Citation Nr: 25014751 Decision Date: 12/10/25 Archive Date: 12/10/25 DOCKET NO. 16-49 524 DATE: December 10, 2025 ORDER Entitlement to service connection for central serous retinopathy (hereinafter "CSR") is granted. FINDING OF FACT The Veteran's CSR disability had its onset during service. CONCLUSION OF LAW The criteria for entitlement to service connection for a CSR disability have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant in this appeal, served on active duty from March 1977 to February 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office, which is the agency of original jurisdiction (AOJ), that denied the Veteran service connection for an eye disability on the basis that the condition was not incurred in or caused by military service. The Board previously remanded the Veteran's claim for service connection for an eye disability in April 2019, January 2020, December 2022 and July 2025 for further evidentiary development. The December 2022 Board remand was issued following a Court of Appeals for Veterans Claims joint motion for remand directing the AOJ to obtain new opinions regarding the nature and etiology of the Veteran's eye conditions. The July 2025 Board remand continued to seek adequate medical opinions regarding the nature and etiology of the Veteran's eye conditions. The Board observes that the Veteran was initially seeking service connection for numerous eye conditions to include CSR, intermittent exotropia, Hollenhorst plaques, refractive error, color vision defect, convergence insufficiency, refractile particles and nuclear sclerotic cataracts. See e.g. June 4, 2024 Medical Opinion Disability Benefits Questionnaire's (DBQ). Recently, however, the Veteran narrowed the scope of his eye condition service connection claims to CSR alone. See December 2025 Submission of Evidence and Appellant's Brief. Therefore, the Board will move forward with adjudicating whether the Veteran is entitled to service connection for CSR and will not discuss the other eye condition medical opinions in its decision herein. Service Connection Applicable Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service.? 38?U.S.C. §§?1110, 1131; 38?C.F.R. §?3.303(a).? Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.? 38?C.F.R. §?3.303(d).????? Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability.? Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009).??? The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant.? Kahana v. Shinseki, 24?Vet. App.?428, 433 (2011).? This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record.? See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24?Vet. App.?at 433-34.??? VA is responsible for determining whether the evidence supports the claim or is in "approximate" (meaning nearly equal) balance, with a claimant prevailing in either event.? 38?U.S.C. §?5107(b); 38?C.F.R. §?3.102.? The claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence regarding any material determination.? See?Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz?v.?Principi, 274 F.3d 1361 (Fed. Cir. 2001).? The appellant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement.? Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).????? Entitlement to service connection for CSR is granted. The Veteran seeks service connection for CSR. See August 2011 VA Form 21-4138 Statement in Support of Claim; December 2025 Submission of Evidence and Appellant's Brief. More specifically, the Veteran contends that he never had eye problems or wore glasses before he was in the Army, and now he is going blind. See August 2011 VA Form 21-4138 Statement in Support of Claim. For the reasons discussed below, the Board finds that service connection for CSR on a direct basis is warranted. The Veteran was afforded a VA eye conditions examination in June 2019, where a diagnosis of CSR with decrease in best corrected vision in the right eye was confirmed. See June 2019 Eye Conditions DBQ. The VA examiner, however, was unable to determine if the CSR of the right eye, resulting in blurred vision of the right eye, started in service without resorting to speculation. Id. The Veteran was afforded another VA eye conditions examination in January 2021, where a diagnosis of CSR of the right eye was again confirmed. See January 2021 Eye Conditions DBQ. The VA examiner opined that the CSR condition is less likely as not incurred or caused by service and explained "The date of onset of all diagnosed conditions occurred more than 30 years after the patients discharge from the service. . . . .There is no known episode in the service record to indicate any event that could have caused these conditions, nor were they diagnosed on discharge in 02/22/1979." See January 2021 Medical Opinion DBQ. This opinion, however, ignored the fact that the Veteran did not have any eye trouble and was not wearing eyeglasses until he entered service, his eyeglasses prescription got worse while in service, he complained of blurry vision and headaches while in service, and he confirmed eye trouble during his separation examination. See February 1977 Report of Medical History; March 2, 1977, Eyewear Prescription; September 20, 1978, Eyewear Prescription and Optometry Clinic STR; February 2, 1979, Report of Medical History; August 2011 VA Form 21-4138 Statement in Support of Claim. An opinion based on an inaccurate factual premise has no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Board assigns this opinion no probative value. The Veteran was afforded a third VA eye conditions examination in May 2023, where a diagnosis of CSR in the right eye was confirmed again. See May 2023 Eye Conditions DBQ. The VA examiner opined it was less likely than not that the CSR was incurred in or caused by service and explained "the lack of evidence stating visual impairment while in service as well as passage of time since discharge from military duties upon arrival of these eye condition diagnoses nearly 30 years after separation from service is indicative of current complaint of eye condition less likely than not having incurred due to his service duties. . . . . Central Serous Retinopathy is a congenital disease secondary to stress and aging which can deteriorate or improve." See May 2023 Medical Opinion DBQ. Just like the January 2021 examiner, the May 2023 examiner ignored the numerous instances of worsening of vision during service, complaints of blurry vision and headaches and complaints of eye trouble on his separation examination. See February 1977 Report of Medical History; March 2, 1977, Eyewear Prescription; September 20, 1978, Eyewear Prescription and Optometry Clinic STR; February 2, 1979, Report of Medical History; Reonal, supra. The Board assigns this opinion no probative value. The Board notes that January 2024 VA opinions were also rendered regarding CSR in the Veteran's left eye. As there is no evidence in the record of CSR in the Veteran's left eye, and since he was not diagnosed with CSR in the left eye in any of the four VA eye conditions examinations of record, the Board will not discuss those opinions herein. After the July 2025 Board remand requesting additional medical opinions regarding the Veteran's eye conditions, a VA clinician opined that "Known risk factors associated with central serous chorioretinopathy include: Type A personality, no refractive error or mild hyperopia, pregnancy, antibiotics, alcohol, hypertension, sleep apnea, depression, Cushing syndrome, Lupus, organ transplantation, and end-stage renal disease. The Veteran's time in service is not related to any of these risk factors. It is less likely than not that the Veteran's central serous retinopathy is due to his time in service." See September 2025 Medical Opinion DBQ. This opinion, however, again ignored all the eye issues the Veteran experienced and reported during service and upon separation and is conclusory. See Reonal, supra; Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (stating that a medical opinion must support its conclusion with an analysis that the Board can weigh, and a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision). The Board assigns this opinion no probative weight. The Board observes that there are several VA opinions and one private opinion of record regarding secondary service connection/aggravation for CSR. However, because the Board is granting service connection for CSR on a direct basis, the Board will not discuss any of the secondary/aggravation medical opinions of record herein and finds no prejudice in doing so. In December 2025, a private opinion by Dr. P.C., M.D. was associated with the Veteran's claims file. P.C. noted that upon enlistment, the Veteran was in good health, had vision in both eyes, denied wearing contacts or glasses, and had a normal medical examination, including 20/20 uncorrected vision in both eyes. See November 2025 Avitus Health Report. P.C. also noted "In March 1977, Mr. [REDACTED] received an eyewear prescription for -0.75 sphere correction bilaterally and +0.75 cylinder correction bilaterally. In February 1978, Mr. [REDACTED]'s left eyewear prescription was changed to -1.25 sphere correction and +1.25 cylinder correction, but his right eye remained unchanged. In September 1978, he complained of 'headaches, blurred vision.' His uncorrected visual acuity was 20/30 in the right eye and 20/40 in the left, with his corrected visual acuity listed as 20/25 bilaterally. Upon separation from active-duty service, Mr. [REDACTED] reported being in 'good' health but noted he wore glasses for the previous two years and endorsed a history of eye trouble. The examiner noted he had a 'refractive error corrected to 20/20.' In multiple statements over the years, Mr. [REDACTED] explained that he 'did not have any need for and did not have any corrective lenses until after [he] was in the Army' and that he was given a prescription in the Army which was 'way too strong,' and 'ruined [his] eyes.'" P.C. then went on to discuss the Veteran's numerous reports of eye trouble from April 2009 to March 2018 and the four VA eye conditions examinations the Veteran was afforded. See November 2025 Avitus Health Report. P.C. explained that the Veteran suffers from CSR that was not present when he enlisted in the Army in February 1977, and that his CSR disability is not a congenital disease. P.C. further explained "Central serous retinopathy is a retinal condition characterized by serous retinal detachment, primarily affecting the macula and often associated with pigment epithelial detachments, retinal pigment epithelial dysfunction, and choroidal thickening." After discussing the difference between acute, chronic, and recurrent CSR, P.C. explained "Understood risk factors for the development of CSR include conditions like Cushing' s disease which causes endogenous hypercortisolism and conditions like primary hyperaldosteronism which leads to higher levels of androgens, such as testosterone. Exogenous corticosteroid usage is another recognized risk factor, as is H. pylori infection which has also been associated with an increased risk of developing CSR. It should be noted that [the Veteran] did not have any of these diagnoses. Most importantly to [the Veteran], psychological stress, which leads to elevated cortisol levels, has been identified as a significant risk factor for CSR. Research also indicates a notable connection between military service, a known high-stress role, and the development of CSR. The high levels of psychological stress experienced by military personnel leads to stress-induced increases in cortisol levels that can impair the retinal pigment epithelium's function, leading to fluid accumulation under the retina and development of CSR. A 2021 study of male military veterans found that symptoms experienced by [the Veteran], including anxiety, depression, sleep impairment and PTSD-like symptoms, were all independent risk factors for development of CSR. According to a 2024 study of CSR patients, 'Stress and psychiatric disorders contribute to the pathophysiology by many factors: they increase the cardiovascular risks, trigger epigenetic modifications, cause abnormality of the hypothalamic-pituitary-adrenal (HPA) axis, derange metabolic and immune profile, and alter homoeostasis.' The years long gap between his service and CSR diagnosis is consistent with the chronic or recurrent form of retinopathy as studies have shown that significant delays in diagnosis are common and sometime stretch into years and even decades." P.C. then opined "After a thorough review of Mr. [REDACTED]' s medical records, medical opinions, layperson statements and the pertinent medical literature on the subject, it is my medical opinion that, given he entered service with normal vision, developed blurry vision during service and was subsequently diagnosed with CSR that he, at least as likely as not, has a chronic or recurrent form of CSR that was primarily due to the stressful experience of military service. His service-related mental health conditions have continued to aggravate the condition since his discharge from military service by causing persistent stress. I completely disagree with the VA optometrists' characterization of this condition as congenital and reiterate that there is no evidence to support the notion that his CSR existed prior to service. I also disagree with the VA optometrist who failed to recognize the link between his service related trauma and stressor related disorder and the development of CSR and who also failed to recognize the worsening of his CSR symptoms clearly noted in his chart." The Board finds the November 2025 private opinion from P.C. to be competent, credible and probative: The opinion was authored by a licensed clinician who reviewed the Veteran's claims file and was therefore familiar with the Veteran's symptoms, diagnoses, and treatment of his eye conditions, including CSR; the opinion is based on a review of the evidence of record as well as lay statements of the Veteran. Additionally, P.C. has training, knowledge, and expertise on which he relied to form his opinion. Further, the opinion is consistent with the medical evidence of record, and contains clear conclusions with supporting data, including relevant medical literature, connected by a reasoned medical explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-02 (2008). Notably, there are no probative medical opinions or other competent medical evidence of record that weighs against this opinion. Accordingly, the Board finds the November 2025 private medical opinion probative, competent, and persuasive medical evidence in this case. In sum, based on the competent and credible lay and medical evidence of record, and resolving any reasonable doubt in the Veteran's favor, the Board finds that the evidence is persuasively in favor of the claim, and that service connection for CSR is warranted.? 38?U.S.C. §?5107(b); 38?C.F.R. §§?3.102, 3.303.? Given the Board's grant of service connection on a direct basis based on the Veteran's symptoms of CSR during service and continuing after his separation from active duty, all other theories of entitlement are rendered moot. See 38 U.S.C. § 7104.? Accordingly, the appeal is granted.?? S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pawlowski, E. Jennifer 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.