Keratoconus C&p Exam And Service Connection

[mayertucker]

I recenly completed my C&P exam for Keratoconus a week ago. I was diagnosed in Septer of 2013, with Kerotoconus. During my entrance med exam, my vision was 20/20 in both eys. About 2 years into my service, I started seeing double, and bluriness. I made an appt with the eye doc in 29 stumps, and was diagnosed with asigmatism. At the time of that exam I was 20/40 in my left eye and 20/20 in my right eye. I had two ofher eye exams while in, and while I do not remember what my visual acuity was My perscriptions changed again. During the second exam a

Keratometry was performed. Here are the notes from previous eye exams.

"22 AUG1997
Plan-075 x 178
-050-100 x 041
3 NOV 1998
-025-050 x 180
-050-100 x 045
Keratometry : no comment on quality of mires
41.87/43.25 x 093
42.50/44.87 x 113
14 JAN 2000
Plan -050 x 175
+025-100 x 064".

I didn't go back for any eye exams until 2013, due to lack of money or vision insurance. I just dealt with the double vision and bluriness. Finally I found out I could get my eyes checked through the VA since I was alred 20% service connected for flat feet and my knee, and made an appt. That was when I was given the diagnosis of Keratoconus. I am in the process of getting a contact to help correct my vision, though the C&P doc said I would probably be better off getting the corneal transplant. I applied for service connection in November 2014, and am awaiting the decision. I wanted to know what the board thinks of it being granted since from my perspective, it started during my time in service and was never diagnosed until my visit in 2013. Thanks for any help in this.

I am including the relevant notes from the exam below if anyone can make sense of them.

"Describe the history (including onset and course) of the Veteran's
current
eye condition(s) (brief summary): history of astigmatism. No one used the
word "keratoconus" while in the service. Never turned down for
refractive
surgery. Dx of keratoconus first used at VA in 2013. No family history
Last eye exam at VA by Mar 27, 2015. Patient not dilated at this visit.
SECTION III: PHYSICAL EXAMINATION
---------------------------------
1. Visual acuity
----------------
a. Uncorrected distance:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [X] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [X] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [ ] 20/40 or better
b. Uncorrected near:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [X] 20/70 [ ] 20/50 [ ] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [X] 20/70 [ ] 20/50 [ ] 20/40 or better
c. Corrected distance:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [X] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [X] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [ ] 20/40 or better
d. Corrected near:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [X] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [X] 20/70 [ ] 20/50 [ ] 20/40 or better
2. Difference in corrected visual acuity for distance and near vision
---------------------------------------------------------------------
Does the Veteran have a difference equal to two or more lines on the Snellen
test type chart or its equivalent between distance and near corrected
vision,
with the near vision being worse?
[ ] Yes [X] No
3. Pupils
---------
a. Pupil diameter: Right: 4 mm Left: 4 mm
b. [X] Pupils are round and reactive to light
c. Is an afferent pupillary defect present?
[ ] Yes [X] No
d. [ ] Other, describe:
No answer provided
4. Anatomical loss, light perception only, extremely poor vision or
blindness
-----------------------------------------------------------------------------
Does the Veteran have anatomical loss, light perception only, extremely poor
vision or blindness of either eye?
[ ] Yes [X] No
5. Astigmatism
--------------
Does the Veteran have a corneal irregularity that results in severe
irregular
astigmatism?
[X] Yes [ ] No
If yes, complete the following section:
a. Does the Veteran customarily wear contact lenses to correct the above
corneal irregularity?
[ ] Yes [X] No
b. Was the corrected visual acuity determined using contact lenses?
[ ] Yes [X] No
If no, explain: patient not a contact lens wearer, has been referred
for RGP fit through fee basis
6. Diplopia
-----------
Does the Veteran have diplopia (double vision)?
[X] Yes [ ] No
a. Provide etiology (such as traumatic injury, thyroid eye disease,
myasthenia gravis, etc.): Monocular double vision in left eye
b. The areas of diplopia must be documented on a Goldmann perimeter chart
that identifies the four major quadrants (upward, downward, left lateral
and right lateral) and the central field (20 degrees or less). Include
the
chart with this Questionnaire.
Report the results from the Goldmann perimeter chart below:
Indicate the areas where diplopia is present (the fields in which the
Veteran sees double using binocular vision):
[X] Central 20 degrees
[ ] 21 to 30 degrees
[ ] 31 to 40 degrees
[ ] Greater than 40 degrees
c. Indicate frequency of the diplopia:
[ ] Constant [X] Occasional
If occasional, indicate frequency of diplopia and most recent
occurrence: No answer provided
d. Is the diplopia correctable with standard spectacle correction?
[ ] Yes [X] No
If no, is the diplopia correctable with standard spectacle
correction
that includes a special prismatic correction?
[ ] Yes [X] No
7. Tonometry
------------
a. If tonometry was performed, provide results:
Right eye pressure: 9 Left eye pressure: 9
b. Tonometry method used:
[ ] Goldmann applanation
[X] Other, describe:
NCT
8. Slit lamp and external eye exam
----------------------------------
a. External exam/lids/lashes:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
b. Conjunctiva/sclera:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
c. Cornea:
Right [X] Normal [ ] Other, describe:
Left [ ] Normal [X] Other, describe: thinning
d. Anterior chamber:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
e. Iris:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
f. Lens:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
9. Internal eye exam (fundus)
--------------------
Fundus:
[X] Normal bilaterally
[ ] Abnormal
10. Visual fields
-----------------
Does the Veteran have a visual field defect (or a condition that may result
in visual field defect)?
[ ] Yes [X] No
a. Was visual field testing performed?
[ ] Yes [X] No
b. Does the Veteran have contraction of a visual field?
No answer provided
c. Does the Veteran have loss of a visual field?
No answer provided
d. Does the Veteran have a scotoma?
No answer provided
e. Does the Veteran have legal (statutory) blindness (visual field diameter
of 20 degrees or less in the better eye, even if the corrected visual
acuity is 20/20) based upon visual field loss?
No answer provided
SECTION IV: Eye conditions
---------------------------
1. Conditions
-------------
Does the Veteran have any of the following eye conditions?
[X] Yes [ ] No
If yes, check all that apply:
[X] Corneal conditions
6. Corneal conditions
---------------------
a. Has the Veteran had a corneal transplant?
[ ] Yes [X] No
b. Does the Veteran have keratoconus?
[X] Yes [ ] No
If yes, indicate eye affected: [ ] Right [ ] Left [X] Both
c. Does the Veteran have a pterygium?
[ ] Yes [X] No
d. Does the Veteran have another corneal condition that may result in an
irregular cornea? (For example, pellucid marginal degeneration,
irregular
astigmatism from corneal scar, post-laser refractive surgery, acne
rosacea
keratopathy, etc.)
[ ] Yes [X] No
e. Is the Veteran's decrease in visual acuity or other visual
impairment, if
present, attributable to keratoconus or another corneal condition, if
present?
[X] Yes [ ] No [ ] There is no decrease in visual acuity or other
visual impairment
If yes, specify corneal condition responsible for visual impairment:
irregular astigmatism
f. Does any eye condition identified in this section cause scarring or
disfigurement?
No answer provided
14. Other eye conditions, pertinent physical findings, complications,
conditions, signs and/or symptoms
---------------------------------------------------------------------
Does the Veteran have any other eye conditions, pertinent physical findings,
complications, conditions, signs and/or symptoms related to the condition at
hand?
[ ] Yes [X] No
SECTION V: Scarring and disfigurement
--------------------------------------
Does the Veteran have scarring or disfigurement attributable to any eye
condition?
[ ] Yes [X] No
SECTION VI: Incapacitating episodes
------------------------------------
During the past 12 months, has the Veteran had any incapacitating episodes
attributable to any eye conditions?
[ ] Yes [X] No
SECTION VII
-----------
1. Functional impact
--------------------
Does the Veteran's eye condition(s) impact his or her ability to work?
[X] Yes [ ] No
If yes, describe the impact of each of the Veteran's eye
condition(s),
providing one or more examples: poor vision in left eye: Unable to do
work
involving fine depth perception
2. Remarks, if any: The question is asked if the patient has keratoconus
that
is as least as likely as not incurred in or caused by double vision or
blurred vision during service.
Keratoconus is a degeneration of the cornea which leads to distortion and
thinning of the front of the eye. As a result, the cornea steepens (this is
measured by keratometry or corneal topography)
Keratoconus is not caused by blurred vision or double vision. It is instead
a
degeneration. Review of the STR reveals no diagnosis of keratoconus. The
three refractions done over the course of three years were consistent.
Keratoconus patients will often fluctuate. Keratometry done in 1998 was not
indicative of keratoconus. The cover test done at the visit with the
complaint of double vision revealed no motion and no further workup.
At Mr. Mayer-Tucker's first visit to the Cheyenne VA in Sep 2013, he
reported
monocular double vision (overlapping images in one eye) and that he had
good
vision with previous glasses. The exam previous to that had been three years
earlier.
VA Records
Sep 2013
OD: plano-1.00x175 20/20-2 push
OS: -1.25-2.25x020 20/40+2 NO IMPROVEMENT WITH PINHOLE
Corneal topography
OD:
steep K: 46.60D @97
Flat K : 42.44D @7
Astigmatism: 4.16D
OS:
steep K: 48.93D @99
Flat K : 42.26D @9
Astigmatism 4.67D
Mar 2014
OD: -0.75sphere 20/25-+
OS: -1.25-2.25x020 20/50- ph 20/40-
Corneal topography
OD:
steep K: 46.35D @99
Flat K : 42.37D @9
Astigmatism: 3.98D
OS:
steep K: 49.01D @96
Flat K : 44.64D @6
Astigmatism 4.37D
Prescription history from STR
22 AUG1997
Plan-075 x 178
-050-100 x 041
3 NOV 1998
-025-050 x 180
-050-100 x 045
Keratometry : no comment on quality of mires
41.87/43.25 x 093
42.50/44.87 x 113
14 JAN 2000
Plan -050 x 175
+025-100 x 064
Cover test was ortho. Patient did not bring glasses to that visit.