Citation Nr: 20076566
Decision Date: 12/02/20	Archive Date: 12/02/20

DOCKET NO. 16-36 259
DATE: December 2, 2020

ORDER

Entitlement to service connection for an eye disability, to include bilateral lattice degeneration with atrophic holes and blepharitis, is denied.

FINDING OF FACT

The competent evidence does not attribute the Veteran’s bilateral lattice degeneration with atrophic holes or blepharitis to active duty service.

CONCLUSION OF LAW

The criteria for service connection for an eye disability, to include bilateral lattice degeneration with atrophic holes and blepharitis have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty service from July 1973 to July 1976 and from December 1978 to April 1990.

This matter is on appeal before the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision dated in September 2015.

The Veteran testified at a Board hearing in July 2019. A copy of the transcript is of record.

This case was most recently remanded by the Board in October 2019 for additional development. The Board finds that the AOJ substantially complied with the remand directives, making another remand unnecessary.

1. Entitlement to service connection for an eye disability, to include bilateral lattice degeneration with atrophic holes and blepharitis

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996).

The Board must assess the credibility and weight of all of the evidence to determine its probative value, accounting for evidence that 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); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value.

Turning to the evidence, the Board notes that the Veteran was not diagnosed with bilateral lattice degeneration or blepharitis during service. The Veteran’s service treatment records (STRs) are silent for either diagnosis. The Veteran had a normal clinical evaluation of his eyes in September 1976, June 1977, October 1978, and July 1983. In June 1985, the Veteran had a foreign body in his left eye. He reported pain, watering, and blurred vision. The Veteran had mild edema and a possible corneal abrasion. His eye was flushed and a dressing applied. A few days later, the Veteran’s left eye was checked. He had a corneal abrasion, which was resolving. He was asymptomatic.

At an outpatient appointment in October 1995, the Veteran’s eyes were normal. No abrasion was noted.

In July 1996, the Veteran was diagnosed with retinal holes.

Outpatient records show that the Veteran has refractive error (presbyopia) and blepharitis.

The Veteran underwent a VA examination for eye conditions in September 2015. He was diagnosed with lattice degeneration with atrophic holes. The Veteran reported a history of eye injury, when he got dirt in his face. He reported that a foreign body was removed and he wore an eye patch for about one week. On physical examination of the external eyes, the Veteran’s corneas were normal. An internal eye examination showed abnormal retinas, as the Veteran had lattice degeneration without holes of the right eye, and lattice degeneration with atrophic holes of the left eye. There was no decrease in visual acuity or other visual impairment attributable to the Veteran’s eye conditions. The examiner reviewed the Veteran’s STRs, which showed foreign body removal with redness and corneal abrasion, but normal vision acuity bilaterally. The examiner opined that the Veteran’s lattice degeneration is “very unlikely (less likely than not)” related to a prior corneal foreign body or corneal abrasion because there was no evidence of residual effects from his in-service eye injury and the Veteran’s corneas were clear without scarring. The lattice degeneration with atrophic holes are “incidental” and unrelated to the foreign body in service.

The Veteran submitted his Form 9 in August 2016. He reported that the September 2015 examiner did not examine his eyes. The Veteran also indicated that he had sensitivity to light after his in-service injury, and his eyesight got progressively worse since, but glasses do not work properly. His symptoms also included trouble with night vision and his left eye “twitches.” He also reported playing football and boxed at West Point.

The Veteran testified at a Board hearing in July 2019. He testified to dry eyes, visual distortions, reduced central vision, difficulty adapting to low light, blurriness, dry eyes, and occasional difficulty recognizing faces. The Veteran also testified that he had light sensitivity during service, and that his problems with visual acuity began then. The Veteran further indicated that he had atrophic holes two years after separation, and he contended that his dry eyes were caused by his in-service injury, which subsequently contributed to his atrophic holes.

The Veteran was afforded another VA examination in December 2019. The symptoms to which the Veteran testified in July 2019 were documented by the VA examiner. The Veteran also reported eye irritation, and feeling like there was something under his left eyelid. He used warm compresses and lubricating eye drops. Visual acuity was reported to be 20/20 or better bilaterally, when corrected, both near and at a distance. The Veteran did not have a visual field defect, or any scarring attributable to an eye condition. The examiner opined that it is less likely than not that the Veteran’s lattice degeneration and atrophic retinal holes were incurred in or caused by an eye injury during service, including boxing and playing football. The examiner explained that lattice degeneration is a peripheral retinal thinning that occurs on its own, and more often than not occurs without trauma and is unlikely to form as the result of trauma. The thinning is a result of stretching of the retina, and the thinning can cause breaks in the retina, which are atrophic retinal holes. Atrophic retinal holes are holes that did not result from trauma or injury; trauma to the eye and head can cause a retinal hole, but it is not the type that is atrophic in appearance. 

Additionally, the Veteran’s reports of dry eyes are unrelated to service and unrelated to lattice degeneration. The in-service injury was to the Veteran’s cornea, the front surface of the eye, and his lattice degeneration is in the retina, the back of the eye. There is no connection or pathophysiological relationship between a corneal injury and retinal thinning. The examiner also indicated that the Veteran’s symptoms, including worsening visual acuity and dry eyes, are more likely than not unrelated to boxing and playing football or an ocular injury during service. Additionally, the Veteran has no signs or symptoms relating to a chronic disability from his time in service. The eye injury in service was an isolated event, managed and treated correctly according to the STRs, and no sequela have developed. The examiner also provided negative nexus opinions for blepharitis and presbyopia. Refractive error with presbyopia is a result of an ageing eye, since humans lose the ability to focus as we age. Presbyopia is unrelated to trauma or injury. Blepharitis is the inflammation of the eyelids and is unrelated to the foreign body during service, as the injury did not involve the eyelid.

After a de novo review of the evidence, the Board concludes that the Veteran’s claim for service connection for an eye disability, including lattice degeneration with atrophic holes, blepharitis, and refractive error with presbyopia, is not warranted.

First, to the extent that the Board must consider service connection for refractive error with presbyopia, the Board finds that the claim must be denied. VA regulations provide that refractive error of the eyes are not diseases or injuries within in the meaning of applicable legislation for disability compensation purposes. See 38 C.F.R. §§ 3.303 (c), 4.9; see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). Therefore, service connection may not be granted on a direct basis for refractive error (including presbyopia. See also Terry v. Principi, 340 F.3d 1378, 1383-84 (Fed. Cir. 2003). Presbyopia is a visual condition that becomes apparent especially in middle age and in which loss of elasticity of the lens of the eye causes defective accommodation, and inability to focus sharply for near vision. McNeely v. Principi, 3 Vet. App. 357, 364 (1992). Presbyopia is “hyperopia and impairment of vision due to old age.” Dorland’s Illustrated Medical Dictionary 1349 (28th ed. 1994). Moreover, the December 2019 examiner only noted diagnoses of lattice degeneration, blepharitis, and refractive error with presbyopia, and that the Veteran “has 20/20 vision in both eyes at both distance and near with the correct spectacle lens prescription.” Additionally, even considering the Veteran’s reports of symptoms, such as dry eyes and light sensitivity, there are “no signs that support any chronic disability related to these symptoms.” Finally, the examiner opined that the in-service eye injury “was an isolated event and no further sequela resulted.” Therefore, the Board finds there is no resulting current eye disability in the record warranting the grant of service connection for a refractive error with presbyopia.

Second, the Board concludes that service connection for lattice degeneration with atrophic holes is not warranted. While the Veteran indicated that the September 2015 examiner did not actually examine his eyes, the Board finds that the December 2019 VA examination is adequate to decide the claim. The examiner addressed the Veteran’s reported symptoms, provided a thorough and logical rationale for all conclusions, and explained the etiology of lattice degeneration with atrophic holes. Importantly, the December 2019 VA examiner, having reviewed the Veteran’s records, concluded that his lattice degeneration is unrelated to service, including boxing, playing football, and a corneal abrasion in 1985. Specifically, the examiner explained that the foreign body was not in the Veteran’s retina, and that the atrophic holes were not traumatic in nature. The opinion receives significant weight in the Board’s conclusion. Therefore, with a negative nexus opinion receiving significant weight, the Board concludes that service connection must be denied.

Third, the Board concludes that service connection for blepharitis is not warranted. In forming this conclusion, the Board affords the December 2019 significant weight, as the examiner reviewed the Veteran’s STRs and addressed the etiology of blepharitis. Specifically, the examiner explained that the in-service injury did not involve the eyelid, and that the foreign body was removed without sequelae. Therefore, with a negative nexus opinion receiving significant weight, the Board concludes that service connection for blepharitis must be denied.

Additionally, there is no evidence to suggest that the Veteran is competent to provide a nexus opinion. The issue is medically complex, as it requires the interpretation of symptoms, history, and medical findings by a trained medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the December 2019 VA examiner explained that the Veteran’s lattice degeneration and blepharitis were not incurred in or related to service, the Board must rely on the competent medical evidence before it in forming its conclusion, specifically the December 2019 VA examination receiving significant weight. Therefore, the opinions regarding blepharitis and lattice degeneration are afforded more weight than the Veteran’s report of symptoms.

Ultimately, the Board finds that the weight of the evidence is against the claim and service connection for an eye disability, including blepharitis and lattice degeneration with atrophic holes, is not warranted. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). 

 

S. L. Kennedy

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	M. Smith, Associate 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.