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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey guys, it's Leah B from Prestige Veteran Medical Consulting. I'm a US Army veteran, physician assistant, informer compensation and pension examiner. So today I wanted to come on and discuss a topic that I think a lot of people have been asking for, well specifically asking for eye conditions. So the first kind of the most popular, one of the most popular eye conditions I could think of was glaucoma. So I wanted to talk about glaucoma today.
Leah Bucholz:So for those of you guys that don't know us, we like to talk about disability related benefits and break down things and give veterans the tools to help them take control of their claims. Glaucoma, again, it doesn't always get a spotlight but a lot of you guys are suffering from it. So it's a serious eye condition that can lead to permanent vision loss. But here's the thing, lot of veterans don't know that they can be service connected for it either directly or indirectly. If you've been diagnosed with glaucoma and you're already rated for things like diabetes, TBI or eye trauma, then this episode is probably for you and it may help you with that.
Leah Bucholz:So what is glaucoma? So let's start off with the basics. Glaucoma is a group of eye conditions that damage the optic nerve usually due to increased pressure inside of the eye. If untreated, it can lead to permanent vision loss or even blindness in some cases. So there are a few different types.
Leah Bucholz:So the main types that we see the most frequently are open angle glaucoma, that's the most common and it is just sort of slow developing. Angle closure glaucoma, that is more sudden and painful. Secondary glaucoma can be caused by other medical conditions or trauma. And the tricky thing is that glaucoma often develops with no early warning signs and you might not even notice anything until your vision is already deteriorating. So can glaucoma be service connected?
Leah Bucholz:So absolutely, on a primary or secondary basis. And we're gonna get into some of that. So the VA can grant service connection for glaucoma if it started during or right after your military service, that would be like a direct service connection. If it was caused or worsened by an already service connected disability, and that is often referred to as secondary service connection. Or in rare cases, if it's presumptively related to some type of toxic exposure.
Leah Bucholz:Most veterans who win claims for glaucoma do so by proving secondary service connection, it's pretty common. Some of you guys are diagnosed in service with it as well. It's not that it's uncommon, it's just typically not diagnosed while on active duty. We're gonna get into that a little bit later. So for direct service connection.
Leah Bucholz:So there's three main parts of an element of any claim that help establish a service connection. So one is that you have a current medical condition. Two is that you have an event or incident in service that has basically led to that disability. So it could even be a secondary service connection. So let me break that down a little further.
Leah Bucholz:So you have a diagnosis, in this case it's glaucoma, then you have an event from service, whether it's you got hit in the eye in service or maybe you develop service connected diabetes and now your condition is related to that secondarily. And then the third thing is that nexus or that link between number one and number two. So direct service connection for glaucoma. So a direct service connection means the condition began during your military service and there's medical evidence to back that up. So, or it's related to something that happened while on active duty.
Leah Bucholz:So an example would be if you served in dusty or sandy environment like Iraq or Afghanistan, you went to sick call a few times for eye irritation or blurry vision. Years later, you get diagnosed with glaucoma. If your service records reflect repeated eye issues or trauma that may be a potential direct link in some cases. Also you could have just been diagnosed while on active duty. Maybe your commands aren't major and you're just getting a little bit older and maybe you're not, again, young people can get it too.
Leah Bucholz:You can have a traumatic glaucoma or you can have some medical condition that leads to it, but maybe you're just developing it as you get older and while you're still in the service. So another example would be as if you suffered blunt trauma to the head or eye during a training accident, that trauma can lead to a traumatic glaucoma which is probably gonna be clearly service related. So again, what do you need? A current diagnosis, evidence of an in service onset or injury, and then a nexus from a medical professional tying it all together. So does that nexus have to come from an outside provider or your doctor?
Leah Bucholz:No, not necessarily. The VA will order you a compensation and pension exam if there's enough evidence that you've submitted to warrant one. And that VA C and P examiner is gonna review your case, listen to you, review your history and provide a nexus. It might not be a positive nexus. They may say, Hey, I do not think there's a nexus here.
Leah Bucholz:Or they may say there is clearly a link. So secondary service connection, we touched on that a little bit. So here's where it gets interesting. Secondary service connection means that your glaucoma was either caused by or worsened by another condition that the VA already recognizes as service connected. So what are some common secondary causes of glaucoma?
Leah Bucholz:Diabetes, type two diabetes, big time. Traumatic brain injury, hypertension or high blood pressure can cause it, long term steroid use like prednisone for asthma or arthritis, eye trauma like an orbital fracture maybe you got hit in the eye, Autoimmune disorders like lupus or sarcoidosis, sleep apnea, you can have medication side effects that cause glaucoma. So some real world examples might be things like you're being related for type two diabetes from agent orange exposure. Later your doctor tells you that the diabetes damaged the blood vessels in your eyes leading to glaucoma. And that is a textbook secondary claim.
Leah Bucholz:Or say that you have a service connected TBI. Studies show TBI can increase intracranial pressure which can affect eye pressure and optic nerve health leading to glaucoma. Another solid case for secondary service connection. So you'll need medical evidence linking the primary condition to glaucoma and your ophthalmologist may help you or your optometrist or your treating doctor. So let's talk about some medical literature because I always like to give you guys some tools and some medical literature to review or to present to your doctors.
Leah Bucholz:So medical literature is your ally when you're, trying to obtain VA disability. So backing your case with peer reviewed research can strengthen your claim in some cases, especially if you're appealing or whatnot. Here's what the science says. So when it comes to diabetes and glaucoma, studies show diabetics are twice as likely to develop glaucoma due to long term damage to the eyes blood vessels and pressure regulation. TBI and glaucoma neurologic studies including some from military medicine linked TBI to increased risk of glaucoma especially if there's optic nerve damage or abnormal cerebrospinal fluid pressure.
Leah Bucholz:Steroid use in glaucoma medications like prednisone often prescribed for arthritis or asthma have been shown to cause steroid induced glaucoma with long term use. Sleep apnea and glaucoma. Sleep apnea restricts oxygen to the optic nerve and multiple studies have have suggested that it raises glaucoma risk. So these studies, can be helpful again if you ask your doctor to reference them if they if they agree. So it's not just their statement that this is related it's actually backed by medical literature and science that says, hey this is why my opinion is this way.
Leah Bucholz:So how does the VA rate glaucoma? So glaucoma is rated under 38 CFR 4.79, which covers eye conditions. The VA looks at visual field loss, visual acuity, or how clearly you see, optic nerve damage. Ratings typically range from ten to 100% depending on how much your vision is actually impacted. In severe cases like legal blindness, you may also qualify for special monthly compensation.
Leah Bucholz:So when you file a claim for glaucoma, you're likely gonna be scheduled for a C and P exam or a compensation and pension exam. That examiner is probably gonna measure your eye pressure, assess your vision loss and peripheral vision. They are gonna probably review your medical records, evaluate any link to your service or existing conditions. And you may wanna bring your own eye exam results. They should have them if you've submitted them or if you've been seen at the VA.
Leah Bucholz:Honestly if you've been denied before or if you have any questions on how to file your claim or how to appeal your claim or whatever, may want to discuss that with an accredited attorney or a VSO or a claims agent. They can obviously strategize with you and help you navigate the appeals process. Things that can be helpful are things like a diagnosis from your treating doctor, your ophthalmologist, your optometrist. If you're already rated for something like diabetes, TBI, or hypertension, you might want to look at that secondary service connection if it applies. Make sure you have your treatment records, your eye exams, any history of symptoms from service.
Leah Bucholz:And again, doctor may support you with the letter. It doesn't have to be something like super long either. It can just be like, hey, I believe my patient, Mr. Smith, his service connected diabetes has caused his glaucoma. So I hope this has been helpful for you guys.
Leah Bucholz:Please drop some comments. I always appreciate the feedback from y'all when you guys give me your real world stories. If you have any other eye conditions or any other eye related matters or any other things that you'd like to hear about or for me to add to upcoming videos, I'm happy to do so. Please like and subscribe and as always thank you for watching.