GLAUCOMA

Summary

The veteran, a veteran who served from December 1986 to September 2009, including deployment to Iraq, appealed the denial of service connection for bilateral primary open-angle glaucoma. The Board of Veterans' Appeals (BVA) reviewed the case based on the record available at the time of the March 2021 decision, as the veteran withdrew a hearing request. The veteran claimed service connection due to in-service findings of elevated eye pressure and pre-glaucoma, and a current glaucoma diagnosis. The BVA acknowledged that the service treatment records (STRs) showed treatment for bilateral pre-glaucoma ocular hypertension in service, and a December 2020 VA examination confirmed a glaucoma diagnosis. However, the Board found the nexus element was not met. The VA examiner opined that the current glaucoma was less likely than not incurred in or caused by service, noting that the in-service ocular hypertension was transient and managed, with normal eye health post-service. The first post-service diagnosis of glaucoma occurred in December 2017, years after separation. The Board found no continuity of symptomatology since service and no indication of a connection between the disorder and service. The Board also found the veteran's lay testimony regarding etiology was not competent due to the medical complexity. The appeal was denied as the evidence persuasively weighed against the claim.

Rationale

No nexus to service; No continuity of symptomatology; In-service event transient and resolved

Full Decision Text

Citation Nr: A26037936
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 211026-193986
DATE: April 22, 2026

ORDER

Service connection for bilateral primary open-angle glaucoma is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from December 1986 to September 2009, to include deployment to Iraq. 

2. Primary open-angle glaucoma was not shown in service, not shown to a compensable degree within one year of service, symptoms were not continuous since service, and open angle glaucoma is not causally or etiologically related to service.

CONCLUSION OF LAW

Bilateral primary open-angle glaucoma was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In March 2021, the agency of original jurisdiction (AOJ) denied service connection for bilateral pre-glaucoma ocular hypertension. The Veteran requested a Higher-Level Review (HLR) in March 2021, and the claim was again denied in June 2021.

In October 2021, the Veteran appealed to the Board via Form 10182 and elected the Hearing docket. A Board hearing was scheduled for May 2025; however, in April 2025, he withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the March 2021 decision on appeal, as well as any evidence submitted by the Veteran within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b).

Notably, in the March 2021 HLR request, the Veteran requested review of January 2021 and March 2021 decisions which denied service connection for bilateral pre-glaucoma ocular hypertension (the March 2021 decision was issued to provide the Veteran with additional laws and regulations and explain favorable findings related to his claim). Thus, to fulfill the Veteran's intent to have the claim undergo appellate review and consider the most complete record, the March 2021 decision is the decision on appeal. See Terry v. McDonough, 37 Vet. App. 1 (2023).

In the March 2021 decision, the AOJ found new and relevant evidence was received to reconsider the claim for service connection for bilateral pre-glaucoma ocular hypertension. The Board is bound by that favorable finding and will address this appeal on the merits. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).

In July 2020 correspondence, the Veteran claimed that service connection for glaucoma was warranted because the medical evidence showed onset in service. He argued that the service treatment records (STRs) showed findings of elevated eye pressure and pre-glaucoma and there was current diagnosis of glaucoma. 

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 (including glaucoma as an organic disease of the nervous system) under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service.  See 38 C.F.R. § 3.307.

As noted above, the Board is bound by favorable findings made by the AOJ in prior decisions. Here, in the March 2021 decision, the AO
3.309 (including glaucoma as an organic disease of the nervous system) under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service.  See 38 C.F.R. § 3.307.

As noted above, the Board is bound by favorable findings made by the AOJ in prior decisions. Here, in the March 2021 decision, the AOJ found the Veteran had been diagnosed with a disability because the December 2020 VA examination confirmed a diagnosis of bilateral primary open-angle glaucoma. The AOJ also found that the evidence showed a qualifying event in service because STRs show treatment for bilateral pre-glaucoma ocular hypertension in April 2009. 

Therefore, the first two elements of service connection are met. Thus, the remaining question is whether the third element, or the nexus requirement, of a service-connection claim is met. In this instance, the Board finds that the nexus element is not met. 

The STRs show the Veteran underwent photorefractive keratectomy (PRK) in May 2008. These records show pre-glaucoma ocular hypertension included on the list of problems and noted that the Veteran had a history of ocular hypertension. 

A November 2009 VA vision examiner reported a history of steroid drops after PRK, no continuous treatment, and no functional impairment from this condition. After interview and examination of the Veteran, the examiner noted that, for the "condition of bilateral pre-glaucoma ocular hypertension, there is no diagnosis. There is no pathology to render a diagnosis. The subjective factors are history of intraocular pressure increases with topical steroid usage. The objective factors are normal IOP/Normal ocular evaluation."  

In support of the appeal, the Veteran submitted private treatment records dated from May 2015 to August 2020. These records noted that the glaucoma was "suspected" based on ocular hypertension. Bilateral primary open-angle glaucoma was initially diagnosed in December 2017, more than 8 years after the Veteran's September 2009 separation from service. 

On a December 2020 VA eye examination, the Veteran recalled having bilateral ocular hypertension in 2009, in service. Eye drops were started temporarily, the pressure went down, the drops were stopped and he was discharged without disability. Glaucoma was diagnosed on 2017-2018. In a corresponding medical opinion, after interview and examination of the Veteran and a comprehensive review of the record, the examiner opined that the current glaucoma is less likely than not incurred in or caused by service. 

The examiner explained that, while the Veteran experienced a transient increase in intraocular pressure after PRK refractive surgery while using steroid eye drops, the transient increase in pressure was managed with hypotensive drops and the eye pressure and ocular health were normal at 3, 6, and 12 month follow-ups. After leaving service, a 2009 eye examination was normal. 

The examiner further explained that, although increase in intraocular pressure is associated with the Veteran's mild stage primary open-angle glaucoma, the inservice event was managed and review of the record does not show that the event caused any acute changes to the optic nerve. After service, the Veteran did not develop increased ocular pressure/raise suspicion for glaucoma until 2015 and was not diagnosed with primary open-angle glaucoma until December 2017. 

The record does not show the Veteran's claimed mild stage primary open-angle glaucoma manifested in service. Although he had a history of ocular hypertension and was treated for pre-glaucoma ocular hypertension in service, the evidence persuasively shows that many years passed after such treatment in service before ocular hypertension was noted and glaucoma was suspected. 

As the initial post-service diagnosis of glaucoma is years after service separation and the Veteran has not claimed otherwise, there is no indication of a connection between this disorder and service. 

Although glaucoma is a chronic disease, the evidence persuasively shows there is no post-service continuity of symptomatology. The evidence does not show the Veteran had symptoms of glaucoma in service which have continued to the present. Consequently, service connection for mild stage primary open-angle glaucoma, on the basis that it manifested in service, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112; 38 C.F.R. § 3.309(a)) is not warranted.

The Board
 

As the initial post-service diagnosis of glaucoma is years after service separation and the Veteran has not claimed otherwise, there is no indication of a connection between this disorder and service. 

Although glaucoma is a chronic disease, the evidence persuasively shows there is no post-service continuity of symptomatology. The evidence does not show the Veteran had symptoms of glaucoma in service which have continued to the present. Consequently, service connection for mild stage primary open-angle glaucoma, on the basis that it manifested in service, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112; 38 C.F.R. § 3.309(a)) is not warranted.

The Board's reliance on multiple factors, only one of which is an absence of complaints or treatment during the years after service, is consistent with the statutory and regulatory requirements to consider all evidence of record, as well as applicable precedential decisions. See Buchanan v. Nicholson, 451 F.3d 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one factor the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible).

What remains then is the question of whether, in the absence of a showing of onset in service and continuity since, the Veteran's glaucoma may otherwise be related to his service. Such competent evidence has been provided by the STRs, clinical evidence, and examination reports. There is no evidence in the record indicating that any of the Veteran's healthcare providers found a relationship between glaucoma and service. 

In this regard, the December 2020 VA opinion is highly probative because it is based on an accurate understanding of the Veteran's medical history, is supported by the record, and includes an explanation that contained clear conclusions and supporting rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). 

The examiner explained that, although the Veteran was treated for increased intraocular pressure after PRK refractive surgery in service, the event was transient and resolved with treatment and post-service increased ocular pressure/suspicion for glaucoma was not shown until 2015, with diagnosis of glaucoma in December 2017. In the absence of equally or more probative evidence suggesting that a disease, injury, or event in service is an etiological factor for the Veteran's development of glaucoma, the opinion is persuasive.

The Board has considered the lay statement that glaucoma manifested in service. While the Veteran is competent to report symptoms as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an opinion as to the etiology of the current glaucoma due to the medical complexity of the matters involved. Providing such an opinion requires specialized medical education and knowledge, to include the ability to interpret complicated diagnostic medical testing.

The Veteran has not presented any competent (medical opinion or treatise) evidence that glaucoma may be etiologically related to service and has not pointed to any clinical data in the record that supports that contention. Accordingly, as the evidence persuasively weighs against the claim, there is no doubt to be resolved. The appeal is denied.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence).

 

 

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K Hughes, 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.