GLAUCOMA

Summary

The Veteran, a veteran who served from July 1980 to July 1983 and October 1984 to July 1989, appeals the denial of service connection for glaucoma. The Veteran was diagnosed with glaucoma in 1994, with symptoms reportedly appearing within one year of his discharge. The initial claim in 2005 was denied without a VA examination, and subsequent appeals were denied based on a lack of new and material evidence. The Board found that the agency of original jurisdiction (AOJ) erred by not providing a VA examination to assess the nexus between the Veteran's in-service refractive errors, his service-connected psychiatric disorder treated with antipsychotics, and his orthopedic conditions causing inflammation, all of which could be related to glaucoma. The Board noted that myopia is a significant risk factor for glaucoma, and inflammation or certain medications can exacerbate it. Citing relevant case law, including McLendon v. Nicholson, the Board determined that the evidence strongly supported granting service connection. The Board found the evidence to be in equipoise, warranting the application of the benefit of the doubt in the Veteran's favor. Service connection for glaucoma is granted. The rating and effective date will be determined by the AOJ.

Rationale

Evidence in equipoise; Benefit of the doubt applied; In-service refractive error and subsequent glaucoma diagnosis; Potential exacerbation from service-connected psychiatric disorder and orthopedic conditions

Full Decision Text

Citation Nr: A26033415
Decision Date: 04/10/26	Archive Date: 04/10/26

DOCKET NO. 250507-542198
DATE: April 10, 2026

ORDER

Service connection for glaucoma is granted.

FINDING OF FACT

The evidence is at least approximately at balance that the Veteran's glaucoma is causally connected to his service.

CONCLUSION OF LAW

The criteria for service connection for glaucoma have been met. 38 C.F.R. § 3.307.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran, a Department of Veterans Affairs (VA) compensation beneficiary service connected for an acquired psychiatric disorder rated totally disabling and multiple orthopedic disabilities causing inflammation, had active duty from July 1980 to July 1983 and from October 1984 to July 1989. This appeal comes before the Board of Veterans' Appeals on his May 2025 VA Form 10182 challenging the January 2022 rating decision issued by the VA agency of original jurisdiction (AOJ) denying him service connection for glaucoma diagnosed in 1994, with medical treatment records including comments indicating that symptoms consistent with glaucoma had been reported by the Veteran as present for about four years prior to the diagnosis, that is, as experienced since 1990, within one year after his discharge from service. 

The record, however, demonstrates that-after the Veteran filed a claim for service connection for glaucoma in 2005, triggering the now phased out legacy system of review-his claim was denied without any VA medical examination. The original denial eventually produced an October 2007 Statement of the Case (SOC) acknowledging that the Veteran experienced vision-related symptoms in service and was treated for refractive error but-without any medical opinion to support this conclusion-the AOJ held that the Veteran's refractive error diagnosis was unrelated to his glaucoma. That SOC was followed by multiple Supplemental SOCs (SSOCs) that declined to revisit the Veteran's challenges on the grounds that he has not presented new and material evidence short of his various forms of paraphrasing his original claim that he experienced symptoms consistent with early onset of glaucoma in service but his reports of the symptoms resulted only in in-service treatment of his refractive errors. Thus, based on the original denial of a VA examination, the claim remained denied for over two decades. 

The denial-citing the lack of new and material evidence-persisted without the required VA assistance to determine whether the Veteran's reports of vision problems, his undeniably treated in service refractive errors, and his service-connected acquired psychiatric disorder (that required medications) and his multiple orthopedic disabilities (that manifested by symptoms that produced inflammation, especially during flare-up periods) were causally related. Moreover, no assessment of the Veteran's glaucoma as a chronic neurological condition was conducted, thereby producing an error as a matter of law. 

Under McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006), as part of its duty to assist, VA must provide a claimant with a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; and (3) an indication that the disability or persistent or recurrent symptoms of disability may be associated with the veteran's service or with another service-connected disability; but (4) there is insufficient competent medical evidence of record to decide the claim. 

It is well established that refractive errors significantly influence glaucoma risk, with myopia, acting as a major risk factor for open-angle glaucoma and normal-tension glaucoma. See https://pmc.ncbi.nlm.nih.gov/articles/PMC4695304; https://pubmed.ncbi.nlm.nih.gov/11782219. Analogously, it is well established that inflammation might cause or exacerbate glaucoma, see, e.g., https://www.arthritis.

org/health-wellness/about-arthritis/related-conditions/physical-effects/six-ways-arthritis-can-affect-your-eyes, and treatments of schizophrenia (that is, the Veteran's service-connected psychiatric disorder), particularly antipsychotics with high anticholinergic effects, can exacerbate or trigger glaucoma (especially narrow-angle) by increasing eye pressure. See, e.g., https://link.springer.com/

article/10.1007/s40263-025-01249-6; https://glaucomatoday.com/articles/2014-jan-feb/glaucoma-associated-with-therapies-for-psychiatric-disorders. 

Based on the foregoing, the Veteran should have been afforded a VA examination to address his glau
-arthritis/related-conditions/physical-effects/six-ways-arthritis-can-affect-your-eyes, and treatments of schizophrenia (that is, the Veteran's service-connected psychiatric disorder), particularly antipsychotics with high anticholinergic effects, can exacerbate or trigger glaucoma (especially narrow-angle) by increasing eye pressure. See, e.g., https://link.springer.com/

article/10.1007/s40263-025-01249-6; https://glaucomatoday.com/articles/2014-jan-feb/glaucoma-associated-with-therapies-for-psychiatric-disorders. 

Based on the foregoing, the Veteran should have been afforded a VA examination to address his glaucoma claim upon duly crediting his recollections and properly reviewing the causal impact of his refractive errors, treatments of schizophrenia, and orthopedic conditions that manifested in frequent inflammations, as well as the treatments of those conditions. See Delacruz v. Collins, 2026 U.S. App. Vet. Claims LEXIS 261 (2026) (discussing McLendon); Hernandez v. Collins, 2026 U.S. App. Vet. Claims LEXIS 253 (Feb. 13, 2026) (stressing the low threshold for the obligation triggering the duty to comply with McLendon); Ordonez v. Collins, 2025 U.S. App. Vet. Claims LEXIS 1219 (Sep. 2, 2025) (emphasizing the same with regard to claims developing from the legacy-system litigation) see also Murphy v. Wilkie, 2019 U.S. App. Vet. Claims LEXIS 1107 (2019) (remanding denial of service connection for glaucoma based on inadequate assistance with a VA examination); accord Ortega v. McDonough, 2024 U.S. App. Vet. Claims LEXIS 996 (2024) (same); Cochrane v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 324 (2020) (same).

Further, the AOJ's position regarding new and material evidence is deficient, even more so in light of the Veteran's application that led to the appeal at bar because this last application was submitted within the AMA system, which has replaced the new and material evidence standard with a markedly less demanding new and relevant evidence requirement. 

Indeed, with regard to new and material evidence and the failure to provide a VA examination in connection with a prior claim, while 38 U.S.C. § 5103A "does not require VA to assist claimants attempting to reopen," nevertheless "VA has chosen to assist claimants attempting to reopen in limited circumstances."  Paralyzed Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334, 1353 (Fed. Cir. 2003). Moreover, under 38 U.S.C. § 5103A(i), "[n]othing . . . preclude[s] the Secretary from providing such other assistance under subsection (a) to a claimant in substantiating a claim as the Secretary considers appropriate," and it is hard to imagine a situation more appropriate for a VA examination where such assistance should have been but was not provided in the first place. See White v. Derwinski, 1 Vet. App. 519-20 (1991); see also Ivey v. Derwinski, 2 Vet. App. 320 (1992); accord Booth v. Brown, 8 Vet. App. 109 (1995); Counts v. Brown, 6 Vet. App. 473 (1994), appeal dismissed 66 F.3d 345 (Fed. Cir. 1995), cert. denied, 516 U.S. 1158 (1996).

Therefore, while the Board does not find that the AOJ committed a clear and unmistakable error by denying the Veteran a VA examination, Cook v. Principi, 318 F.3d 1334, 1344-47 (Fed. Cir. 2002), a remand would have been warranted, especially because the new and relevant AMA evidence standard is markedly less demanding. 38 C.F.R. § 3.2501(a) ("The new and relevant standard will not impose a higher evidentiary threshold than the previous new and material evidence standard under § 3.156(a)"); VA Adjudication Procedures Manual, M21-1, X.ii, 2.A.2.d ("[n]ew evidence that affirms findings previously deemed favorable to the claimant is still relevant.  There is no requirement that relevant evidence prove a previously unsubstantiated matter"). 

But no remand is warranted where, on
1344-47 (Fed. Cir. 2002), a remand would have been warranted, especially because the new and relevant AMA evidence standard is markedly less demanding. 38 C.F.R. § 3.2501(a) ("The new and relevant standard will not impose a higher evidentiary threshold than the previous new and material evidence standard under § 3.156(a)"); VA Adjudication Procedures Manual, M21-1, X.ii, 2.A.2.d ("[n]ew evidence that affirms findings previously deemed favorable to the claimant is still relevant.  There is no requirement that relevant evidence prove a previously unsubstantiated matter"). 

But no remand is warranted where, on the record already accrued, the Board is in a position to find that the Veteran's glaucoma should have been awarded service connection.  Under 38 C.F.R. § 3.307(c), while "[n]o presumptions may be invoked on the basis of advancement of the disease when first definitely diagnosed for the purpose of showing its existence to a degree of 10 percent within the applicable period," "[t]his will not be interpreted as requiring that the disease be diagnosed in the presumptive period, but only that there be then shown by acceptable medical or lay evidence characteristic manifestations of the disease to the required degree, followed without unreasonable time lapse by definite diagnosis. Symptomatology shown in the prescribed period may have no particular significance when first observed, but in the light of subsequent developments it may gain considerable significance. Cases in which a chronic condition is shown to exist within a short time following the applicable presumptive period, but without evidence of manifestations within the period, should be developed to determine whether there was symptomatology which in retrospect may be identified and evaluated as manifestation of the chronic disease to the required 10-percent degree."

Further, the list of organic diseases of the nervous system, stated in VA Adjudication Procedures Manual, V.iii.12.A.1.d, Other Organic Diseases of the Nervous System Under 38 C.F.R. § 3.309(a) (updated September 14, 2023), includes glaucoma. While the Manual is not binding on the Board, the Board may rely on the Manual if it finds its provisions instructive and applicable to the matters at bar.

Here, the record strongly supports granting the Veteran's claim. There is no dispute that he experienced vision problems in service and was diagnosed and treated for refractive error, a condition known to cause glaucoma. The Veteran's medical treatment records reflect his lay statements that his vision-while treated for refractive error-continued manifesting with additional symptoms, thereby prompting him to seek further medical assistance, and his medical providers made findings tracing his glaucoma back to one year after his discharge. Accordingly, while the record demonstrates that the Veteran's glaucoma symptoms were minor, they manifested within a compensable degree during the period applicable to chronic diseases. A fortiori, the Veteran's reports of glaucoma and his acquired psychiatric disorder and inflammations of joints lend additional support for award of service connection of the secondary basis, but this finding does not need to be made in light of the Veteran's entitlement to service connection of the primary basis. Finally, the fact that the Veteran's glaucoma remained well controlled is inapposite to the issue of service connection because it relates only to its rating.

In light of the foregoing, and mindful that the Veteran's burden to establish service  connection is merely by equipoise evidence, meaning that evidence does not even  have to be perfectly at balance and could be even slightly below equal in favor of the Veteran to support his claim for service connection for glaucoma, the claim is granted. No statement in this Order should be construed as dispositive with regard to the rating or effective date of the grant, and these matters are to be addressed by the AOJ. The Veteran is reminded that, in the event he disagrees with either the rating or the effective date determinations, his timely actions would be required to bring these claims to the Board's attention.

In conclusion, the Board thanks the Veteran for his honorable service to the nation. 

 

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Anna Kapellan, 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.