BVA9506333 DOCKET NO. 91-13 455 ) DATE ) RECONSIDERATION ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for a left eye disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. B. Weiss, Associate Counsel INTRODUCTION The veteran had active military service from September 1975 to September 1978. A Board of Veterans' Appeals (Board) decision dated March 1993 denied service connection for a left eye disorder. In September 1993, a motion for reconsideration of the Board's March 1993 decision was granted, in accordance with the provisions of 38 U.S.C.A. § 7103(b) (West 1991). The case is now before an expanded reconsideration panel of the Board. The decision contained herein will replace the March 1993 decision. In accordance with the provisions of Thurber v. Brown, 5 Vet.App. 119 (1993), the representative was provided with a copy of the medical literature cited in this decision, in a letter dated in February 1995. In a letter dated in February 1995, the representative responded that he had no further evidence or argument to present. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his herpes keratitis was incurred in active service, or that such disorder should be presumed to have begun in service. He asserts that he was told by a doctor that herpes keratitis resulted from exposure to the hot, humid, tropical climate in the Canal Zone, Panama, where he was stationed for 18 months in service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim. FINDING OF FACT A left eye disorder including herpes keratitis was not shown in service; herpes keratitis, first demonstrated after service, is not shown to be related to service. CONCLUSION OF LAW A left eye disorder including herpes keratitis was not incurred in or aggravated by peacetime service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1994). REASONS AND BASES FOR FINDING AND CONCLUSION Initially, we note that the provisions of 38 U.S.C.A. § 5107 have been met, in that the claim is well grounded and adequately developed. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. In an August 1993 statement, which is again referenced in an October 1994 statement, the veteran's representative requests that an ophthalmologic specialist be asked to provide an opinion as to the time frame "from a herpes simplex contamination to the time that a keratitis condition becomes manifest." We have considered the appropriateness of this request. However, as will be shown by the medical information discussed below, such an opinion would not bear significant evidentiary weight, and a remand for duty to assist purposes is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active peacetime service. 38 U.S.C.A. § 1131. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran served for 90 days or more during peacetime and an organic disease of the nervous system develops to a degree of 10 percent or more within one year from date of service separation, then such disease will be considered to have been incurred in service even though there is no evidence of such disease in service. This presumption is rebuttable by affirmative evidence to the contrary. No condition other than one listed in § 3.309(a) will be considered chronic. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Review of the veteran's service medical records, including the records of the Gorgas Hospital, Balboa, Republic of Panama, shows no complaint or finding of any eye disorder or herpes lesion at any locus. The separation medical examination in September 1978 revealed that the eyes were normal, and that each eye had visual acuity of 20/20. In February 1979, the veteran reported for Department of Veterans Affairs outpatient treatment of a painful left eye of one week's duration. On examination, there was erythema and injection of the sclera of the left eye. This condition was subsequently diagnosed as herpes simplex keratitis, and continued to be treated through April 1980. The records of such treatment contain no etiologic determination, and no reference to hot, humid weather as a cause of the disorder. Beginning in January 1984, the veteran received private medical treatment for herpes simplex keratitis in the left eye. We have considered all of the pertinent evidence and the veteran's arguments. In essence, the veteran does not deny that the first known manifestation of herpes keratitis was after service, but asserts that because this manifestation was five months after service, we should infer that the herpes was somehow incurred in active service. We disagree. A pertinent medical text reveals: Herpes simplex virus is a ubiquitous parasite. It is so prevalent that, by age 60, 97% of the population have antibodies to this virus. Antibodies to the virus cross the placental barrier and are generally protective to the newborn for the first 6 months of life. After that time, children may be infected. By age 5, 70% of children have titers against herpes simplex. Most infections are unrecognized by the patient or the parents. Of the symptomatic primary infections that occur in children, a systemic illness or a focal lip lesion are most common. Primary ocular infections as the first herpetic infection are uncommon but do occur. When they occur, both inflammation of the cornea (keratitis) and conjunctival inflammation (conjunctivitis) may be seen. The primary ocular infection is frequently accompanied by vesicles on the skin that may be obvious or may need to be searched for carefully. Preauricular adenopathy may also occur. William H. Coles, M.D., Ophthalmology 32 (1989). There is no way on the basis of the available evidence to know whether the herpes keratitis was the first infection but it was the first documented by the evidence although primary ocular herpetic infections are somewhat uncommon. Many herpetic infections are apparently unrecognized, but certainly none was noted in service. Also, as there is no indication in the service records that any pre-existing, subclinical herpes was aggravated during active duty, this scenario would also result in the disallowance of this claim. There is no adequate evidentiary basis on which an ophthalmologist could reasonably relate initial infection with the herpes virus, or the first manifestation of illness due to same, with service. See Id. Association of the veteran's herpes keratitis with service would, therefore, be speculative under the facts presented here. No persuasive evidence on file relates the infection to active service. We are unable to identify a reasonable basis on which to grant the claim. We recognize that service connection may be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Nonetheless, in this case, nothing links the left eye disorder to service except the veteran's allegations that service in a hot, humid climate caused herpes, which first manifested after service. As a layman, the veteran is not medically qualified to render an opinion as to the etiology of herpes keratitis. See Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). We appreciate that the veteran recalls that he heard of an etiological relationship between climate and herpes from a doctor. Nonetheless, herpes has not been medically attributed to climate or to particular geographic areas by any doctor whose opinion is of record. Nor has such causation of herpes been disclosed by our study of Ophthalmology, which, to the contrary, indicates that herpes is a "ubiquitous parasite." Id. at 32. A herpes infection may be latent, however, harbored in the neural system, and the activity of the virus may be triggered by a number of stimulating mechanisms, including exposure to sunlight and heat. Id. at 33. In the instant case, however, no such triggering occurred during service, as shown by the silence of the service records for herpes symptomatology. We have also considered the argument that the veteran's herpes keratitis should be considered an organic disease of the nervous system which manifested to a compensable degree within one year from service. No evidence has been submitted to indicate that herpes keratitis should be considered an "organic disease of the nervous system." Herpes keratitis is not included in the provisions of 38 C.F.R. § 3.309. No condition other than one listed in § 3.309 qualifies for presumptive service connection, as applicable to this case. 38 C.F.R. § 3.307(a). ORDER Service connection is denied for a left eye disorder. VICKY JORDAN JOHN E. ORMOND WILLIAM J. REDDY N. PHILLIPS G. R. SENYK ______________________ S. W. WARNER NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.