or examination cannot cause the continuance or natural progress of a disease or injury for which the care, treatment, or examination was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. Id.; 38 C.F.R. § 3.361(c)(2). Regarding the third element, the proximate cause of disability or death is the action or event that directly caused the disability or death, as distinguished from a remote contributing cause. 38 C.F.R. § 3.361(d). To establish that carelessness, negligence, lack of proper skill, error in judgment or similar instances of fault on VA's part proximately caused a veteran's additional disability or death, the evidence must show that such care or treatment caused a veteran's additional disability or death, and either (1) VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or (2) VA furnished the hospital care, medical or surgical treatment, or examination without a veteran's or, in appropriate cases, a veteran's representative's informed consent. 38 C.F.R. § 3.361(d)(1). Finally, in establishing whether the proximate cause of a veteran's additional disability or death was not reasonably foreseeable, the event need not be completely unforeseeable or unimaginable. Instead, it must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. 38 C.F.R. § 3.361(d)(2). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding any point, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 9, 53-56 (1990). 2. Entitlement to compensation benefits under 38 U.S.C. § 1151 for vision loss. The Veteran claims compensation benefits under 38 U.S.C. § 1151 for vision loss. Specifically, the Veteran claims that he has tunnel vision as a result of April 2010 and April 2011 scar revision surgeries performed at the VA. For the reasons discussed below, the Board find that compensation under 38 U.S.C. § 1151 for vision loss is not warranted. Service treatment records reflect the Veteran was diagnosed with a refractive error upon entrance to and separation from service. Post-service treatment records reflect a normal disc, maculae, vessels, and peripheral retina, with continued refractive error in March 1982, and bilateral refractive error and anisometropia with mild amblyopia in the left eye in October 1984. The Veteran was diagnosed with macular degeneration by May 2002, and mild macular drusen and suspected open-angle glaucoma by February 2008. In August 2008, he reported a recent fall on his nose without eye trauma. In May 2009, the Veteran was diagnosed with bilateral cataracts. A December 2009 VA otolaryngology consult reflects that a year and a half earlier, the Veteran reported working under a car when an object fell and resulted in a through-and-through laceration from his nasal tip to cheek. While repaired, the Veteran sought to have the scar corrected. On examination, a scar was noted starting in the soft tissue triangle on the left going across the nasal tip where it was a depressed scar, then goes across the lower lateral cartilage. On the right, there was some asymmetry with the inferior portion being slightly raised relative to the superior portion and then goes across the cheek where the scar was barely noticeable. The clinician was to consult with a colleague on treatment options and contact the Veteran. In February 2010, the Veteran reported floaters in his left eye that were getting worse over the last six months. He reported seeing flashes, pain, and headaches. The diagnoses were suspected open-angle glaucoma based on the cup-to-disc ratio, degenerative drusen bilaterally, and bilateral dry eyes. April 2010 VA treatment records reflect the Veteran underwent a scar revision surgery without complication. Follow-up treatment revealed a well-healing surgical incision that was almost unnoticeable and without sign of infection. The Veteran was advised to use sunscreen and over-the-counter cream but did not need to return to the clinic. An April 15, 2010 VA eye clinic note reflects that the Veteran reported his glasses were taken and he had been using an old pair. He was issued a new pair of glasses. In March 2011, he reported that his eyes were doing good but were still dry. Diagnoses included bilateral mild macular degeneration, cataracts, and dry eye. April 2011 VA surgical treatment records reflect the Veteran reported he was previously involved in a motor vehicle accident with excessive trauma to his nose. He reported a scar revision one year earlier but complained about the scar. The Veteran underwent an excision of the nasal scar and nasal valvoplasty and was discharged the same day. An April 25, 2011 VA eye clinic treatment record reflects the Veteran requested a visual field examination because it felt like he had blinders on, and his eyes felt strained after reading. A May 2011 eye clinic record reflects the Veteran reported his side vision was blacked out and had been that way for years. The diagnoses were suspected open-angle glaucoma and constricted visual field in the left eye with history of sinus symptoms. A June 2011 VA eye clinic record reflects the Veteran reported experiencing headaches for about 8 weeks since nasal surgery and that he felt like he had blinders on. He reported decreased visual acuity for six months but that he had had vision problems since the military after exposure to exhaust and fumes. The clinician noted that tunnel vision with the visual field was the same at near distance and at six feet. The clinician noted the Veteran had a history of suspected bilateral open angle glaucoma based on the cup-to-disc ratio and normal light perception. The clinician noted that old records showed the same cup-to-disc ratio with no visual field loss and referred the Veteran to a neuro-ophthalmologist. Follow-up VA treatment records dated in September 2011 and November 2011 for the Veteran's scar revision reflect the Veteran had rhinophyma which was treated, and his nose appeared to be healing. In a January 2012 statement, the Veteran reported that his tunnel vision started after a nasal surgery in September 2011. He felt the surgeon was negligent in the surgery, which he thought was supported by June 2011 VA treatment records. A January 2012 VA ophthalmology consult reflects the Veteran reported constant headaches since a scar revision on his nose in 2009 which had worsened after a second scar revision in 2010. He reported floaters and loss of peripheral vision since the second scar revision. A February 2012 VA neurology consult reflects the Veteran reported onset of vision changes, specifically, central vision loss in the eyes bilaterally, which he first noticed after a scar revision from his sinus surgery three years earlier. On examination, optic disks were flat, and the visual field revealed tunnel vision that was the same constriction at two feet and 8 feet. Extraocular eye movements were intact, pupils were equal and reactive, and there was no nystagmus. The clinician diagnosed a functional type of defect but that the examination revealed a peripheral vision defect rather than a central vision defect as reported. A March 2012 MRI of the brain was normal. An April 2012 neurology note continued to note a functional type visual field constriction. March and April 2012 VA treatment records reflect rhinophyma had cleared and the Veteran's scar was invisible. A May 2012 VA neurology consult reflects the Veteran complained of headaches and loss of peripheral vision after a nasal surgery and scar revision. The Veteran reported an episode in the past of trauma to the left eye with a sharp wire. On examination, the clinician noted internal inconsistencies upon examination, such as the Veteran not being able to move his eyes laterally while on the examination table, and difficulty with peripheral vision when located six feet from the clinician but was able to ascertain movement in the periphery when seated one foot from the examiner. The clinician reported the Veteran had mild asymmetric smile on the left side and multiple surgical changes on his note. Based on the Veteran's use of NSAIDs and report of snoring, the clinician diagnosed rebound headaches suggested a sleep study to rule out sleep apnea. A May 2012 private ophthalmology treatment record reflects the Veteran reported loss of peripheral vision since his sinus surgery that he needed to document. After examining the Veteran, the clinician diagnosed bilateral macular scars of the retina, nuclear sclerotic cataracts, dermatochalasis, and unspecified visual disturbances. A June 2012 VA treatment record noted that the Veteran's visual field defect seemed very functional and was unchanged. In a September 2012 statement, the Veteran reported that his vision was normal until he had nasal surgery at the VA. An October 2013 VA neurology treatment record noted that visual fields were intact despite previous reports and subsequent VA neurology records noted that the Veteran's history was inconsistent, with visual field loss in the periphery and then in the central field. A May 2016 private vision record reflects the Veteran complained of blurriness at a distance and near vision bilaterally for several years. After examining the Veteran, the clinician provided diagnoses of age-related macular degeneration and nuclear cataracts, presbyopia, myopia. Visual acuity was noted to be 20/20 in each eye with glasses. During the June 2016 Board hearing, the Veteran testified that his first revision surgery at the VA in 2010 caused a nerve issue and that his VA doctor confirmed this during his second revision surgery in 2011. During a December 2019 VA eye examination by Dr. E.R., the Veteran denied tunnel vision during the examination and indicated that he believed his current blurry vision was due to his psychiatric medications. Upon examination, the Veteran was found to have very mild dry age-related macular degeneration in his right eye and bilateral mild age-related cataracts. The examiner also suspected glaucoma. The Veteran had visual field loss consistent with functional visual loss in his left eye, but no objective findings to support a true visual field defect. In January 2020, after reviewing the December 2019 VA examination report by Dr. E.R. and the record, Dr. G.B. noted that the Veteran's visual field defect was thought to be functional in nature. As to whether there was additional disability due to VA surgery in April 2010 or April 2011, Dr. G.B. indicated that he was unable to anatomically connect the nasal surgery to visual field loss in the absence of any ocular nerve problem or brain findings on MRI. The examiner noted that the Veteran's vision was corrected to 20/20 bilaterally on examination and while the Veteran reported a subjective tunnel field loss in each eye, the visual field contraction was of unknown etiology. Dr. G.B. indicated, however, that there were several references to eye examinations in the record, but that few were available to him as part of the record. A December 2019 private vision record reflects the Veteran reported blurry vision. Confrontational visual field testing was full, and the Veteran was diagnosed with bilateral pinguecula, age-related nuclear cataracts, and vitreous degeneration. In August 2020, the Board remanded the matter so that ophthalmology records could be obtained and associated with the record and an addendum medical opinion obtained. A December 2020 VA examination report reflects a diagnosis of cataracts and that the Veteran's vision was corrected to 20/20 bilaterally. After examining the Veteran and reviewing the claims file, the examiner indicated that the Veteran did not have tunnel vision. As to whether the Veteran had additional disability due to the April 2010 or April 2011 surgeries, the examiner indicated that the Veteran had good vision and healthy eyes and did not have loss of vision; thus, the examiner found that there was no additional disability. Outstanding ophthalmology records dated from 2005 through 2019 were obtained and associated with the record in March 2021 and are summarized above. In October 2021, the Board remanded the matter for an addendum opinion, noting that the December 2020 examiner was unable to consider the ophthalmology records as they were not associated with the record until March 2021. In a December 2021 VA medical opinion, the examiner noted that the Veteran's January 1981 discharge examination was consistent with refractive error and a March 1982 VA examination revealed normal disc, maculae, vessels, and peripheral retina, with findings of a refractive error only. The examiner noted the nasal surgeries and the Veteran's lay statements pertaining to loss of vision after his nasal surgeries. The examiner explained that evidence of nasal scar correction would not have any proposed mechanisms to impact ocular health. The examiner emphasized that the Veteran's macular degeneration, drusen, suspected glaucoma, cataracts, loss of and/or poor visual field, and vitreous degeneration were all age-related and that such were not due to surgery as their onset and progression did not correspond to the surgeries. Thus, the examiner opined that it was less likely as not that the Veteran had any additional disability involving his eyes and/or vision caused by the April 2010 or April 2011 surgeries. At the outset, the Board finds the Veteran's assertions regarding his tunnel vision are not credible, as his statements are inconsistent. Specifically, he as at various times claimed that he experiences loss of peripheral vision and at other times that he experiences loss of central vision, and in several instances, denied that he has any vision loss at all. He has reported that his visual field defect occurred after a nerve injury during his first revision surgery at VA in 2010 and that the nerve injury was confirmed by his 2011 VA doctor, and at other times that his visual field defect began after the second revision surgery at VA in 2011. When he first reported a visual field defect in 2011, he reported onset years prior, but later reported onset to coincide with the second revision surgery. The Veteran's treating clinicians have also noted inconsistencies during their examinations of the Veteran. Due to these inconsistencies in the record, the Board finds the Veteran's statements regarding his visual field defect are not credible and gives them little probative weight. However, even if the Board accepts that the Veteran has vision loss, specifically, a visual field defect as reported by the Veteran, the Board finds that the evidence weighs against a finding that the Veteran's vision loss is a disability caused by hospital care, medical or surgical treatment, or examination furnished by VA. The Veteran's treating clinicians have all noted that the Veteran's visual field defect was not due to a physiologic or organic component as imaging studies were normal. Rather, his clinicians have found that his visual field defect was functional in nature. In addition, while the Veteran asserts that the April 2011 surgeon confirmed a nerve problem, treatment records associated with the April 2011 surgery do not support that assertion. Similarly, while the Veteran asserts that his clinical records support that this visual field defect is due to his revision surgeries, a review of the records reflects that the Veteran himself reported a visual field defect due to his revision surgeries and that such was not a finding made by the clinicians themselves. Furthermore, the January 2020 and December 2021 VA examiners have indicated that there is an absence of an ocular nerve problem or brain finding on MRI, or any other mechanism impacting ocular health, to anatomically connect the nasal revision surgeries to the Veteran's visual field loss. Although the Veteran believes his vision loss is related to his scar revision surgeries, as a layperson, he is not competent to provide an etiological opinion in this case. This issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Here, the evidence does not show that the Veteran has a visual field disability that was caused by hospital care, medical or surgical treatment, or examination furnished by VA. In the absence of additional disability due to VA medical treatment, the matter of alleged VA negligence is moot. That is, in the absence of an additional disability which is demonstrated to be the result of VA medical care, whether such medical care was careless or not is of no consequence. Similarly, in the absence of disability due to VA medical treatment, the matter of (un)foreseeability need not be discussed. See 38 U.S.C. § 1151. (Continued on next page) In short, for the reasons and bases expressed above, the Board concludes that a preponderance of the evidence is against the Veteran's claim for VA compensation under the provisions of 38 U.S.C. § 1151. His claim is accordingly denied. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Owen, 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.