Denied dry eye syndrome from PRK surgery.

[rigo8582]

I made a claim for bilateral dry eye from PRK surgery and was denied. I'm wondering if I could set some opinions on what the appeal battle would be like for this. Here is the Reasons for decision below:

Service connection may be granted for disability which began in military service or was caused by some event or experience in service.

VA examiner noted that although you have a history of PRK that could be contributing to your dry eyes, you also use a CPAP machine for sleep apnea which is most likely contributing to your dry eyes. It was noted that you do not consistently treat your dry eyes.

Service connection for bilateral dry eye syndrom (also claimed as bilateral eye condition) is denied since this condidition neither occurred in nor was caused by service.

Appreciate any advice on this.

Edited April 6, 2018 by rigo8582

[rigo8582]

Realistically I had issues with dry eyes after surgery. I even told the examiner that the symptoms are no different since using a CPAP. I've already made a request for my C-file. I know the CPAP argument is just an easy method of denial. I even saw a VA optometrist and he said the dry eyes were normal from PRK surgery. I will say I probably could've gone to the doctor about it while I was active duty but since they told me it was normal I didn't go which in the grand scheme of things backfired.

The civilian optometrist I use was prior navy and performed PRK surgeries so I most likely see if he will provide a nexus rebuttal to their arguments.

I appreciate the inputs. For what its worth these things I could in my current c file about PRK and dry eyes. Don't know how well they would hold up in an appeal. If my sleep apnea appeal is successful then I will definitely use this as well.

Edited April 7, 2018 by rigo8582

[Vync]

If approached from the Caluza perspective

1. You had PRK surgery while in service
2. You currently suffer from side effects of the surgery
3. You would need a medical opinion connecting #1 and #2 <==

From the relative equipoise perspective, you have a C&P doc advising against and your civilian eye doc advising in favor. Sounds like the evidence for and against may be in balance, thus the decision should be granted in favor of the veteran (in my opinion). The civilian eye doc you mentioned should be able to get you a nexus letter.

I use a CPAP and remember the full face mask causing dry eye due to leaks. After trying a variety of masks, I was given a nasal pillow mask and no longer have that problem. If you haven't tried the nasal pillow mask, it might be worth a shot. If it doesn't leak, that should remove that C&P doctor's reason to deny.

[rigo8582]

1 hour ago, Vync said:

If approached from the Caluza perspective

1. You had PRK surgery while in service
2. You currently suffer from side effects of the surgery
3. You would need a medical opinion connecting #1 and #2 <==

From the relative equipoise perspective, you have a C&P doc advising against and your civilian eye doc advising in favor. Sounds like the evidence for and against may be in balance, thus the decision should be granted in favor of the veteran (in my opinion). The civilian eye doc you mentioned should be able to get you a nexus letter.

I use a CPAP and remember the full face mask causing dry eye due to leaks. After trying a variety of masks, I was given a nasal pillow mask and no longer have that problem. If you haven't tried the nasal pillow mask, it might be worth a shot. If it doesn't leak, that should remove that C&P doctor's reason to deny.

The dry eyes from the CPAP is minimal in my opinion. By the time I went to the C&P I was using a nasal mask and would use a sleep mask if it was blowing into my eyes. I even got a new nasal mask where the exhaust is forward instead of up and my symptoms are essentially the same.

Its just discouraging and down right insulting to be told the cause of my dry eyes that I've experience for 13+ years after this surgery, is most likely caused by a CPAP that I've only started using for about a year.

Thank you for the input. I also can bring up a 90 day report for my CPAP that tracks leaks so I may use that. Cuz it does include the frame at which I went to my C&P appointment.

I'm not ready to try nasal pillow just yet. I don't like things in my nose. I started using a full face mask in the beginning and switched to a nasal mask. Made it much easier to get a seal that is for sure. Thank you for the input.

Edited April 9, 2018 by rigo8582

[Vync]

5 minutes ago, rigo8582 said:

The dry eyes from the CPAP is minimal in my opinion. By the time I went to the C&P I was using a nasal mask and would use a sleep mask if it was blowing into my eyes. I even got a new nasal mask where the exhaust is forward instead of up and my symptoms are essentially the same.

Its just discouraging and down right insulting to be told the cause of my dry eyes that I've experience for 13+ years after this surgery, is most likely caused by a CPAP that I've only started using for about a year.

Thank you for the input. I also can bring up a 90 day report for my CPAP that tracks leaks so I may use that. Cuz it does include the frame at which I went to my C&P appointment.

I'm not ready to try nasal pillow just yet. I don't like things in my nose. I started using a full face mask in the beginning and switched to a nasal mask. Made it much easier to get a seal that is for sure. Thank you for the input.

I'm with you on this. For the years prior to using CPAP, it might be worth checking your medical records during that time to look for instances where dry eye was noted. Having it solidly documented in your medical treatment history can help to solidify your contentions and show the C&P doc may not have thoroughly reviewed your records.

If your C&P doc was not a specialist (eye doctor), that could be a glaring reason to discount his opinion or request a new exam by a specialist. However, your current eye doc's nexus letter might save you from all that trouble.

The best option for CPAP is to use whichever mask works for you. I had to switch to the nasal pillow because I have bad TMJ and the full mask felt like I was wearing a bear trap.

 

[rigo8582]

For anyone that has paid attention to the thread. I got my appeal back. The issue on dry eyes was remanded, which the attorney expected would happen. But part of my appeal was I was granted service connection for sleep apnea and an increase of my acid reflux.

[Carl the Engineer]

Two wins and a remand, not a bad day at the VA.  Looks like you eye(s) could be secondary'd to you SA now.  

But, which came first the chicken or the egg, when looking at a EED.

Hamslice