Citation Nr: 1306775 Decision Date: 02/27/13 Archive Date: 03/01/13 DOCKET NO. 09-15 366A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for a left eye disability. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. W. Kim, Counsel INTRODUCTION The Veteran had active service from January 1988 to September 1991, and from November 1992 to September 1995. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In June 2012, the Board remanded the appeal for further development. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. REMAND The Veteran asserts that service connection is warranted for a left eye disability, specifically, left eye keratoconus. The Board notes that service connection is currently in effect for right eye keratoconus. In the June 2012 remand, the Board requested a supplemental etiological opinion from the optometrist who conducted the September 2008 VA eye examination and provided a January 2012 addendum. In a July 2012 addendum, the examiner stated, "It is less likely than not that either service caused [left eye] Keratoconus or that one eye caused [the] other eye to develop Keratoconus. C-file was reviewed today. Generally if somebody has Keratoconus, it is a bilateral condition, but often asymmetric." The above opinion does not fully address the questions posed by the Board. The examiner did not provide an opinion on whether the Veteran's left eye keratoconus was aggravated by the service-connected right eye keratoconus, and the rationale does not adequately support the opinions. Thus, another supplemental opinion is needed, in compliance with the June 2012 remand. See Stegall v. West, 11 Vet. App. 268 (1998). In this regard, the Veteran should be scheduled for an eye examination by an optometrist other than the one who conducted the September 2008 VA eye examination to obtain the necessary supplemental opinion. The Veteran is advised that it is his responsibility to report for any examination and to cooperate in the development of his claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655 (2012). Accordingly, the case is REMANDED for the following actions: 1. Schedule the Veteran for an eye examination by an optometrist other than the one who conducted the September 2008 examination in order to ascertain the nature and etiology of his left eye disorder. The claims folder and a copy of this REMAND should be reviewed by the examiner, and the examiner must annotate the examination report that the claims file was in fact made available for review in conjunction with the examination. A complete history of left eye symptoms should be obtained from the Veteran. a) The examiner should state whether it is at least as likely as not (i.e., a likelihood of 50 percent or greater) that the Veteran's left eye disorder was caused by his service. b) If, and only if, the examiner determines that the Veteran's left eye keratoconus is not related to his service, the examiner should state whether it is at least as likely as not (i.e., a likelihood of 50 percent or greater) that the Veteran's left eye keratoconus was caused by, or aggravated by, his service-connected right eye keratoconus. c) The examiner is required to provide a clear rationale and explanation for all conclusions reached based on medical principles and the medical and lay evidence of record. If the examiner cannot express any part of the requested opinions, the examiner should explain the reasons therefor. d) The term "at least as likely as not" does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. e) "Aggravation" means a chronic or permanent worsening of the underlying condition (versus a temporary flare-up of symptoms) beyond its natural progression. If aggravation is present, the examiner should indicate, to the extent that is possible, the approximate level of disability before the onset of the aggravation. 2. After completing the above, readjudicate the issue on appeal. If the determination remains unfavorable to the Veteran, he should be provided with a supplemental statement of the case (SSOC) that addresses all relevant actions taken on the claim, to include a summary of the evidence, and applicable law and regulations considered. The Veteran and his representative should be given an opportunity to respond to the SSOC. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).