CORNEAL DISEASE INCLUDING SCARS OPACITIES

Summary

The Veteran, an Army Veteran who served from August 1969 to April 1971, appeals the denial of service connection for bilateral dry eye syndrome. The Board found that the Veteran has a current diagnosis of dry eye syndrome, and that the second element of service connection (in-service incurrence or aggravation) was met due to conceded exposures to environmental hazards, herbicide agents, other toxins, and participation in Toxic Exposure Risk Activities (TERA) during service. However, the Board found the third element, a causal relationship (nexus), was not established. Two VA examiners, E.P. and J.P., both opined that it was less likely than not that the dry eye syndrome was related to service. Examiner E.P. considered the Veteran's lay statement about dust and dirt exposure but concluded that natural aging was a more likely cause. Examiner J.P. considered all TERA exposures and lay statements, also concluding that age-related changes and post-service lifestyle factors played a more significant role than military service. While the Board found the examiners' opinions sufficient, it noted E.P. did not consider all job-related exposures. The Board assigned less weight to E.P.'s opinion due to this oversight but still found it sufficient. Both examiners concluded that natural aging was a more likely etiology. The Board found the Veteran competent to report symptoms but not a medical professional, and his lay statement alone was insufficient to establish a nexus. No medical professional opined a service connection. The Board concluded the weight of the probative medical evidence was against a nexus, denying service connection for dry eye syndrome.

Rationale

Current diagnosis of dry eye syndrome established.; In-service exposures (environmental, herbicide, TERA) conceded.; Two VA examiners opined less likely than not related to service.; Natural aging cited as more likely etiology.; Weight of probative medical evidence against nexus.

Full Decision Text

Citation Nr: A26037399
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 251003-587695
DATE: April 22, 2026

ORDER

Entitlement to service connection for bilateral dry eye syndrome is denied.

FINDING OF FACT

The probative evidence does not demonstrate that the Veteran's dry eye syndrome is related to service, to include conceded toxic exposures in service.

CONCLUSION OF LAW

The criteria for service connection for dry eye syndrome have not been met. 38 U.S.C. §§ 1101, 1110, 1710(e)(4)(C), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from August 1969 to April 1971.

In August 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an October 2023 rating decision. During the processing of the HLR, required development was identified and, as such, in an April 2025 rating decision the claim was adjudicated under the Supplemental Claim lane so the additional evidence could be considered in deciding the claim.

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

Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

This appeal has been advanced on the docket. 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.800(c).

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, 1131; 38 C.F.R. §§ 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service--the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Lay testimony is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Falzone v. Brown, 8 Vet. App. 398, 405 (1995).

Medical examination reports are adequate "when they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion." Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012). An adequate medical opinion must be based upon a consideration of the relevant evidence and must provide the Board with a foundation sufficient to evaluate the probative worth of that opinion. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (adequate medical examination is one that is based on consideration of veteran's prior medical history and describes his or her condition with a level of detail sufficient to allow the Board to make a fully informed decision on the relevant medical question). This requires the examiner to not only render a clear conclusion on the relevant medical question but to support that conclusion "with an analysis that the
o v. Shinseki, 26 Vet. App. 97, 106 (2012). An adequate medical opinion must be based upon a consideration of the relevant evidence and must provide the Board with a foundation sufficient to evaluate the probative worth of that opinion. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (adequate medical examination is one that is based on consideration of veteran's prior medical history and describes his or her condition with a level of detail sufficient to allow the Board to make a fully informed decision on the relevant medical question). This requires the examiner to not only render a clear conclusion on the relevant medical question but to support that conclusion "with an analysis that the Board can consider and weigh against contrary opinions." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion"). See also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (examiner must provide "not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two").

But an examination report need not "explicitly lay out the examiner's journey from facts to a conclusion." Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (holding that a medical examination report must be read as a whole and does not require that it "explicitly lay out the examiner's journey from the facts to a conclusion").

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. Pub. L. No. 117-168, 136 Stat. 1759. The PACT Act also provides that, when a veteran submits a claim for compensation with evidence of a disability and evidence of a Toxic Exposure Risk Activity (TERA) during active military service, and such evidence is not sufficient to establish service connection for the disability, VA shall provide the veteran with a medical examination under 38 U.S.C. § 5103A(d) and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. The PACT Act further provides that, when providing a medical opinion under this provision, the health care provider shall consider the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all TERAs of the veteran.

The Board is responsible for determining whether the evidence persuasively supports the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Dry eye syndrome

The Veteran contends that he is entitled to service connection for his dry eye syndrome. See October 2025 Notice of Disagreement.

As to the first element of service connection, the Board finds that the Veteran has a current diagnosis of dry eye syndrome. The Veteran was diagnosed with dry eye syndrome at the April 2024 and December 2024 VA examinations. The July 2024 and April 2025 rating decisions noted a diagnosis of dry eye syndrome. The Board is bound by this favorable finding.

Turning to the second element of service connection, the Board observes that the service treatment records (STRs) are silent as to diagnosis of, treatment for, or complaint of dry eye while in service. The July 2024 and April 2025 rating decisions conceded exposure to environmental hazards from exposure to herbicide agents in the Republic of Vietnam. The April 2025 rating decision further conceded exposure to other toxins in service and participation in TERA. The August 2024 TERA Memorandum lists job related exposures of "heavy vehicle fuels, fumes, construction materials, and chemicals associated with heavy vehicle braking and cooling systems." The Board is bound by this favorable finding, and the second element of service connection is met. The Board notes that the Veteran claimed exposure to heavy dust and dirt particles while in service and is competent to describe what he experienced while in service.

As to the third element of service connection, the probative evidence does not show a causal relationship between the current dry eye syndrome and the in-service exposures.

In an April 2024 medical opinion, examiner E.P. opined that it is less likely than not
 conceded exposure to other toxins in service and participation in TERA. The August 2024 TERA Memorandum lists job related exposures of "heavy vehicle fuels, fumes, construction materials, and chemicals associated with heavy vehicle braking and cooling systems." The Board is bound by this favorable finding, and the second element of service connection is met. The Board notes that the Veteran claimed exposure to heavy dust and dirt particles while in service and is competent to describe what he experienced while in service.

As to the third element of service connection, the probative evidence does not show a causal relationship between the current dry eye syndrome and the in-service exposures.

In an April 2024 medical opinion, examiner E.P. opined that it is less likely than not that the Veteran's dry eye is due to military service. E.P. considered the Veteran's lay statement that the heavy dust and dirt particles that he was exposed to in service could have caused the dry eye. Based on the record, E.P. opined that it was more likely that the dry eye developed as part of natural aging of the eyes.

In this case, examiner E.P. considered the Veteran's lay statement about exposures during service in formulating the medical opinion, including heavy dust and dirt particles. After considering the credible lay statement, the examiner determined that there was an alternate etiology, that is, the natural aging of the eyes. The Board assigns this opinion less weight, however, because while the examiner did consider some of the Veteran's exposures, the examiner did not consider all of the job related exposures to include fuels and chemicals related to cooling systems. The Board still finds the opinion sufficient for rating purposes. Perfection is not the standard, but rather sufficiency, and in this case, the Board finds this medical opinion sufficient for rating purposes because it adequately informs the Board about the medical expert's judgement and the supporting rationale.

In a September 2024 medical opinion, examiner J.P. considered all of the Veteran's TERA exposures including the Veteran's lay statements and the job related toxic exposures and opined that the dry eye syndrome was less likely than not caused by the indicated TERA after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran. J.P. provided the following rationale, 

"Dry eye syndrome can have multiple causes, but it is most commonly linked to the natural aging process, prolonged screen use, and environmental factors like low humidity. While the Veteran's military service involved exposure to dust and dirt, which could exacerbate dry eye symptoms, the fact that this condition was diagnosed long after service suggests a more significant role for age-related changes and lifestyle factors post-service. Therefore, the connection to military service is weak, making it less likely that the dry eye syndrome is service-related."

Thus, after considering the additional in-service TERA, examiner J.P. came to the same conclusion as to the etiology of the dry eye syndrome as examiner E.P. did. Both examiners considered the natural aging of the eyes to be a more likely etiology.

While the Veteran is competent to report on his symptoms and those things which he observes with his senses, the Veteran is not a medical professional, and his lay statement alone is not sufficient to establish a nexus between the in-service exposures and his present diagnosis. No examiner or other medical professional has opined that there is a relationship between the Veteran's dry eye syndrome and service. In this case, the weight of probative medical evidence is against a nexus.

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?

As such, service connection for dry eye is denied. The probative evidence of record demonstrates that the dry eye is not related to service, to include conceded in-service exposures. Because there is not an approximate balance of positive and negative evidence, the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Schneider, Joan K.

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.