Citation Nr: 18140424 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 12-35 363 DATE: October 3, 2018 REMANDED Entitlement to service connection for a left eye disability, to include congenital cataract, glaucoma, pseudophakia, and dry eye syndrome, as secondary to service- connected right eye disability and posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, served on active duty from December 1967 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated April 2009 of the Department of Veterans Affairs (VA) Regional Office (RO) in Albuquerque, New Mexico. In February 2015, the Board reopened the Veteran’s claim for service connection for a left eye disability and denied the claim on the merits. This decision was appealed to the United States Court of Appeals for Veterans Claims (Court). The Court, in a February 2016 Memorandum Decision, vacated the Board’s February 2015 decision, in part, finding that the Board failed to provide an adequate statement of reasons or bases for its reliance on a March 2011 VA examination and April 2011 addendum medical opinion in concluding that the Veteran’s left eye disability was not aggravated by his service-connected right eye disability, as the VA examiner did not address the issue of aggravation. See Court decision dated February 29, 2016 at pgs. 3-4. Pursuant to the Court’s decision, the Board remanded the claim in October 2016, requesting a VA examination and opinion to address whether it is at least as likely as not that the Veteran’s left eye disability was aggravated beyond its natural progression by his service-connected right eye disability or his service-connected PTSD, a theory of service connection raised by the Veteran on appeal. See Appellate argument dated August 26, 2016 (requesting VA examination to determine whether Veteran’s left eye disability is aggravated by PTSD). On remand, the Veteran was afforded a VA examination, and a November 2016 examination report and medical opinion have been associated with the claims file. 1. Entitlement to service connection for a left eye disability, to include congenital cataract, glaucoma, pseudophakia and dry eye syndrome, as secondary to service-connected right eye disability and PTSD, is remanded. Where the remand orders of the Board or the Courts are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. 268, 271 (1998). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the Veteran’s claims file. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). Also of significance is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. Bloom v. West, 12 Vet. App. 185, 187 (1999). A VA examiner must consider all pertinent medical and lay evidence relevant to the Veteran’s claim. 38 C.F.R. § 3.303(a); See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2006). When VA undertakes to provide a VA examination or obtain a VA opinion it must ensure that the examination and/or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, the November 2016 VA examiner opined that the Veteran’s left eye disability, to include congenital cataract, glaucoma, and pseudophakia are less likely than not aggravated beyond their natural progression by his service-connected right eye disability or service-connected PTSD; and he noted that the Veteran’s dry eye syndrome is not visually significant. See VA Eye Conditions examination report dated November 2016 at pg. 8. However, the opinion is conclusory in that the examiner provided no rationale in support of the opinion; and whether or not dry eye syndrome is visually significant an etiology opinion pertaining to that disorder is needed. Thus, the November 2016 VA medical opinion lacks probative value. See Miller v. West, 11 Vet. App. 345, 348 (1998) (the Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record). Accordingly, the Board finds the November 2016 VA medical opinion inadequate. See Bloom; Barr, supra. Additionally, the opinion fails to comply with the Board’s October 2016 remand. See Stegall, supra (finding that a remand by the Board confers on the Veteran the right to compliance with its remand orders). Therefore, a factually accurate, fully articulated, and soundly reasoned medical opinion is still needed. The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Thereafter, obtain an addendum opinion with regard to the etiology of the Veteran’s left eye disabilities. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After a complete review of the claims file, the examiner is asked to respond to the following: (a) Provide an opinion whether it is at least as likely as not (50 percent or greater probability) that EACH of the Veteran’s left eye disabilities, to include congenital cataract, glaucoma, pseudophakia, and dry eye syndrome, was aggravated beyond its natural progression by his service-connected right eye disability AND/OR his service-connected PTSD. The examiner must provide a factually accurate, fully articulated, and soundly reasoned rationale for each opinion, citing to examination findings or other evidence in the record to support the conclusions. If an opinion cannot be reached without resorting to speculation, the examiner must explain why. 3. Thereafter, readjudicate the claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brad Farrell, Associate Counsel