Citation Nr: 22040100 Decision Date: 07/13/22 Archive Date: 07/13/22 DOCKET NO. 15-10 143 DATE: July 13, 2022 ORDER Service connection for a bilateral eye disorder, to include secondary to service-connected diabetes mellitus is denied. FINDING OF FACT The probative evidence of record including a January 2020 VA examiner's opinion supports a finding that the Veteran's bilateral eye disorder is not causally related to his service. Additionally, the probative evidence of record including January 2020 and February 2022 VA examiners' opinions support a finding that the Veteran's bilateral eye disorder was causally related to, or aggravated beyond its natural progression by, his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria have not been met for service connection for bilateral eye disorder, (including secondary to service-connected diabetes mellitus). 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1967 to May 1979. These matters are before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision. In August 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge of the Board; a transcript is associated with the record. In December 2020, the Board denied the Veteran's claim. The Veteran timely appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Veterans Court). In August 2021, the Veterans Court granted a Joint Motion for Remand (JMR), vacating the December 2020 decision on the basis that a January 2020 VA examination was inadequate to decide the claim, and returned the case to the Board for further development. The case was before the Board in January 2022 and was remanded for further development. Service connection for a bilateral eye disorder, to include as secondary to service-connected diabetes mellitus is denied. Legal Criteria Service connection may be granted for a disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a causal relationship (or nexus) between the current disability and any injury or disease during service. Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. To establish secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). Factual Background A March 2015 private diabetes examination indicates that the Veteran has a diagnosis of diabetic retinopathy. The Veteran also submitted the results of a March 2015 eye examination which did not list diabetic retinopathy underneath the diagnosis section. The Veteran submitted a June 2016 private physician's note from Dr. O which indicates that the Veteran had a diagnosis of retinopathy. At an October 2016 VA eye consultation, the conducting physician opined that the Veteran displayed no active retinal diabetic changes. The Veteran submitted an August 2017 internal medicine physician's letter which stated that the Veteran had a diagnosis of retinopathy. The Board remanded these matters to verify whether the Veteran had a diagnosis of retinopathy and whether it was causally related to service or his service-connected diabetes. At a January 2020 VA examination, the conducting physician opined that the Veteran did not have diabetic retinopathy in either eye. As a rationale, the physician explained that at the Veteran's last evaluation at a retinal clinic, the attending doctor reported no diabetic retinopathy but rather the laser barricade for retinal tears. The physician also explained that the Veteran's last retinal examination performed in November 2019 indicated no diabetic retinopathy. Regarding the June 2016 diagnosis of diabetic retinopathy by Dr. O, the physician opined that Dr. O might have been speculating that the Veteran had received laser surgery for retinopathy rather than for a retinal tear. Finally, the physician stated that the August 2017 internal medicine doctor did not perform a dilated fundus examination and had no access to, or the expertise to use or perform an indirect ophthalmoscopy for dilated retinal evaluation. The physician diagnosed the Veteran with bilateral senile nuclear sclerosis, pinguecula in the left eye and a retinal tear without detachment post prophylactic laser therapy. The physician opined that it was less likely than not that the Veteran's diagnosed eye disabilities were incurred in or otherwise related to the Veteran's active service. As a rationale, the physician explained that the Veteran's pinguecula does not cause reduction in visual acuity and that the service treatment records are silent for this condition. The physician further explained that pinguecula is an extremely common, innocuous, and asymptomatic condition. The physician noted that pinguecula is not caused or the result of diabetes mellitus. The physician also opined that the Veteran's senile nuclear sclerosis was not causally related to his service. The physician explained that senile nuclear sclerosis is to be expected in a 72-year-old person and that the Veteran's service treatment records are silent for this condition. The physician also explained that senile nuclear sclerosis is not caused by or the result of diabetes mellitus. Finally, the physician opined that it was less likely than not that the Veteran's retinal tear was causally related to service. As a rationale, the physician explained that the Veteran did not experience a retinal tear until 2010, which was 41 years after his separation from service in 1969. The physician also explained that retinal tears are not caused by or the result of diabetes mellitus. The physician noted that retinal tears are caused by dynamic vitreoretinal traction and have a predilection for upper retinal aspect. They are usually symptomatic, u-shaped and may be associated with vitreous hemorrhage resulting from the rupture of peripheral retinal blood vessels. In accordance with the February 2022 Board remand instructions, the Veteran was afforded a February 2022 VA examination to determine whether his bilateral eye condition was causally related to, or aggravated beyond its natural progression by his service-connected diabetes mellitus. The physician performed a fundus examination and determined that there was no evidence of diabetic retinopathy at present. The physician opined that it was less likely than not that the Veteran's bilateral eye condition was causally related to his diabetic mellitus. Regarding the Veteran's history of retinal holes, the conducting physician explained that they are either caused by localized degeneration associated to aging or by traction on the retina by vitreous humor, usually associated with posterior vitreous detachment. The physician opined that that the Veteran's loss of visual acuity was due to refractive error and senile nuclear sclerosis. The physician explained that refractive error is considered congenital and developmental in origin and that nuclear sclerosis is not caused by, or the result of diabetes mellitus. The physician also opined that the Veteran's pinguecula in his left eye is not caused by diabetes mellitus but is rather a superficial degeneration due to actinic changes affecting the collagen and elastoid fibers of the conjunctiva. Regarding aggravation, the physician indicated that it was possible to determine a baseline level of severity. The physician explained that the Veteran had been treated for retinal holes with laser in both eyes around 2003. The physician noted that the Veteran's service treatment records indicated the Veteran was discharged from service in May 1979 and that 24 years later (2003) he displayed symptoms of dark spots with peripheral retinal holes that were treated with surrounding laser marks with excellent results. Accordingly, the physician opined that the current severity of the Veteran's eye condition was not greater than the baseline. Analysis The Board finds that the probative evidence of record is against a finding that the Veteran's bilateral eye condition is directly related to his service. The Board assigns significant probative value to the January 2020 VA examiner's opinion because they indicated that they reviewed the claims folder and supported their opinion with a rationale. The examined also provided alternative theories as to the cause of the Veteran's eye condition including natural aging and explained that the Veteran did not experience a retinal tear until 41 years after exiting from service. The Board also finds that the probative evidence of record is against a finding that the Veteran's bilateral eye condition was caused by his service-connected diabetes mellitus. The Board assigns significant probative value to the January 2020 and February 2022 VA examiners' opinions because they indicated that they reviewed the claims file and supported their opinion with a rationale explaining that all of the Veteran's eye conditions are caused by other factors than diabetes mellitus. The Board notes that the January 2020 examiner addressed the private diagnoses of diabetic retinopathy and why he disagreed with them. Indeed, all of the retinal examinations the Veteran attended indicated that he did not have a diagnosis of diabetic retinopathy. Accordingly, the Board assigns more probative value to the January 2020 VA examiner rather than Dr. O or the internal medicine physician's opinions. The Board also finds that the probative evidence of record is against a finding that the Veteran's bilateral eye condition was aggravated beyond its natural progression by his service-connected diabetes mellitus. The Board assigns probative value to the February 2022 VA examiner's opinion because they provided a rationale as to why the current severity of the Veteran's eye condition was not greater than the baseline. [CONTINUED ON NEXT PAGE] Accordingly, the Veteran's appeal for service connection for a bilateral eye condition must be denied. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexander Bahus 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.