PERIPHERAL VESTIBULAR DISORDERS

LUKE PELICAN · 2026 · Case ID: A26036397

DENIED

Summary

The veteran, who served honorably in the United States Air Force from July 1967 to April 1971, appeals the denial of service connection for dizziness, headaches, and reddened sclerae, all claimed as secondary to his service-connected hypertension. The Board reviewed the evidence, including VA examinations and medical opinions obtained after a prior remand. For dizziness and headaches, the VA examiners found no medical diagnosis or substantiation for the Veteran's subjective complaints, noting the absence of treatment history and the lack of a clear link to hypertension in medical literature. While acknowledging the Veteran's lay statements and belief that hypertension caused these symptoms, the Board found the VA opinions more probative due to the lack of objective medical evidence and the general medical understanding that hypertension is often asymptomatic or linked to severe complications. The Board also considered medical articles submitted by the Veteran but found they did not support his specific symptomology or establish a causal link without severe, uncontrolled hypertension, which was not evidenced. For reddened sclerae, the VA examiner diagnosed other eye conditions but not reddened sclerae, and opined it was less likely than not related to hypertension, citing a lack of studies linking the two. The Board acknowledged the Veteran's belief but found no in-service event or injury for the reddened eyes, and the medical evidence did not support a causal or aggravating link to hypertension. The Board denied all claims, finding no current disability or nexus to service or hypertension.

Rationale

No medical diagnosis for dizziness; No objective findings on examination; No medical evidence or history to substantiate complaints; No medical literature supports link between hypertension and dizziness; Symptoms described as vague and unsubstantiated

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251001-583604

Full Decision Text

Citation Nr: A26036397
Decision Date: 04/20/26 Archive Date: 04/20/26

DOCKET NO. 251001-583604
DATE: April 20, 2026

ORDER

Entitlement to service connection for dizziness, including as secondary to hypertension, is denied.

Entitlement to service connection for headaches, including as secondary to hypertension, is denied.

Entitlement to service connection for eye condition, claimed as reddened sclerae, including as secondary to hypertension, is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran had a dizziness disability during the pendency of the claim or at the time of or recent to the filing of the claim.

2. The evidence of record persuasively weighs against finding that the Veteran had a headache disability during the pendency of the claim or at the time of or recent to the filing of the claim.

3. The evidence of record persuasively weighs against finding that the Veteran's eye condition, claimed as reddened sclerae, was incurred or aggravated during active-duty service, caused or aggravated by his service-connected hypertension, or otherwise related to active-duty service or his service-connected hypertension.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for dizziness have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.310, 4.3.

2. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.310, 4.3.

3. The criteria for entitlement to service connection for eye condition, manifested as reddened sclerae, have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.310, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran honorably served on active duty in the United States Air Force from July 1967 to April 1971. He was awarded the National Defense Service Medal, Air Force Good Conduct Medal, and Vietnam Service Medal, among others.

Evidence Window

In the October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the October 2024 agency of original jurisdiction (AOJ) rating decision on appeal, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of, the VA Form 10182. See 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182 (October 4, 2024 to October 1, 2025), or (2) more than 90 days following the date the Board received the VA Form 10182 (December 30, 2025), the Board did not consider it in its decision. See 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. See 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. See Cook v. McDonough, 36 Vet. App. 175 (2023).

Preliminary Matter

The October 2024 rating decision on appeal was issued following a remand by the Board. In a June 2023 Board decision that denied an initial compensable rating for hypertension, the issues of entitlement to service connection for headaches, service connection for eye condition manifested by reddened sclerae, and service connection for dizziness were remanded for clarifying medical opinions, pursuant to Bailey v. Wilkie, 33 Vet. App. 188, 203-04 (2021). The Board explained that the Veteran provided a lay statement in January 2023 indicating that he had headaches and other complications from his hypertension, but the VA clinicians did not provide adequate rationale for whether the claimed headaches, reddened sclerae, or dizziness were causally related to the hypertension. The remand also directed clarification of the physical findings in connection with the headache exam, and clarification regarding etiology of the claimed dizziness.

After remand, the AOJ obtained VA DBQ examinations and medical opinions to address whether the claimed headaches, eye condition manifested as reddened sclerae, and dizziness were caused by or aggravated by the Veteran's service-connected hypertension.

The Board finds that the VA examinations and medical opinions, after remand, adequately address the Veteran's statements, medical history, and findings on examination. Additionally, the VA clinicians provide adequate rationale for the opinions stated therein.

Service connection legal criteria

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d).

Establishing direct service connection generally 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. See 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding that "but for" causation or aggravation is enough to show entitlement to secondary service connection).

In the absence of proof of a current disability, there can be no valid claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, even should the disability resolve prior to the Secretary's adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 310 (2007).

Evidence Assessment

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomology. Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 494
person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 494 F.3d at 1376-77.

The Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In Jefferson v. Principi, 271 F.3d 1072, 1076 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit, citing its decision in Madden, recognized that the Board had inherent fact-finding ability. See also 38 U.S.C. § 7104(a). Further, the Court has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. See Bryan v. West, 13 Vet. App. 482 (2000); Wilson v. Derwinski, 2 Vet. App. 614 (1992).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When a Veteran seeks benefits and the evidence is in relative equipoise, the Veteran prevails. See Gilbert v. Derwinski, 1?Vet. App.?49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. See Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

The Board has reviewed the evidence in the claims file, with an emphasis on the evidence pertinent to the issues on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss in detail all contents of the extensive evidence of record. See Gonzalez v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim.

1. Entitlement to service connection for dizziness, including as secondary to hypertension, is denied.

2. Entitlement to service connection for headaches, including as secondary to hypertension, is denied.

The Veteran seeks secondary service connection for his claimed dizziness and headaches. He asserts that his service-connected hypertension caused and/or aggravated his dizziness and headaches. The Veteran submitted medical articles in support of this claim. See October 2025 Attorney Argument; October 2025 Medical Articles.

In the October 2024 rating decision on appeal, the AOJ made a favorable finding that the Veteran is service connected for hypertension. The Board is bound by this favorable finding absent clear and unmistakable error. See 38 C.F.R.§ 3.104(c).

Evidence and Analysis

VA Examinations and Medical Opinions

The Veteran was afforded a VA Headaches DBQ examination in September 2024. The VA examiner made no diagnosis of a headache condition. The VA examiner reported that the Veteran gave a history of unspecified headaches which onset in the 2000s. He stated the headaches are in the temporal region and occur 1 to 2 times per month and last a few hours. He takes Tylenol and lays down to alleviate the pain. The Veteran denied other symptoms are associated with the headaches, denied prostrating attacks, and denied physical findings, conditions, or complications related to his headaches. The VA examiner further reported that the claim file is silent for any diagnosis, treatment, or care for any type of headaches. With respect to functional impact, the examiner indicated
Q examination in September 2024. The VA examiner made no diagnosis of a headache condition. The VA examiner reported that the Veteran gave a history of unspecified headaches which onset in the 2000s. He stated the headaches are in the temporal region and occur 1 to 2 times per month and last a few hours. He takes Tylenol and lays down to alleviate the pain. The Veteran denied other symptoms are associated with the headaches, denied prostrating attacks, and denied physical findings, conditions, or complications related to his headaches. The VA examiner further reported that the claim file is silent for any diagnosis, treatment, or care for any type of headaches. With respect to functional impact, the examiner indicated that the Veteran's claimed headaches did not impact his ability to work.

A VA DBQ Medical Opinion was also obtained in September 2024. The VA clinician noted the assertion by the Veteran of headaches related to his hypertension, the conceded in-service toxic exposures, and the requested clarifications sought on remand. Finding no history of diagnosis, treatment, or care for any type of headaches, the VA clinician opined that no medical diagnosis is warranted or could be rendered. The VA clinician also noted that no baseline or nexus could be established absent any medical history or record of any types of headache complaints, diagnosis, or treatment. The VA clinician considered and quoted from a published January 2023 study, noting that "most people with high blood pressure have no symptoms, even if blood pressure readings reach dangerously high levels. You can have high blood pressure for years without any symptoms. A few people with high blood pressure may have: Headaches, Shortness of breath, Nosebleeds....They usually do not occur until high blood pressure has reached a severe or life-threatening stage." The VA clinician reviewed the Veteran's blood pressure readings and stated that given his hypertension readings, the Veteran's symptoms have a different etiology outside the claimed hypertension. The VA clinician further stated that she disagrees with the Veteran's complaints of dizziness and headaches being related to the hypertension. It was notated that the dizziness is likely completely unrelated to the hypertension, and there is a plethora of other origins for the complaint. Additionally, the VA clinician reported that the claim of headaches related to hypertension is not substantiated by the literature. Further explaining the opinions, the VA clinician states that a thorough review of medical literature failed to demonstrate a causal relationship between the claimed hypertension and episodes of dizziness and headaches. The etiology of dysfunctions and disorders is a medical determination and is to be confirmed with objective medical evidence. In summary, the VA clinician stated she could not report the claimed association between dizziness and headache symptoms without mere speculation.

The Veteran was afforded a VA Ear Condition DBQ in September 2024. The VA examiner made no diagnosis. The Veteran reported onset of dizziness in the late 1990s after being diagnosed with high blood pressure. He reported feeling "woozy" when out in the sun or getting up in the morning. He would sit on the side of his bed for a few minutes. The VA examiner reported no vestibular condition and no inflammatory or infectious condition. The physical examination findings were all normal. With respect to functional impact, the examiner noted the Veteran's reported dizziness did not impact his ability to work. The VA examiner reviewed the claim file and reported that it was silent for any complaints of dizziness, though the Veteran was self-reporting symptoms of dizziness. Therefore, the VA examiner concluded that absent evidence to substantiate the symptoms and based solely on subjective complaints with no medical evidence, it would be medical speculation to render an ENT/Ear condition diagnosis.

A VA Medical Opinion was also obtained in September 2024, to consider the VA Ear Condition DBQ. The VA clinician noted the Veteran's TERA exposure and his claims that his hypertension caused headaches, shortness of breath, and occasional nosebleeds. The VA clinician reports that the Veteran is in actuality reporting a potential dizziness symptom, but the complete record, medical history, and Veteran's statements do not support a medical diagnosis. It is further reported that the claim file is silent about any complaints of dizziness, and the Veteran's self-reported symptoms are vague and not substantiated by medical evidence. The VA clinician then reports that there is no medical evidence to substantiate a diagnosis and no nexus can be established.

Medical Articles

The Veteran submitted medical articles and information published on the Cleveland Clinic website. In a May 2022 article, "High Blood Pressure and Headaches: Is there a Link?" it is reported that having "mild (stage 1) or moderate (stage 2) hypertension is not likely to cause headaches."
izziness symptom, but the complete record, medical history, and Veteran's statements do not support a medical diagnosis. It is further reported that the claim file is silent about any complaints of dizziness, and the Veteran's self-reported symptoms are vague and not substantiated by medical evidence. The VA clinician then reports that there is no medical evidence to substantiate a diagnosis and no nexus can be established.

Medical Articles

The Veteran submitted medical articles and information published on the Cleveland Clinic website. In a May 2022 article, "High Blood Pressure and Headaches: Is there a Link?" it is reported that having "mild (stage 1) or moderate (stage 2) hypertension is not likely to cause headaches." It is noted that "the vast majority of people have no symptoms whatsoever from high blood pressure but if your blood pressure spikes to an unusually high level, you may have symptoms including a headache." The website information also states that "another thing to remember about headaches and blood pressure is that it is not always blood pressure that causes a headache."

The information submitted by the Veteran includes an article entitled "How Do You Treat Dizziness from High Blood Pressure?" updated on October 4, 2023, by Rachael Zimlich. The article states that dizziness alongside high blood pressure can signal more serious medical complications and the risk of dizziness from high blood pressure increases with age. Importantly, the article states dizziness can appear as a symptom of high blood pressure, but it is more often linked to severe complications of uncontrolled high blood pressure. It is also stated that there are other possible causes of dizziness such as vertigo, ear disorders, migraines, low blood sugar, and dehydration. Therefore, consult with a doctor about individual symptoms and medical history may be necessary.

The Veteran also submitted an article entitled "Easy Habits That Will Help You Stay Healthy at Work" dated March 23, 2022, by Amy Boyington, published in the Health Digest. The article discusses stress management, healthy habits to avoid illness, and maintaining good habits for mental and emotional health.

Other Medical Evidence

The enlistment and separation examinations and medical histories do not report or notate hypertension, headaches, or dizziness. The Service Treatment Records do not report complaints, treatment, or symptoms associated with hypertension, headaches, or dizziness. See December 2019 Service Treatment Records. The private treatment records for March 2009 to March 2016 specifically notate that the Veteran denied headaches, and the records do not show any complaint of dizziness. See April 2016 Private Treatment Records.

Lay Evidence

As noted in the prior June 2023 Board decision, the Veteran submitted a Statement in Support of Claim in April 2023 stating that he has chronic headaches which he associates with his service-connected hypertension. He reports that there were symptoms during service. Additionally, the Veteran provided statements to the VA examiners in September 2024, explaining his medical history regarding his headaches and dizziness. No other lay statements are of record.

As noted above, the Veteran provides general supportive statements indicating that he believes his hypertension caused or aggravated his headaches and dizziness. He did not report seeking treatment or being diagnosed with either headaches or dizziness. He did not report instances of uncontrolled hypertension, extremely elevated blood pressure, hospitalizations, or other monitoring of elevated blood pressure readings, which coincided with the onset of dizziness or headaches.

Analysis

The Board finds that the VA DBQ examinations and medical opinions are adequate and probative of the nature of the Veteran's claimed headaches and dizziness. The VA clinicians considered the Veteran's full medical history, lay statements, and available medical literature. The VA clinicians noted the requests for clarification of prior opinions and the need for further rationale. The reports provide explanations and rationale for the opinions, including the lack of any medical evidence documenting the subjective complaints of the Veteran. Accordingly, the Board gives the VA DBQ examinations and opinions significant weight.

The VA examiners and medical opinions found no medical basis for a diagnosis of dizziness or headaches. The VA clinicians noted the Veteran's general complaints and descriptions of his symptoms. Also, the VA clinicians noted the absence of any reported treatment or complaints in the medical history. Significantly, the VA clinicians opined that there was no medical evidence, no medical history, no findings on exam, and no symptomatology reported by the Veteran to support a medical diagnosis of either dizziness or headaches. Also, the VA clinicians reported that the symptoms described by the Veteran did not establish a functional impairment or loss.

The Board acknowledges that the Veteran is competent to report his observable symptoms associated with his claimed dizziness and headaches. See Jandreau v. Nicholson, 492 F. 3d 1376 (Fed.
. The VA clinicians noted the Veteran's general complaints and descriptions of his symptoms. Also, the VA clinicians noted the absence of any reported treatment or complaints in the medical history. Significantly, the VA clinicians opined that there was no medical evidence, no medical history, no findings on exam, and no symptomatology reported by the Veteran to support a medical diagnosis of either dizziness or headaches. Also, the VA clinicians reported that the symptoms described by the Veteran did not establish a functional impairment or loss.

The Board acknowledges that the Veteran is competent to report his observable symptoms associated with his claimed dizziness and headaches. See Jandreau v. Nicholson, 492 F. 3d 1376 (Fed. Cir. 2007). Further, the Board acknowledges and accepts the Veteran's statements that he has dizziness and headaches, and he believes the complaints are related to his hypertension.

Additionally, the Board has considered the medical articles and literature submitted by the Veteran. However, the articles and literature do not reference symptomatology of hypertension like that described or experienced by the Veteran. Additionally, the articles note that symptoms such as dizziness and headaches are not common for people diagnosed with hypertension. If present, the medical articles support the conditions being generally associated with severe, uncontrolled hypertension. The medical literature also discusses that there are several causes of dizziness and headaches, and it is recommended that consultation with a health care provider be obtained. Here, the medical providers failed to substantiate the complaints as a diagnosable medical condition. Therefore, the Board cannot give any significant weight to this medical literature and articles.

The severity, duration, and frequency of the claimed dizziness and headaches do not support a finding of a loss of functional impairment of earning capacity. Additionally, the probative evidence does not show that the Veteran has symptomatology that constitutes a disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Wait v. Wilkie, 33 Vet. App. 8 (2020). In this regard, the Board observes the September 2024 VA headaches exam indicated that while the Veteran reported headache pain in his temporal region that was alleviated with laying down in a dark room or Tylenol PM, characteristic prostrating attacks of migraine / non-migraine headache pain were not present. For VA purposes, prostrating means "causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities." See also Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018) (noting that characteristic prostrating attacks describes migraine attacks that typically produce powerlessness or a lack of vitality). The Veteran presented no evidence indicating that his subjective symptoms are severe enough to result in impaired earning capacity and thus constitute a disability. See 38 C.F.R. § 4.124a, Diagnostic Code 8100.

With respect to the Veteran's dizziness, the September 2024 VA examination report indicated that the Veteran exhibited no objective signs or symptoms of dizziness. Although occasional dizziness would warrant a 10 percent rating under a reasonably applicable diagnostic code, objective findings supporting the diagnosis are required before a compensable evaluation may be assigned under that code. See 38 C.F.R. § 4.87, Diagnostic Code 6204. The Veteran did not provide any evidence demonstrating that his subjective reports are dizziness are severe enough to cause impaired earning capacity and thereby result in a disability.

Nor does the medical evidence of record, medical articles and literature, and VA opinions corroborate or support a causal connection between the Veteran's claimed symptoms and his hypertension.

In sum, the evidence of record does not include medical reports, records, complaints, treatment, or diagnosis to support a current disability for dizziness or headaches. There is no medical diagnosis and no persistent symptomatology for either dizziness or headaches. There is no evidence that the claimed conditions reach the severity of impacting the Veteran's functional impairment of earning capacity. See 38 U.S.C. § 1110; see also Saunders v. Wilkie, supra; Wait v. Wilkie, supra. Additionally, the medical evidence fails to show any causal relationship between the Veteran's service-connected hypertension and his claimed dizziness and headaches. Therefore, the Board also finds that the evidence of record fails to show that the Veteran's service-connected hypertension either caused or aggravated the claimed dizziness and headaches.

There can be no valid claim for service connection in the absence of a current disability. Entitlement to service connection for dizziness and headaches is not warranted, on either a direct or secondary basis. The rule of reasonable doubt in favor of the Veteran is not applicable. See Lynch v. McDon
38 U.S.C. § 1110; see also Saunders v. Wilkie, supra; Wait v. Wilkie, supra. Additionally, the medical evidence fails to show any causal relationship between the Veteran's service-connected hypertension and his claimed dizziness and headaches. Therefore, the Board also finds that the evidence of record fails to show that the Veteran's service-connected hypertension either caused or aggravated the claimed dizziness and headaches.

Entitlement to service connection for dizziness is denied. Entitlement to service connection for headaches is denied. Accordingly, the appeal is denied.

3. Entitlement to service connection for eye condition, manifested as reddened sclerae, including as secondary to hypertension, is denied.

The Veteran contends that his hypertension causes his eyes to be red. He asserts that the eye condition, manifested as red sclerae, onset while he was in service and continued thereafter. See September 2024 VA Eye Condition DBQ; September 2025 Attorney Argument.

The AOJ made favorable findings of (1) a current eye condition disability based on the Veteran's diagnosis of bilateral meibomian gland dysfunction, lattice degeneration of retina, and bilateral pseudophakia, and (2) the Veteran being service connected for hypertension. The Board is bound by these favorable findings absent clear and unmistakable error. See 38 C.F.R.§ 3.104(c).

The Board notes that the Veteran did not assert a claim for service connection for bilateral meibomian gland dysfunction, lattice degeneration of retina, or bilateral pseudophakia. These eye conditions were diagnosed by the VA examiner, but the Veteran's claim was limited to service connection for reddened eyes that he related to his hypertension. Neither the record or the development of the claim shows any common symptomatology or any association between the reddened eye condition (which is limited to an outer eye problem) and the bilateral meibomian gland dysfunction, lattice degeneration of retina, or bilateral pseudophakia. Therefore, the Board declines to expand the Veteran's claim to include the incidental diagnosed eye conditions. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). If the Veteran wishes to pursue a claim for service connection for bilateral meibomian gland dysfunction, lattice degeneration of retina, or bilateral pseudophakia, the Board encourages him to do so.

Medical Evidence

A VA Eye Condition DBQ examination was completed in September 2024. The VA clinician diagnosed bilateral Meibomian Gland Dysfunction (form of dry eyes), Lattice Degeneration of Retina, and Pseudophakia, but did not diagnose red eyes or reddened sclerae. The Veteran gave a history of red eyes which onset in the 1970s. He said that his eyes have been a little red since separation from service in 1971, but he denied any other symptoms and stated that the reddened eye condition does not bother him. It is reported that the Veteran had cataract surgery with replacement lenses and had no visual impairment.

A VA Medical Opinion was also obtained in September 2024. The VA clinician opined that the claimed reddened sclerae was less likely than not causally related to the Veteran's hypertension, and further, opined that it not at least as likely as not that the claimed condition was aggravated beyond its natural progression by the hypertension. As explained by the VA clinician, there are no definitive studies that link the claimed red sclerae to hypertension, and after review of medical studies with peer review, there are no sources that support a link between redness of the sclerae (external eye) and hypertension.

The Veteran submitted a medical article, "The Connection Between Red Eyes and Blood Pressure Explained," which was published in the Health Digest, in June 2022 by Sabika Hassan. The article states that increased pressure in the blood vessels can lead to red eyes. "The blood vessels in the retina can become a little more stiff and hardened. They'll push on each other and cross...When it gets really bad, we'll see some of the blood vessels start to leak, we'll see some hemorrhaging. And that can cause a whole range of vision issues." [internal quotes omitted].

The enlistment and separation examinations and medical histories do not report or notate any eye condition, to
(external eye) and hypertension.

The enlistment and separation examinations and medical histories do not report or notate any eye condition, to include any manifested by reddened eyes or a red eye irritation. It is noted that the Veteran requires glasses or contacts. The Service Treatment Records do not report complaints, treatment, or symptoms associated with reddened eyes or external red eye irritation. The private treatment records for March 2009 to March 2016 do not notate any complaint of reddened eyes or eye irritation. It is noted that the list of prescribed medications includes an eye drop commonly used for dry eyes, but there is no diagnosis of any eye condition notated in the records. See December 2019 Service Treatment Records; April 2016 Private Treatment Records.

Lay Evidence

The Veteran provided a medical history to the VA examiner in September 2024. He stated that his eyes look red and have been a little red since his separation from service. The Veteran stated that the condition onset during service in the 1970s. He did not give a history of any treatment for the condition and reported that there were no other symptoms, than his noticing that his eyes are red. See September 2024 VA Eye Condition DBQ examination. The Veteran made no claim and gave no history regarding any diagnosed eye conditions.

Analysis

The Board finds the September 2024 VA examination and medical opinion are adequate and probative of the Veteran's eye condition, manifested as reddened sclerae. The VA clinicians considered the Veteran's statements, medical history, and available medical literature. The VA clinicians and AOJ accepted the Veteran's claim that his eyes appeared red. However, no in-service event, illness, or injury was claimed or established.

As such, the first element for direct and secondary service connection is conceded, but the second element for direct service connection, i.e., an in-service event or injury, is not satisfied. Therefore, secondary service connection must be considered, i.e., whether the Veteran's hypertension caused or aggravated the Veteran's claimed eye condition, manifested by reddened sclerae.

The VA medical opinion reported that it was less likely than not that the reddened eye condition was related to the Veteran's hypertension. The VA clinician reports the absence of any treatment, complaints, or report of the condition. Also, the VA clinician explained that he found no study or research to link reddened sclerae (outer eye) to the Veteran's hypertension. The VA clinician opined that absent any link or causal connection, there could be no aggravation of the reddened sclerae by the service-connected hypertension.

The medical article submitted by the Veteran reported that with "extreme" or "spiked" high blood pressure there could be hemorrhaging of the eye blood vessels, which may be associated with vision problems. However, there is no evidence of record showing that the Veteran has ever observed, been treated for, or made complaints of extremely high blood pressure or vision problems associated with reddened sclerae. Notably, the medical evidence of record does not report or show any observation, complaint, or treatment of reddened eyes or any similar eye condition.

The Board acknowledges that the Veteran believes that his hypertension caused his eyes to appear red. However, the evidence does not show that the Veteran has the training, education, or experience to provide opinions regarding medical issues such as why he has the appearance of redness of his eyes. See Jandreau v. Nicholson, supra. Accordingly, the Board must give the most probative weight to the medical evidence of record regarding the etiology of the Veteran's claimed eye condition, manifested as reddened sclerae. The Board cannot give weight to the Veteran's lay statements regarding the medical cause of this condition.

The foregoing considered, the Board finds that there is no showing of any causal relationship between the Veteran's claimed reddened sclerae and his service-connected hypertension. The probative evidence of record shows that it is less likely than not that the service-connected hypertension caused or aggravated, the claimed reddened sclerae, beyond its natural progression. See September 2024 VA Medical Opinion. The elements for secondary
au v. Nicholson, supra. Accordingly, the Board must give the most probative weight to the medical evidence of record regarding the etiology of the Veteran's claimed eye condition, manifested as reddened sclerae. The Board cannot give weight to the Veteran's lay statements regarding the medical cause of this condition.

The foregoing considered, the Board finds that there is no showing of any causal relationship between the Veteran's claimed reddened sclerae and his service-connected hypertension. The probative evidence of record shows that it is less likely than not that the service-connected hypertension caused or aggravated, the claimed reddened sclerae, beyond its natural progression. See September 2024 VA Medical Opinion. The elements for secondary service connection are not satisfied, and service connection for the claimed reddened sclerae is not warranted.

Entitlement to service connection for reddened sclerae is denied. The rule of reasonable doubt in favor of the Veteran is not applicable. See Lynch v. McDonough, supra.

The appeal is denied.

Luke Pelican

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Smith, Linda L.

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.

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