Citation Nr: 22019908 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 19-10 072 DATE: April 3, 2022 ORDER Entitlement to service connection for a right eye disability is denied. FINDING OF FACT A chronic right eye disability was not manifested in service; the Veteran's current eye conditions are not shown to be etiologically related to her service, to include the injury to her right eye in 1992. CONCLUSION OF LAW The criteria for service connection for a right eye disability are not 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 on active duty for training (ACDUTRA) in the U.S. Army National Guard from October 1982 to May 1983, on active duty in the Army Reserve from June 2004 to May 2006, and from May 2008 to May 2011, with additional ACDUTRA in the Army Reserve and National Guard until April 2014. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021 a video conference hearing was held before the undersigned; a transcript is in the record. In November 2021 the matter was remanded for additional evidence. Entitlement to service connection for a right eye disability. There has been substantial compliance with previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Notably, treatment records have been obtained from the Jackson VAMC, and a medical opinion was provided in November 2021. Service connection may be established for disability due to disease or injury that was incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for a claimed disability, there must be evidence of: (i) a present claimed disability; (ii) incurrence or aggravation of a disease or injury in service; (iii) and a causal relationship between the present disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a). Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159 (a)(2). Competent medical evidence is necessary where the determinative question requires medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a)(1). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Veteran asserts entitlement for service connection for a right eye disability, which she contends was caused by an injury to the right eye that occurred during a period of active duty for training. For the reasons set forth below, the Board finds that entitlement to service connection is not warranted. A July 1992 urgent care record notes the Veteran was seen after a card hit her right eye causing redness, pain, and excessive tearing. The record notes the injury occurred during active duty for training. On April 1994 report of medical history, the Veteran reported a history of eye trouble. The Veteran's subsequent clinical evaluation of the eyes were normal. January 1999 and May 2003 physical examination reports were silent for any reports by the Veteran or observations by an examiner of residuals. Visual acuity was measured as 20/20 on all occasions. There are records of injury to the cervical spine area in a motor vehicle accident in 2004. No eye symptoms were noted in July 2006, June 2007, and February 2009 routine eye examinations. In March 2013, the Veteran sought initial primary care at a VA outpatient clinic. No eye abnormalities were reported by the Veteran or noted by clinicians. In a June 2013 VA general medical examination, the examiner noted only reported decreased visual acuity requiring corrective lenses. On examination, the examiner estimate acuity as normal with no organic eye abnormalities. In a January 2015, a VA clinician noted the Veteran's reports of dry eye and pain in the left eye with a family history of glaucoma. Subsequent VA eye treatment periodically for the next three years included reports and treatment for "red eye" and inflamed pinguecula. A January 2016 ophthalmology record notes the Veteran was seen with complaints of red eyes occurring twice over several months prior lasting for several days. She reported that the entire white part of the eye would become red. The provider noted inflamed pinguecula. The Veteran denied trauma. A family history (cousin) of glaucoma was noted. The conjunctiva showed early pinguecula, white without injection. In March 2018 a clinician noted the Veteran's reports of red eyes and pain at times. The clinician noted a review of the electronic claims file and on examination diagnosed pinguecula and cortical cataracts. The Veteran was unable to report on the start of the symptoms but mentioned that it was before a motor vehicle accident. The examiner opined that it was less likely than not that the Veteran's eye disability was related to service but provided no rationale. At the May 2021 video conference hearing the Veteran testified that while completing paperwork in service a piece was torn off and hit her in the right eye. She testified that she was seen by a doctor and given an eye patch on it and was told she had cut the black part of her eye. She testified that she has been receiving treatment for her eyes at VA in approximately 2020. She also testified that she was told by a provider at the Jackson VAMC that her eye disability was related to service. A September 2021 primary care record notes the Veteran was seen with left eye sharp pain. A family history of glaucoma was noted. On November 2021 medical opinion, the clinician opined that it was less likely than not that the Veteran's eye disabilities were related to service. The clinician noted that the Veteran's pinguecula and cataract had onset significantly after service. The clinician further noted that a superficial injury to one eye would not cause pinguecula or cataract disabilities to both eyes. The clinician noted that follow up treatment for the Veteran's 1992 injury did not indicate the presence of the Veteran's current eye disabilities. The clinician noted a more likely causes of the Veteran's current eye disability were typical lifestyle and aging changes. It is not in dispute that the Veteran currently has a right eye disability (the Veteran has been diagnosed with pinguecula and cataracts). What remains for consideration is whether the currently diagnosed eye disabilities are related to service, to include etiologically related to the Veteran's 1992 injury to the right eye. As pinguecula and cataracts were not noted in service or manifested until many years after service, whether such eye disabilities are related to remote complaints of eye pain (attributed to a piece of paper hitting the Veteran's eye) is a medical question beyond the scope of common knowledges or capability of resolution by lay observation. It requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board has carefully considered the contentions of the Veteran that her claimed right eye disability was due to his military service. However, the Board finds that the Veteran's assertions of nexus concern an internal medical process, which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board acknowledges the Veteran's testimony May 2021 testimony that a provider at Jackson VAMC attributed the Veteran's eye disabilities to her service. However, a review of the Veteran's medical records from the Jackson VAMC did not contain such opinion. The Veteran has been treated by ophthalmology. However, such treatment has not included an opinion as to the etiology of the Veteran's current eye disabilities. As detailed above, the November 2021 VA examiner determined that it is less likely than not that the Veteran's right eye conditions were incurred in service. The examiner identified another (more likely) factor for the development of the Veteran's current eye disabilities of typical lifestyle and age. The opinion reflects familiarity with the Veteran's record and identifies known etiological factors for development of pinguecula and cataracts. The opinion is probative evidence in this matter, and in the absence of competent evidence to the contrary, is persuasive. Considering the record, including post-service medical evidence, the November 2021 VA medical opinion, and lay evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In summary, the weight of the competent and credible evidence is against the Veteran's claim. Accordingly, the appeal in this matter must be denied. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Staskowski, 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.