Citation Nr: 22047892 Decision Date: 08/23/22 Archive Date: 08/23/22 DOCKET NO. 16-00 185 DATE: August 23, 2022 ORDER Entitlement to service connection for an eye condition, to include vision loss, is denied. FINDINGS OF FACT 1. The Veteran's bilateral color vision deficiency pre-existed service and was not aggravated by service, nor is there evidence that deficient color perception was subject to a superimposed injury or disease during service. 2. The Veteran does not have a bilateral eye condition manifested by vision loss that is etiologically related to his military service or to service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for a bilateral eye condition, to include colorblindness and vision loss, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107(b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310, 3.311. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from January 1969 to September 1970, to include service in the Republic of Vietnam. The Veteran died in September 2009, and the appellant is his surviving spouse. The appellant was properly substituted in an October 2019 VA memorandum. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision by a Department of Veterans Affairs (VA) regional office (RO), which, in pertinent part, denied entitlement to service connection for vision loss. The Board remanded this matter for additional development in November 2018, February 2021, April 2021, September 2021, and February 2022. Service Connection The Veteran sought entitlement to service connection for a condition manifested by vision loss, which he contended was due to in-service herbicide exposure. The Veteran also asserted that his eye condition was related to his service-connected diabetes mellitus. A. Legal Criteria Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) 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); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d). A Veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to certain herbicide agents (e.g., Agent Orange) during such service, absent affirmative evidence to the contrary. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). Service connection based on herbicide exposure will be presumed for certain specified diseases that become manifest to a compensable degree within a specified period of time in the case of certain diseases. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Even if a Veteran is not entitled to presumptive service connection for a disease claimed as secondary to herbicide exposure, VA must also consider the claim on a direct service-connection basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Lay evidence is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition is capable of lay observation and may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature." Lay evidence can be competent and sufficient to establish a diagnosis when a layperson (1) is competent to identify the medical condition; or (2) is reporting a contemporaneous medical diagnosis; or (3) describes symptoms at the time which supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for the evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). This benefit-of-the-doubt rule applies if the competing evidence is nearly equal but does not apply when the evidence persuasively favors one side or the other. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). B. Factual Background During the Veteran's June 1968 pre-induction examination, he reported a history of color blindness, and he denied wearing glasses. On the associated examination report, the Veteran's near and far vision was normal (20/20) bilaterally, and his eyes were evaluated as clinically normal, except for colorblindness. A January 1969 service treatment record shows that the Veteran's vision was normal and that he had a color defect. Service treatment records are otherwise silent for complaints of or treatment for eye injuries or conditions. During the Veteran's September 1970 separation examination, the Veteran's vision was normal, and his eyes were evaluated as clinically normal. A November 2007 private treatment record shows that the Veteran was seen at the emergency department after having jerking of his left arm. He also complained of headaches and vertigo. He denied any symptoms until the day of his seizure, and he denied any other complaints. On examination, the Veteran had adequate vision. A CT (computed tomography) scan of the head showed a left occipital parietal lesion, which was diagnosed to be glioblastoma. A December 2007 private treatment record shows that the Veteran "has recovered quite satisfactorily and he has no major neurologic deficit." The Veteran did complain of some dizziness and headache. On examination, the Veteran's pupils were equal and reactive. A December 2007 private treatment record shows that the Veteran reported "doing very well since leaving the hospital." A December 2007 private treatment record shows that the Veteran had no significant neurologic deficit. A biopsy confirmed that his occipital lesion was glioblastoma. A December 2007 private treatment record shows that the Veteran reported a several days history of headaches and weakness. A January 2008 private treatment record shows that the Veteran was tolerating chemotherapy well. He denied complications, other than that his right foot felt larger than the left foot. A March 2008 private treatment record shows that the Veteran's brain tumor increased in size; however, he denied any new symptoms. A March 2008 private treatment record shows that the Veteran underwent a workup for chest pain. He denied diabetes and renal disease. A March 2008 VA treatment record shows that the Veteran reported to urgent care to establish care. He reported blurred vision. During a March 2008 VA agent orange examination, the Veteran reported that he had recently been diagnosed with glioblastoma. He also reported recently diagnosed kidney stones, low back pain, a seasonal forearm rash, and heartburn. He denied any other medical history. On examination, the Veteran extraocular muscles were intact, and there was good fundus and pupillary reflex. The Veteran was afforded a VA aid and attendance or housebound examination in April 2008. He reported "poor vision even when wearing corrective lenses." He also reported that he was recently diagnosed with adult-onset diabetes. An April 2008 private treatment record shows that the Veteran was admitted due to a progression of his brain tumor. He reported headaches, weakness, and "changes in vision described as seeing spots." He also reported that he was recently diagnosed with diabetes at the VA hospital. He was diagnosed with dehydration, glioblastoma, and headaches. An April 2008 private consultation report shows that the Veteran was evaluated for new onset hyperglycemia in a patient with no known prior history of diabetes. He reported increased thirst, increased urination, decreased appetite, and fatigue. He denied blurry vision. On exam, the Veteran's eyes were normal. He was diagnosed with steroid-induced diabetes. An April 2008 private discharge summary shows that the Veteran was admitted to the hospital with "laboratory evidence of diabetic ketoacidosis." His blood sugars normalized and were stable prior to discharge. A May 2008 private treatment record shows that the Veteran reported occasional headaches and sinus drainage with some blood tinge. A June 2008 private treatment record shows that the Veteran reported bilateral ankle pain and swelling and intermittent headaches. A July 2008 private treatment record shows that the Veteran reported occasional headaches and an ingrown toenail. He denied any new complaints, and he reported that his blood sugars had been relatively well controlled. A September 2008 private treatment record shows that the Veteran reported that he tolerated his last cancer treatment "well other than mild fatigue." He reported minimal nausea. He also reported continuing headaches and steroid-induced hyperglycemia. An October 2008 private treatment record shows that the Veteran reported an episode of shaking of the left upper extremity, as well as some swelling in the right lower jaw. He denied any other, new complaints. A November 2008 private treatment record shows that the Veteran reported increasing headaches. The Veteran was afforded a VA diabetes mellitus examination in December 2008. He denied any symptoms related to his diabetes, and he reported that he was "asymptomatic as far as he knows prior to the diagnosis." He also denied a history of retinopathy, and he denied any medical problems prior to his glioblastoma diagnosis. A funduscopic exam revealed no abnormalities. He was diagnosed with type 2 diabetes mellitus, with "no complications related to the [V]eteran's diabetes." A December 2008 private treatment record shows that the Veteran reported occasional headaches and insomnia. He also reported significant nausea and vomiting after his most recent chemotherapy. A December 2008 private emergency department record shows that the Veteran's pupils were brisk. A January 2009 private treatment record shows that the Veteran reported frequent headaches. A February 2009 private treatment record shows that the Veteran reported frequent headaches. A March 2009 private treatment record shows that the Veteran reported difficulty with his memory, occasional pain in the hip area, intermittent headaches, and decreased appetite. An April 2009 private treatment record shows that the Veteran denied any new complaints. He reported no recent seizure activity and no change in headaches. A May 2009 private treatment record shows that the Veteran denied any new complaints except for headaches. A June 2009 private treatment record shows that the Veteran was "doing well with no recent evidence of progression." He reported an occasional headache and increasing difficulty with chemotherapy, including nausea, vomiting, and fatigue. He denied any change in neurological symptoms. A July 2009 private treatment record shows that the Veteran reported increasing headaches over the past two weeks with occasional changes in mental status. A September 2009 private treatment record shows that the Veteran began having seizures after reporting increasing headaches. He also presented with confusion and short-term memory loss. His physician noted that the Veteran "seem[s] to have progressive symptoms, including memory loss and increasing confusion." A September 2009 private discharge summary shows that the Veteran was admitted with increased seizure activity with progressive glioblastoma. He had intermittent confusion throughout his hospital course, and he was discharged to hospice care. In June 2021, a VA examiner opined that the Veteran's vision loss was less likely as not related to service. The examiner noted that service treatment records documented no vision loss or ocular pathology, other than colorblindness since childhood. The examiner also noted that the Veteran reported blurred vision, even when wearing corrective lenses, in 2008 "secondary to right occipital brain lesion." The examiner indicated that "[a]lthough there is evidence available which indicated subjective symptoms of blurred vision in 2008, there is no evidence presented which indicate an ocular pathology." The examiner also indicated that "it is common and expected for refractive error to change over time and cause blurry vision." The examiner noted that "there is no evidence provided which indicates evidence of ocular pathology or measurement of any vision loss." The examiner opined that it was less likely as not that there is any vision loss incurred or caused in service. In November 2021, a VA examiner opined that the Veteran did not have any current disorders related to an in-service injury or disease, including his presumed in-service exposure to herbicide agents, because "records show no ocular pathology other than developmental errors of refraction." In May 2022, a VA examiner opined that the Veteran's eye condition was less likely as not related to service, to include any environmental or chemical exposures therein. The examiner noted that there were no ocular findings in the Veteran's treatment records and that the Veteran's vision was normal in service. The examiner also noted that he agreed with the June 2021 VA examiner's opinion that the Veteran's vision loss was less likely as not related to service. The May 2022 VA examiner also opined that the Veteran's vision loss was less likely as not caused or aggravated by diabetes based on a lack of ocular findings to indicate any specific eye conditions related to diabetes. The examiner acknowledged the Veteran's reports of blurred vision, seeing spots, and progressive vision loss; however, the examiner indicated that these symptoms less likely as not represented symptoms of ocular pathology, such as diabetic eye disease, based on a lack of ocular findings showing cataract development or diabetic retinopathy. The examiner also noted that the Veteran's symptoms could be due to any number of reasons other than the Veteran's service exposures and diabetes. C. Analysis Initially, the Board will address the Veteran's colorblindness. Neither the Veteran nor the appellant asserted that the Veteran's colorblindness is related to service or to a service-connected disability. Nor have they asserted that the Veteran's colorblindness impacted his visual acuity. In general, service connection may not be granted for congenital or developmental defects because they are not considered diseases or injuries for the purpose of service connection. 38 C.F.R. §§ 3.303 (c), 4.9. However, service connection may be granted for a congenital or hereditary disease, as opposed to a defect, when the disease first manifested during service (incurrence), or when it preexisted service but was worsened beyond its normal progression as a result of service (aggravation). See Quirin v. Shinseki, 22 Vet. App. 390, 394 (2009) (discussing VAOPGCPREC 82-90); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). For VA purposes, a "defect" is defined as a structural or inherent abnormality or condition that is more or less stationary in nature and is generally incapable of improvement or deterioration. In contrast, a "disease" is capable of improvement or deterioration. Refractive errors, including astigmatism, myopia, hyperopia, and presbyopia, are considered congenital defects. In the absence of a superimposed disease or injury, service connection may not be allowed for congenital defects or refractive errors of the eyes, even if visual acuity decreased in service, as these are not diseases or injuries within the meaning of applicable legislation relating to service connection. Thus, VA regulations specifically prohibit service connection for either a congenital defect or a refractive error of the eye unless such a defect was subjected to a superimposed disease or injury that created additional disability. See VAOPGCPREC 82-90, 55 Fed. Reg. 45711 (July 18, 1990) (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). Thus, in the absence of some event or trauma, a refractive error is a constitutional or development abnormality for which compensation benefits may not be authorized. 38 C.F.R. §§ 3.303 (c), 4.9 (congenital or developmental defects, refractive error of the eye, personality disorders, and mental deficiency as such are not diseases or injuries within the meaning of applicable legislation); see also VAOPGCPREC 82-90. VA's General Counsel issued an opinion interpreting 38 C.F.R. § 3.303 (c) to mean that that service connection may be granted for diseases of congenital, developmental, or familial origin if the evidence as a whole shows that manifestations of the disease in service constituted "aggravation" of the disease within the meaning of applicable VA regulations. VAOPGCPREC 67-90. The VA General Counsel also has issued an opinion that a congenital defect can be subject to superimposed disease or injury, and, if superimposed disease or injury occurs during military service, service connection may be warranted for the resultant disability. VAOPGCPREC 82-90. Here, while it appears that the Veteran's color blindness was a congenital defect based on the Veteran's reports that he had been colorblind since childhood and the notation of the Veteran's color blindness as a "defect" in the service treatment records, the Board notes that the medical evidence of record does not clearly establish that fact. The Board also notes that it is not competent to supplement the record with an unsubstantiated medical conclusion regarding the proper classification of the Veteran's color vision deficiency as a congenital disease or defect. See e.g., Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Nevertheless, whether color vision deficiency is considered a congenital disease or defect for purposes of the Board's analysis, the weight of the evidence is against a grant of service connection for color vision deficiency. Considering color vision deficiency as a congenital disease, the Board first notes that the Veteran's colorblindness was noted at entry. Accordingly, the presumption of soundness does not attach, and the evidence of record must show that there was an increase in disability during service to trigger the presumption of aggravation. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). Here, the Board finds there is no such evidence of an increase in disability during service. In this regard, neither the Veteran nor the appellant contended that the Veteran's color blindness increased in severity during service. Moreover, the evidence does not reflect any increase in disability related to the Veteran's eyes during service. Service treatment records are completely silent for any eye pathology, to include any injury or trauma. During the Veteran's separation examination, his eyes and vision were evaluated as normal. Furthermore, there is a lack of any post-service medical evidence reflecting treatment for the Veteran's color vision deficiency. Considering color vision deficiency as a congenital defect, the Board finds that there is no evidence of subjected to superimposed disease or injury. As discussed above, service treatment records are completely silent for any eye pathology, to include any injury or trauma, and the Veteran did not contend otherwise. Accordingly, the Board finds that service connection for colorblindness is not warranted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. Regarding the Veteran's vision loss, the Board notes that the record does not reflect diagnoses related to the eyes. However, the Veteran was competent to report eye symptoms, such as vision loss, blurry vision, and spots in his eyes. As such, the Board finds the current disability element is established. Shedden v. Principi, 381 F.3d 1163, 1167. The Veteran's service records show that he served in the Republic of Vietnam from July 1969 to September 1970. The Veteran is therefore presumed to have been exposed to Agent Orange or other herbicide agents. See 38 C.F.R. § 3.307 (a)(6)(iii). However, a condition manifested by vision loss is not listed as one of the disabilities for which presumptive service connection based on herbicide exposure can be granted under 38 C.F.R. § 3.307 (a)(6) and 38 C.F.R. § 3.309 (e). Thus, service connection may not be granted on a presumptive basis based on herbicide exposure. The Veteran is therefore not entitled to invoke these presumptions, but his claim is still considered under traditional service connection principles. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). The Board concludes that the evidence of record is against a finding that the Veteran's vision loss was related to any injury, event, or illness in service, to include his presumed herbicide exposure. As noted, service treatment records are negative for any treatment or diagnosis related to vision loss, and the Veteran's vision was normal during his September 1970 separation examination. The Veteran's vision symptoms were first noted in 2008, almost 40 years after his separation from service. The Veteran did not assert, and the evidence does not show, that his vision problems began prior to 2008. Thus, there is no medical or lay evidence that vision problems manifested during active service or until many years thereafter. Moreover, there is no competent medical evidence of a nexus between the Veteran's eye condition and the Veteran's military service. The Board finds the June 2021, November 2021, and May 2022 VA opinions to be highly persuasive to the issue of whether the Veteran's current eye condition was related to service. The Board places great probative weight on the VA opinions in this case, as they are consistent with the evidence of record and based upon medical knowledge and skill, as well as a review and analysis of the Veteran's specific disability picture. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (a medical report must be read as a whole in the context of the claim and, even an opinion lacking in detail may be provided some probative value based upon the amount of information and analysis contained therein); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). Specifically, the June 2021 and November 2021 VA examiners opined that the Veteran's eye condition was less likely as not related to service because there was no evidence of eye pathology or vision during service and because there were no ocular findings post-service, other than refraction errors. Similarly, the May 2022 VA examiner opined that the Veteran's eye condition was less likely as not related to service because there was no evidence of in-service trauma or accident to the eye and because the evidence of record reflects no ocular findings other than refractive error. Overall, the opinions of record are supported by an explanation, based on a review of the claims folder and examination of the Veteran, and supported by the Veteran's medical records. The Board also acknowledges that it previously found the June 2021 and November 2021 VA opinions to be inadequate on the issue of whether the Veteran's current eye condition was related to service. The Board notes that even if a medical opinion is inadequate to decide a claim, it is not necessarily entitled to absolutely no probative weight. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). However, if the opinion is merely lacking in detail, then it may be given some weight based upon the amount of information and analysis it contains. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (citing United States v. Welsh, 774 F.2d 670, 672 (4th Cir.1985) ("The probative value of evidence is its tendency...to establish the proposition that it is offered to prove."). "VA is not permitted to completely ignore even an 'inadequate' opinion or examination, whether it is in favor or against a veteran's claim." Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). Here, the Board finds that the June 2021 and November 2021 VA opinions retain at least some probative value insofar as they tend to prove or disprove the proposition for which they were offered. In this case, the opinions were against the Veteran's claim. Insofar as they are in agreement with the other opinions of record, they provide corroborating evidence to support that medical opinion. The Board acknowledges the Veteran's and the appellant's assertions that the Veteran's current eye condition was related to service. 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, the etiology of an eye condition falls outside the realm of common knowledge of a lay person. In this regard, while the Veteran could competently report his symptoms, any opinion regarding whether his diagnosed eye condition was related to his military service requires medical expertise that neither the Veteran nor the appellant has demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board assigns no probative weight to the lay assertions that the Veteran's current eye condition is related to service. The Veteran and the appellant also raised the issue of entitlement to service connection for an eye condition as secondary to his service-connected diabetes. After reviewing the foregoing evidence, the Board finds that service connection is not warranted on a secondary basis. The Board finds the May 2022 VA opinion to be highly persuasive to the issue of whether diabetes caused or aggravated the Veteran's eye condition. The examiner found that the Veteran's vision loss was less likely as not caused or aggravated by diabetes based on a lack of ocular findings to indicate any specific eye conditions related to diabetes. The examiner acknowledged the Veteran's reports of blurred vision, seeing spots, and progressive vision loss; however, the examiner indicated that these symptoms less likely as not represented symptoms of ocular pathology, such as diabetic eye disease, based on a lack of ocular findings showing cataract development or diabetic retinopathy. The examiner also noted that the Veteran's symptoms could be due to any number of reasons other than the Veteran's service exposures and diabetes. The Board places great probative weight on the VA opinion in this case, as it is consistent with the evidence of record and based upon medical knowledge and skill, as well as a review and analysis of the Veteran's specific disability picture. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (a medical report must be read as a whole in the context of the claim and, even an opinion lacking in detail may be provided some probative value based upon the amount of information and analysis contained therein); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). In this regard, the opinion is supported by the other evidence of record, including the March 2008 agent orange examination showing a normal eye examination and the December 2008 VA diabetes mellitus examination showing that the Veteran denied retinopathy and reflecting a normal eye examination. There are no contrary medical opinions of record. The Board has also considered the Veteran's and the appellant's statements that his eye condition is secondary to his diabetes. However, the Board accords his statements little probative value because, as noted above, they are not competent to opine on such a complex medical question. In this regard, the question of causation and aggravation of vision loss involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In a case such as this, where the diseases have multiple potential etiologies, expert testimony is necessary to establish causation. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. See Jandreau, supra; see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Therefore, based on the foregoing, the Board finds that service connection for an eye condition manifested by vision loss is not warranted on a direct or secondary basis. The weight of the competent evidence is against a finding of relationship between the Veteran's vision loss and service, to include exposure to herbicides. The evidence is also against a finding of a relationship between the Veteran's vision loss and his service-connected diabetes mellitus. While the Board is grateful for the late Veteran's honorable service in defense of his country and is sympathetic to the appellant's claim, the Board concludes that service connection for an eye condition manifested as vision loss is not warranted. In reaching this conclusion, the Board considered the applicability of the benefit of the doubt doctrine. However, that doctrine is not applicable in the instant appeal as the weight of the evidence is against the claim. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kipper, 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.