Citation Nr: 22032012 Decision Date: 06/01/22 Archive Date: 06/01/22 DOCKET NO. 16-47 657 DATE: June 1, 2022 ORDER Entitlement to service connection for diverticulosis and diverticulitis is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted. Entitlement to service connection for hypertension is denied. Entitlement to service connection to a right eye disability, to include right eye vision loss and choroidal nevus, is denied. FINDINGS OF FACT 1. The Veteran's diverticulosis and diverticulitis was not caused or aggravated by the Veteran's active service. 2. The Veteran's GERD began during his active service. 3. The Veteran's hypertension is not caused or aggravated by his active service or manifested within one year of separating from service. 4. A disability of the right eye, other than refractive error, was not manifest in service and is not attributable to service. CONCLUSIONS OF LAW 1. The criteria for service connection of diverticulosis and diverticulitis are not met. 38 U.S.C. §§ 1110, 1112, 113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for GERD are met. 38 U.S.C. §§ 1110, 1112, 113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a right eye disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 4.9. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had served on active duty with the Unites States Army from May 1979 to May 1999. This matter comes before the Board of Veterans' Appeals (Board) from May 2013 and July 2014 decisions by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). The Board previously remanded this matter in December 2018 and July 2021. With respect to the Veteran's claims herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). The Board notes that the Veteran stated multiple times that his records from Winn Army Community Hospital were not addressed in the AOJ's decision. There was some question as to whether VA had obtained those records. The Board finds that the records that the Veteran referenced in his May 2014 statement are in the record and were reviewed in connection with the adjudication. Thus, the Board finds that VA fulfilled its duty to assist. Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). 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). Hypertension is a listed disease, with a presumptive period of one year following active service. 1. Diverticulosis and Diverticulitis The Veteran contends that his diverticulosis and/or diverticulitis began in-service. Service treatment records show that in January 1981, the Veteran reported to service providers that he had symptoms of dizziness, nausea and vomiting. In October 1981, the Veteran complained of spiting up blood for 4 days with stomach cramping. The provider included the impression of an upper GI bleed. In August 1982, the Veteran underwent an upper GI series. The provider noted a history of spitting up blood. The results were a normal upper GI series. In a January 1988 report of medical history, the Veteran checked the box indicating he coughed up blood. In October 1991, the Veteran reported to the emergency room. The Veteran complained of abdominal pain, vomiting, and stomachache. The service provider diagnosed the Veteran with gastroenteritis that had resolved. During his separation examination, the Veteran reported that he coughed up blood. The examiner noted that the Veteran was treated for coughing up blood. In January 1999, the Veteran underwent a contract general examination. During the examination, the Veteran reported that he occasionally had mild heart burn. The Veteran reported that in 1982, the Veteran developed some discomfort in the right midabdominal, and coughed up some blood. The examiner noted a GI series was done which revealed a possible ulcer. The examiner noted that the Veteran was treated with oral medication and appeared to recover. The Veteran further reported that about three times a year he will have pain the right midabdominal which can last several seconds to a minute, and it may cause him to cough up a little bit of blood. The Veteran noted he did not have any blood in his stool or any melena. The examiner noted that the Veteran had a scar on his right abdomen from a procedure which was performed several days after his birth. The examiner noted that when he did have abdominal pain, that pain was located just at the very lateral edge of the scar. Upon examination of the abdomen, the examiner found no masses or tenderness. The examiner found that no definitive diagnosis could be made related to his abdomen pain. The examiner noted that the discomfort at the lateral edge of surgical scar may be related to a surgery the Veteran had as an infant. The Veteran's post-service treatment records indicate that the Veteran was first diagnosed with diverticulitis in May 2005. In January 2010, the Veteran underwent a CT examination. The results were evidence of diverticulitis with an apparent perforation. In November 2013, the Veteran reported a history of GERD. The Veteran underwent another CT examination. The results of the CT examination were diverticulosis without evidence of acute diverticulitis. A December 2013 colonoscopy confirmed the diagnosis of diverticulosis. The Veteran underwent a partial colectomy. In March 2014, the Veteran underwent a VA intestinal surgery examination. The examiner noted the Veteran had undergone resection of the large intestine due to diverticulitis coli. During the examination, the Veteran reported he had cramping and GI related problems intermittently through his military service; all were diagnosed as gastroenteritis but on one occasion he had an upper GI bleed. The Veteran stated that in 2005 he was diagnosed with diverticulitis and in 2013 sigmoid colon. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran had several episodes of acute gastroenteritis and one episode of upper GI bleed during his service. The examiner noted that the Veteran did not have conditions that lead to diverticulitis. The examiner noted that the Veteran's diverticulitis was not diagnosed until 5-6 years after his separation from service. In December 2019, the Veteran underwent another intestinal conditions examination. The examiner diagnosed the Veteran with sigmoid diverticulosis and status post partial sigmoid colon resection. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the medical records showed that the Veteran had several episodes of GI complaints during activity duty. One episode found to be an upper GI bleed and several episodes of acute gastroenteritis. The examiner explained the Veteran had a negative acute abdominal series in 1991 and a negative colonoscopy in 2010. The examiner stated the Veteran was not diagnosed with diverticulosis until 2005, some six years after service. The examiner stated while no colonoscopy was performed during service, given the unremarkable acute abdominal series in 1991, his current diverticulosis, which was diagnosed 6 years after service was less likely than not related to active service. The examiner further opined that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner reasoned that there is no evidence of an abdominal disability prior to service. The examiner noted that the Veteran had abdominal surgery at 6 weeks of age, but the diverticulosis is less likely than not related to that abdominal surgery. In December 2021, the Veteran underwent another VA examination. The examiner opined that the Veteran's diverticulosis and/or diverticulitis was not due to the Veteran military service. The examiner reasoned that diverticulosis and/or diverticulitis is not associated with and not related to gastroenteritis. The examiner stated that these are separate diagnoses. The examiner explained that the Veteran did not have a current diagnosis of gastroenteritis. The Veteran was treated for gastroenteritis in 1991 and it resolved in 1991. The examiner noted that gastroenteritis is an acute illness, not an ongoing chronic diagnosis. The examiner further opined that the Veteran was not diagnosed with diverticulitis or diverticulosis until after separation from service, years later in 2005. The examiner stated although symptoms are similar with gastroenteritis and diverticulosis and/or diverticulitis. The examiner explained that the Veteran's current symptoms are more likely associated with diverticulosis and/or diverticulitis, not gastroenteritis. The Veteran stated that his symptoms that he had the same stomach pain and symptoms since his service in January 1981. The Veteran indicated that he was constantly treated for his symptoms without an understanding of his actual problem of diverticulitis until 2005. The Veteran stated that his symptoms and treatment had been the same throughout the years except for the blood. Although the Veteran believes that his diverticulosis and/or diverticulitis is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of gastrointestinal disorders are matters not capable of lay observation and require medical expertise to determine. Therefore, although the Board finds that Veteran is competent and credible to describe his symptoms in-service and post-service, the inference that these symptoms were related to his diverticulosis and diverticulitis is not competent medical evidence. Consequently, the Board finds the Veteran's statement provide no probative weight. The Bord finds that the December 2019 VA opinion together with the December 2021 VA opinion are probative. The opinions are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board finds that the Veteran has a current diagnosis of diverticulosis and diverticulitis. The Board finds that the Veteran had gastrointestinal incidents in-service. However, the Board finds that the only probative evidence in the record find that the diverticulosis and diverticulitis was not caused or aggravated by the Veteran's service. His in-service symptoms primarily impacted the upper gastrointestinal system, and examiners have found such unrelated to the current, post-service diagnosis. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for diverticulosis and diverticulitis are not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Gastrointestinal disorder to include GERD The Veteran contends that his currently diagnosed GERD is related to his service. As noted above, service treatment records show that in January 1981, the Veteran reported to service providers that he had symptoms of dizziness, nausea and vomiting. In October 1981, the Veteran complained of spiting up blood for 4 days with stomach cramping. The provider included the impression of an upper GI bleed. In August 1982, the Veteran underwent an upper GI series. The provider noted a history of spitting up blood. The results were a normal upper GI series. In a January 1988 report of medical history, the Veteran checked the box indicating he coughed up blood. In October 1991, the Veteran reported to the emergency room. The Veteran complained of abdominal pain, vomiting, and stomachache. The service provider diagnosed the Veteran with gastroenteritis that had resolved. During his separation examination, the Veteran reported that he coughed up blood. The examiner noted that the Veteran was treated for coughing up blood. The Veteran's VA treatment records indicate that the Veteran reported a history of GERD in November 2013. In January 1999, the Veteran underwent a contract general examination. During the examination, the Veteran reported that he occasionally had mild heart burn. The Veteran reported that in 1982, the Veteran developed some discomfort in the right midabdominal, and coughed up some blood. The examiner noted a GI series was done which revealed a possible ulcer. The examiner noted that the Veteran was treated with oral medication and appeared to recover. The Veteran further reported that about three times a year he will have pain the right midabdominal which can last several seconds to a minute, and it may cause him to cough up a little bit of blood. The Veteran noted he did not have any blood in his stool or any melena. The examiner noted that the Veteran had a scar on his right abdomen from a procedure which was performed several days after his birth. The examiner noted that when he did have abdominal pain, that pain was located just at the very lateral edge of the scar. Upon examination of the abdomen, the examiner found no masses or tenderness. The examiner found that no definitive diagnosis could be made related to his abdomen pain. The examiner noted that the discomfort at the lateral edge of surgical scar may be related to a surgery the Veteran had as an infant. In March 2014, the Veteran underwent a VA esophageal conditions examination. The examiner diagnosed the Veteran with GERD. The examiner opined the Veteran's GERD was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran had persistent upper GI complaints since about 1992. The examiner explained that he was admitted to a hospital in Korea and diagnosed with an upper GI bleed. The examiner stated that the Veteran's upper GI condition had its inception during his military service. The Veteran underwent a VA examination in December 2021. The VA examiner opined that the Veteran did not have a diagnosis of gastroenteritis. The examiner reasoned that the Veteran was treated for gastroenteritis in 1991 and it resolved in 1991. The examiner noted that gastroenteritis is an acute illness, not an ongoing chronic diagnosis. The examiner further opined that the Veteran was not diagnosed with diverticulitis or diverticulosis until after separation from service, year later in 2005. The examiner stated although symptoms are similar with gastroenteritis and diverticulosis and/or diverticulitis. The examiner explained that the Veteran's current symptoms are more likely associated with diverticulosis and/or diverticulitis, not gastroenteritis. The Board finds that service connection for GERD is warranted. The January 1999 VA examiner found the Veteran had mild heart burn. The March 2014 examiner opined that the Veteran a diagnosis of GERD and it is likely related to the Veteran's persistent upper GI complaints in-service, concluding that the Veteran's GERD began in-service. Therefore, the Board finds that the Veteran's GERD began in-service and continued. Thus, service connection for GERD is warranted. The Board finds that service connection for abdominal pain is not warranted. The record is clear that the Veteran's abdomina symptoms that are similar to gastroenteritis (impacting the lower gastrointestinal system) are symptoms of his diverticulosis and diverticulitis, not a separate diagnosis. In the absence of proof of a present disability, there can be no valid claim for service connection for abdominal pain. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In summary, the Board finds that service connection for GERD, accounting for symptoms not associated with diverticulosis or diverticulitis, is warranted. 3. Hypertension The Veteran contends his hypertension was caused or aggravated by his service. In this decision, all blood pressure (BP) measurements are noted in units of pressure in millimeters of mercury (mmHg). For VA compensation purposes, the term hypertension means that the diastolic BP is predominantly 90 or greater; and isolated systolic hypertension means that the systolic BP is predominantly 160 or greater with diastolic BP less than 90. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). In addition, hypertension must be confirmed by readings taken two or more times on at least three different days. See id. The Veteran's service treatment records indicated that the Veteran did not have hypertension during service, to include an April 1998 cardiovascular screening. The Veteran's service treatment records did document one instance of elevated BP with diastolic BP of 90 in October 1991. In October 1991, the Veteran went to the emergency room for abdominal pain, vomiting, and stomachache. The Veteran's BP was taken twice with readings of 140/94 and 130/90. The Veteran's post service treatment records indicate that the Veteran's BP began to rise around March 2009. The Veteran was diagnosed with mild hypertension in March 2009. The Veteran was proscribed medication for his hypertension in June 2009. Prior to 2009, the Veteran's post-service treatment records do not document any elevated BP or hypertension. In January 1999, the Veteran underwent a VA contracted general examination. The examiner found the Veteran's BP was 102/52. In December 2019, the Veteran underwent a VA hypertension examination. The examiner diagnosed the Veteran with hypertension. The examiner noted that the Veteran was diagnosed with hypertension in 1999. The examiner described the history of the Veteran's condition as beginning with elevated BP during a routine medical examination in 1999 and the condition stayed the same. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the isolated documentation of high blood pressure does not meet the criteria of hypertension. The examiner noted that the Veteran's hypertension is most likely an idiopathic hypertension that had no identifiable cause, most commonly affecting 95 percent of patients with hypertension. In December 2021, VA obtained an addendum medical opinion. The examiner opined the Veteran's hypertension is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran was noted to have elevated blood pressure (once) when seen in the ER for abdominal pain. The examiner noted that an April 1998 in-service cardiovascular screen noted the Veteran was had good health, with no medication, and a BP of 104/65. The examiner stated that the Veteran was not diagnosed or treated for hypertension until 2009. The examiner stated the Veteran's medical records are silent for a diagnosis of hypertension prior to 2009. The examiner explained that the diagnosis of hypertension in 2009 is unrelated to an episode of elevated blood pressure in 1991. Elevated blood pressure in 1991 was more likely related to the pain for which was being evaluated at the time. The examiner stated one episode of elevated blood pressure does not meet the medical criteria of hypertension. The examiner concluded that the medical records were silent for hypertension until 2009. Initially, the Board notes that the December 2019 VA medical opinion was found not adequate in the July 2021 Board remand. Further, the examiner's statement that the Veteran had elevated BP in a routine examination in 1999 is not consistent with the record. There is no indication that the Veteran had elevated blood pressure in 1999. This statement is directly contradicted by the January 1999 VA contracted general examination that noted the Veteran's BP was 102/52. Indeed, the Veteran's BP did not begin to rise until the beginning of 2009. At which time the Veteran's provider noted that the Veteran may have hypertension. That diagnosis was confirmed in June 2009, at which time the Veteran was placed on BP medication. Therefore, the Board finds that the December 2019 statement that the Veteran's hypertension began in 1999 is not consistent with the record and is not probative. Based on the evidence summarized above there is insufficient evidence of medical nexus to support a finding of service connection. In this regard, the Board notes that the December 2021 VA examiner's etiology opinion is highly probative because it is based on a detailed review of the Veteran's active duty and post-service treatment records, and a thorough rationale supported by relevant medical citation. The Board considered the December 2019 VA examiner's statement that the Veteran was diagnosed with hypertension in 1999. However, as noted above, that finding is not probative as it is not consistent with the record. Accordingly, the Board finds that while the Veteran has a current diagnosis of hypertension, and there is some evidence of isolated elevated blood pressure readings during active-duty service, there is insufficient evidence of hypertension during or within a year of separation from active-duty service. Additionally, there are no blood pressure readings indicative of continuity of symptoms between the Veteran separation from active-duty service and 2009. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for hypertension is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Right Eye Condition The Veteran contends that his right eye disability of loss of vision and a right eye growth since 2013 are related to an in-service eye injury. The Veteran's service treatment records document a right eye injury. Specifically, while welding sparks hit his eye. The Veteran reported that his eye was blurry and watery. The service provider noted a corneal abrasion with no clear evidence of a foreign body. The examiner found the Veteran's right eye acuity was 20/30. In April 1998, the Veteran reported that it was hard to read small print. Upon the Veteran's October 1998 retirement examination, the Veteran reported eye trouble and lack of vision either eye. The examiner noted the Veteran needed glasses to read and the Veteran's eye was damaged during welding. The Veteran's post-service records document that the Veteran has a current diagnosis of refractive error to include astigmatism and choroidal nevus. Post-service treatment records indicate that that the choroidal nevus was first suspected in 2009 and later confirmed in 2011. In January 1999, the Veteran underwent a VA contract eye examination. The Veteran complained of blurred vision on and off for two years. The examiner found the Veteran had normal visual fields; uncorrected vision of 20/20 in both eyes; had 20/20 corrected vision in both eyes. He examiner stated that the Veteran had latent hyperopia. The examiner stated that the condition was an age-related problem. The examiner noted the Veteran would need to wear glasses more often as he got older. In January 2012, the Veteran underwent a VA eye examination. The examiner diagnosed the Veteran with benign neoplasm of choroidal nevus; dry eye syndrome; and astigmatism. The examiner opined that the Veteran did not have a melanoma. The examiner found the Veteran had a choroidal nevus, a benign neoplasm of the tissue under the retina. The examiner explained ultraviolet radiation does not cause choroidal nevus. In April 2013, the Veteran underwent another VA eye examination. The examiner diagnosed the Veteran with a choroidal nevus of the right eye. The examiner opined that the Veteran's choroidal nevus was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In December 2019, the Veteran underwent a VA eye examination. The examiner diagnosed the Veteran with anatomical narrow angle. The examiner remarked for the Veteran's claimed condition of a right eye disorder, there is no diagnosis because there were no findings, signs, or symptoms to support a diagnosis. The examiner noted the Veteran's eye was not dilated because it would create an acute angle closure glaucoma attack. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury event, or illness. The examiner reasoned that narrow angle is genetic in nature. The examiner found no ocular pathology was present. The examiner stated the cornea was completely recovered with no scar from the abrasion in August 1982. In January 2022, VA obtained a medical opinion. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that there were no residual signs of the welding injury form 1982 in his right eye. The examiner noted that the choroidal nevus or defect would not be caused by a welding injury and was not diagnosed until September 2009 well after the ocular injury. The examiner noted that his vision declination was related to his congenital refractive error. A choroidal nevus is a commonly occurring growth composed fa cluster of cells called melanocytes and not predisposed to the formation due to an eye related injury. In June 2011, the Veteran stated that he went to several eye doctors and consults. He stated the doctors told him it could be melanoma. The Veteran stated that after his eyes were dilated, he was asked if he had an impact to his eye. The Veteran noted that he went to another eye appointment, and they asked him if he had an impact to his eye. The Veteran reported that each time he told his doctors about the welding incident. The Veteran stated his eye doctors did not mention further about any eye injury. In May 2014, the Veteran stated that he throughout the military he had 20/20 vision and no issues except the welding accident in the late 1990s. In August 2020, the Veteran stated that his claim has always been about his right eye growth and right eye vision loss. The Veteran stated that he was told by his doctor that when it was first discover it could have been caused by the welding accident or a blow to the eye. The Board finds that service connection for choroidal nevus and right eye vision loss is not warranted. The Veteran has a current diagnosis of choroidal nevus and right eye vision loss. The Veteran's right eye vision loss was diagnosed as presbyopia, astigmatism, refractive error and hypermetropia. Generally, service connection may not be granted on a direct basis for refractive error of the eyes, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable regulations. See 38 C.F.R. §§ 3.303 (c), 4.9; see also Terry v. Principi, 340 F.3d 1378, 1383-84 (Fed. Cir. 2003). However, service connection may be granted if the refractive error was subject to a superimposed disease or injury. See VAOPGCPREC 82-1990. Thus, the question is whether a superimposed disability of residuals of the Veteran's in-service right eye abrasion caused any refractive error. The Board finds that the medical evidence is clear, the Veteran did not have any residuals of his in-service right eye abrasion. The January 2022 VA examiner found there no residuals signs of an eye abrasion. Further, the January 2022 VA examiner found the Veteran's eye declination was related to his congenital refractive error. The next issue is whether the Veteran's choroidal nevus was caused or aggravated by the Veteran's in-service right eye injury. The Board finds the most probative evidence is the January 2022 examiner's opinion that choroidal nevus or defect would not be caused by a welding injury and was not diagnosed until September 2009 well after the ocular injury. The Board considered the Veteran's statements that his eyesight began to decline after the injury. The implication being that his injury was the cause of the declining eyesight. The Veteran has not been shown to be competent to opine as to the reason why his eyesight declined. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board also considered the Veteran's August 2020 contention that his doctors told him that an eye injury could cause the growth. The Board notes that the Veteran is competent to relay the information told to him by doctors. The Board finds that while the Veteran's statement is somewhat inconsistent with the June 2011 statement that his doctors did not comment on his in-service eye injury, ultimately it is credible. However, the Board finds the Veteran's secondhand reports of his doctors' opinions are less probative than the January 2022 VA medical opinion. The Board finds the January 2022 VA opinion highly probative as 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's statement relaying his doctors' statements to him did not include any reasoning as to why his in-service eye injury caused the choroidal nevus. Thus, the Board provides the Veteran's statement little probative weight. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a right eye disability to include loss of vision choroidal nevus is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert Batten 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.