Citation Nr: 1320313 Decision Date: 06/24/13 Archive Date: 07/02/13 DOCKET NO. 05-29 528 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for eye disabilities, including glaucoma and diplopia, to include as secondary to diabetes mellitus and peripheral neuropathy. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Janee Juliano, Counsel INTRODUCTION The Veteran served on active duty from January 1965 to January 1968. This matter comes before the Board of Veterans Appeals (Board) on appeal from a February 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In February 2008, February 2011, and August 2012, the Board remanded the Veteran's claim for further development. Such development has been completed and associated with the claims file, and this matter is returned to the Board for further review. As a preliminary matter, the Board notes that in its August 2012 remand, the Board recharacterized the issue on appeal more generally as for eye disabilities (claimed as glaucoma) based on the medical evidence of record. In that regard, the Board specifically notes that service connection for cataracts has already been granted by way of an October 2003 rating decision. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran served on active duty from January 1965 to January 1968. He claims that he has an eye disability, to include glaucoma and diplopia, secondary to Topamax that he was prescribed in April 2002 for his service-connected diabetes mellitus or diabetic peripheral neuropathy. See Notice of Disagreement, July 2004; Statements, August 2004 and April 2005; see also Rating Decisions, May 2002, October 2003, and August 2009 (granting service connection for diabetes mellitus and for peripheral neuropathy of the upper and lower extremities). By way of background, an October 2003 VA examiner opined that the Veteran's glaucoma was not related to his diabetes. In February 2008, the Board remanded the Veteran's claim for another VA examination because the October 2003 VA examiner did not address whether the Veteran's glaucoma may be related to medication for his service-connected diabetes or diabetic peripheral neuropathy (i.e., Topiramate). A November 2008 VA examiner opined that the Veteran's glaucoma was not caused by his use of Topiramate. In February 2011, the Board again remanded the Veteran's claim so that a VA medical opinion could be obtained from the same examiner to clarify whether the Veteran's glaucoma was permanently aggravated by his diabetes or peripheral neuropathy (including medication taken therefor). A May 2011 VA medical opinion reflects the examiner opined that the Veteran's glaucoma was less likely as not permanently aggravated by his diabetes or peripheral neuropathy. A subsequent April 2012 VA treatment record reflected diagnosed diplopia. Therefore, in August 2012, the Board again remanded the Veteran's claim for another VA medical opinion to address whether any diagnosed eye condition (other than cataracts and diabetic retinopathy) was caused or aggravated by his diabetes or peripheral neuropathy. A September 2012 VA medical opinion reflects that the examiner reviewed the claims file, noted all of the Veteran's diagnosed eye conditions during the period on appeal, and essentially opined in part that the Veteran's glaucoma and diplopia were not likely caused by his service or service connected diabetes or peripheral neuropathy (and medications taken therefore). The examiner did not, however, address whether the Veteran's diagnosed diplopia was aggravated by his service-connected diabetes, peripheral neuropathy, or medication taken therefor (i.e., Topiramate). The Board notes again that the prior May 2011 VA examiner's opinion already addressed aggravation with regard to the claimed glaucoma. The September 2012 examiner also acknowledged diagnosed blepharitis, meibomianitis, trichiasis, and dry eye back in 2003. With regard to the Veteran's dry eye, the examiner essentially opined that it was less likely as not caused by his active service or diabetes; the examiner did not, however, opine as to whether the Veteran's dry eye was aggravated by his diabetes, or whether it was caused or aggravated by his peripheral neuropathy, or by the medications taken therefor (albeit the Board acknowledges that the examiner generalized that the dry eye was most likely secondary to blepharitis/meimobianitis/trichiasis, which in turn he generalized are often age-related). With regard to the diagnosed blepharitis, meibomianitis, and trichiasis, the examiner essentially opined that these conditions were not caused by the Veteran's active service. The examiner did not, however, opine as to whether they were caused or aggravated by the Veteran's diabetes or peripheral neuropathy or medications therefor except to generalize that these conditions are often secondary to age-related changes affecting the eyelids. In light of all of the above, the Board finds that, regrettably, another remand is necessary to obtain clarification from the VA examiner as outlined above. In addition, the Board notes that the September 2012 VA examiner cites to an August 2011 VA ophthalmology record (reflecting diagnosed diplopia) that has not been associated with the paper or electronic claims file. Therefore, the Board also finds that a remand is necessary to obtain copies of any outstanding August 2011 VA ophthalmology records and associate them with the claims file. As a final matter, in its April 2012 remand, the Board directed that a copy of the April 2012 Supplemental Statement of the Case (SSOC) be mailed to the Veteran's last known address in Florida. While the Board acknowledges that a January 2013 SSOC was subsequently mailed to the Veteran's Tampa, Florida address, the Board notes that no copy of the prior April 2012 SSOC was sent to the Veteran at the Florida address (and the contents are not substantively included in the later SSOC). Therefore, a remand is also necessary so that a copy of the prior April 2012 SSOC may be mailed to the Veteran's last known address, presumably in Tampa, Florida. Accordingly, the case is REMANDED for the following action: 1. Obtain copies of outstanding August 2011 VA ophthalmology records (including noting diagnosed diplopia) and associate them with the paper or electronic claims file. If any of these records are found to be unavailable, this should be specifically noted in the claims file, and the Veteran should be provided with notice as provided in 38 C.F.R. § 3.159(e). 2. Mail a copy of the April 2012 SSOC to the Veteran's last known address, in Florida, and document that this occurred in the claims folder or the Veteran's electronic record. 3. After the above development has been completed, please ask the same VA examiner who provided the September 2012 VA medical opinion (or an appropriate substitute if he is unavailable) to review the claims file, including a copy of this remand, and to address as follows: a) Whether it is at least as likely as not (50-50 probability) that the Veteran's diplopia was permanently aggravated (i.e., worsened) beyond the natural progress of the disease by his service-connected diabetes, peripheral neuropathy, or any medications taken therefor (i.e., Topiramate). Please provide a complete explanation for the opinion. b) Whether it is at least as likely as not (50-50 probability) that the Veteran's dry eye was permanently aggravated (i.e., worsened) beyond the natural progress of the disease by his service-connected diabetes. Please provide a complete explanation for the opinion. c) Whether it is at least as likely as not (50-50 probability) that the Veteran's dry eye was caused or permanently aggravated (i.e., worsened) beyond the natural progress of the disease by his service-connected peripheral neuropathy or medications taken therefor (i.e., Topiramate). Please provide a complete explanation for the opinion. d) Whether it is at least as likely as not (50-50 probability) that the Veteran's blepharitis, meimobianitis, and trichiasis were caused or permanently aggravated (i.e., worsened) beyond the natural progress of the disease by his service-connected diabetes, peripheral neuropathy, or any medications taken therefor (i.e., Topiramate). Please provide a complete explanation for the opinion. 4. Then, readjudicate the Veteran's claim. If the claim remains denied, the Veteran should be provided a Supplemental Statement of the Case (SSOC). After the Veteran and his representative have been given the applicable time to submit additional argument, the claim should be returned to the Board for further review. 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). _________________________________________________ S. S. TOTH 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).