CORNEAL DISEASE INCLUDING SCARS OPACITIES

Summary

The Veteran, an Army Veteran who served from November 2013 to June 2018, appeals the denial of service connection for dry eye syndrome, photophobia, and right knee patellofemoral pain syndrome (PFPS), and seeks remand for right and left shoulder strains. The Board granted service connection for dry eye syndrome and photophobia, noting a June 2021 VA examiner's opinion that these conditions were at least as likely as not related to service, specifically linking dry eyes to PRK surgery and photophobia to its aftermath. The Board found this opinion persuasive and unrefuted. For the right knee PFPS, the Board acknowledged the Veteran's existing service connection for right knee strain and a June 2021 VA examination diagnosing PFPS. Despite a July 2021 VA examiner's unfavorable opinion, the Board found its rationale nonsensical and resolved doubt in the Veteran's favor, granting service connection for right knee PFPS. The claims for right and left shoulder strains were remanded. For the right shoulder strain, the Board found a June 2021 VA examiner's opinion inadequate as it did not address aggravation by the service-connected lumbosacral strain. For the left shoulder strain, the Board found the June 2021 VA examiner's opinion contradictory and inadequate, failing to provide a nexus or secondary relationship. Remand actions require addendum opinions on aggravation and causation/aggravation, respectively.

Rationale

Current diagnosis of dry eye syndrome; In-service treatment for dry eyes; June 2021 VA examiner opinion: at least as likely as not related to service; No competent medical opinion to refute nexus or suggest alternative etiology

Full Decision Text

Citation Nr: A26034584
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 210812-179089
DATE: April 14, 2026

ORDER

Service connection for dry eye syndrome and photophobia is granted.

Service connection for right knee patellofemoral pain syndrome (PFPS) is granted.

REMANDED

Service connection for right shoulder strain is remanded.

Service connection for left shoulder strain is remanded.

FINDINGS OF FACT

1. Dry eye syndrome and photophobia are related to eye surgery performed during active service.

2. Right knee PFPS is etiologically related to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for dry eye syndrome and photophobia have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 

2. The criteria for service connection for right knee patellofemoral pain syndrome have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the U.S. Army from November 2013 to June 2018.  An initial rating decision was issued in July 2021; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In his August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  On October 29, 2024, the Veteran withdrew the hearing request.  Therefore, the Board may only consider the evidence of record at the time of the July 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302(b).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

Because the Board is remanding the claims of service connection for left and right shoulder disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims.  38 C.F.R. § 3.103(c)(2)(ii).  However, the claims for service connection for dry eyes and right knee PFPS are being fully granted.  Therefore, any procedural or duty-to-assist error was not prejudicial to the Veteran for those claims.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Dry eyes syndrome and photophobia

The AOJ favorably found that the Veteran has current diagnoses of dry eye syndrome and photophobia.  It also favorably found that the Veteran was treated for dry eyes during service.  The Board notes that the Veteran also underwent photorefractive keratectomy (PRK) surgery for his eyes in August 2016.

A June 2021 VA examiner stated that the Veteran's current dry eye syndrome and photophobia are at least as likely as not related to service, noting that dry eyes are the number one complication from PRK surgery, and that the Veteran reported the onset of photophobia after the surgery took place.

There is no competent medical opinion to refute this conclusion or otherwise indicate an alternative etiology for the claimed disabilities.  Therefore, service connection is appropriate.

Right knee PFPS

Service connection for right knee strain was granted in an April 2021 rating decision.  This was based in part on a September 2020 VA examination which diagnosed knee strain.  In a June 2021 VA examination of the knees, the Veteran was also diagnosed with right knee PFPS.  It appears
 that the Veteran's current dry eye syndrome and photophobia are at least as likely as not related to service, noting that dry eyes are the number one complication from PRK surgery, and that the Veteran reported the onset of photophobia after the surgery took place.

There is no competent medical opinion to refute this conclusion or otherwise indicate an alternative etiology for the claimed disabilities.  Therefore, service connection is appropriate.

Right knee PFPS

Service connection for right knee strain was granted in an April 2021 rating decision.  This was based in part on a September 2020 VA examination which diagnosed knee strain.  In a June 2021 VA examination of the knees, the Veteran was also diagnosed with right knee PFPS.  It appears this examination was prompted by a left knee claim.  However, having diagnosed right knee PFPS, the AOJ then sought an opinion regarding etiology.

In July 2021, a VA examiner stated that right knee PFPS was less likely than not related to service.  However, the rationale is nonsensical.  She stated, "No chronic diagnosis is made for right knee from flexion," "C-file silent for a diagnosis of right knee strain from degenerative joint disease extension," and "Unable to confirm a chronic diagnosis right knee from degenerative joint disease extension."  There is no reference to PFPS specifically.

Given that the Veteran is already service-connected for right knee strain and noting that he is also service-connected for left knee PFPS, the Board will resolve any doubts in his favor in concluding that right knee PFPS is related to service.

REASONS FOR REMAND

Service connection for right shoulder strain 

The AOJ favorably found that the Veteran has a current diagnosis of right shoulder strain.  He contends this disability is secondary to his service-connected lumbosacral strain.  A June 2021 VA examiner concluded that the shoulder condition was not caused by lumbosacral strain but did not address whether it was aggravated by lumbosacral strain.  This is a breach of VA's pre-decisional duty-to-assist and should be corrected on remand.

Service connection for left shoulder strain 

The AOJ favorably found that the Veteran has a current diagnosis of left shoulder strain.  He contends this disability is secondary to his service-connected lumbosacral strain.  Despite diagnosing a strain, the June 2021 VA examiner stated that she was unable to confirm a current diagnosis based on the available records and examination findings.  Therefore, there was no nexus or secondary relationship.  This opinion contradicts the diagnosis of a shoulder strain noted during the examination and is therefore not adequate.  This is a breach of VA's pre-decisional duty-to-assist and should be corrected on remand.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right shoulder strain, diagnosed in a June 2021 VA examination, is at least as likely as not aggravated by his service-connected lumbosacral strain.

A complete rationale must be provided for all opinions expressed. If an opinion cannot be provided without resort to speculation, the examiner should explain whether the inability to provide the needed opinion is due to the limits of medical knowledge generally, a lack of expertise from the examiner, or inadequate information such as missing evidence.  If a new examination is necessary to provide the requested opinion, one should be scheduled.

2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's left shoulder strain, diagnosed in a June 2021 VA examination, is at least as likely as not a) caused by his service-connected lumbosacral strain, and b) aggravated by his service-connected lumbosacral strain.

A complete rationale must be provided for all opinions expressed. If an opinion cannot be provided without resort to speculation, the examiner should explain whether the inability to provide the needed opinion is due to the limits of medical knowledge generally, a lack of expertise from the examiner, or inadequate information such as missing evidence.  If a new examination is necessary to provide the requested opinion, one should be scheduled.

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Patel, Shamil

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.