Citation Nr: 18147488 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 07-16 007 DATE: November 5, 2018 REMANDED Entitlement to service connection for bilateral hearing loss, to include as secondary to service-connected diabetes mellitus, type II, is remanded. Entitlement to service connection for glaucoma, to include as due to exposure to ionizing radiation and/or herbicide agents, or as secondary to service-connected diabetes mellitus, type II, is remanded. Entitlement to service connection for a lung disorder, including chronic obstructive pulmonary disease (COPD) and asbestosis, to include as due to exposure to ionizing radiation, asbestos, and/or herbicide agents, or as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1954 to April 1974. His awards and decorations include the Combat Action Ribbon. He died in March 2017 and the appellant is his surviving spouse, who has been accepted as the substitute claimant for the purpose of processing this appeal to its completion. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2006 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2009, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In June 2010, August 2012, and March 2016, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for bilateral hearing loss, to include as secondary to service-connected diabetes mellitus, type II. 2. Entitlement to service connection for glaucoma, to include as due to exposure to ionizing radiation and/or herbicides, or as secondary to service-connected diabetes mellitus, type II. 3. Entitlement to service connection for a lung disorder, including COPD and asbestosis, to include as due to exposure to ionizing radiation, asbestos, and/or herbicides, or as secondary to service-connected PTSD. In the March 2016 remand, the Board requested a VA examiner to provide a variety of opinions regarding the Veteran’s claimed disorders. Specifically, a medical opinion was needed to address (i) whether the Veteran’s bilateral hearing loss was caused or aggravated by his service-connected diabetes mellitus; (ii) whether the Veteran’s glaucoma was caused or aggravated by his service-connected diabetes mellitus; and (iii), following the Agency of Original Jurisdiction’s (AOJ’s) development of potential in-service asbestos exposure, if deem verified, whether the Veteran’s lung disorder, to include COPD and/or asbestosis, was related to such in-service exposure. Thereafter, while the AOJ attempted to obtain the aforementioned opinion regarding the Veteran’s bilateral hearing loss in November 2016, the VA examiner stated that an audiologist could not make a medical opinion about hearing loss as secondary to diabetes mellitus. There is no indication that the AOJ referred the matter to an appropriate clinician for such opinion. Therefore, such should be obtained on remand. With regard to the Veteran’s glaucoma, a November 2016 VA examiner opined that it was less likely than not that such disorder was caused by or a result of his diabetes. As rationale, the examiner explained that the Veteran’s glaucoma preceded his September 2012 diagnosis of diabetes, and diabetes and glaucoma usually occur independently of one another. He further explained that the records indicated that the Veteran’s glaucoma was diagnosed in 2007 and, in November 2011, he had severe glaucoma damage in his right eye. He further explained that the Veteran did not have evidence of diabetic retinopathy. For these reasons, the examiner concluded that it was less likely as not that the Veteran’s glaucoma was caused by or a result of his diabetes. However, the examiner failed to provide an opinion addressing whether his glaucoma was aggravated by his diabetes. Further, the November 2016 VA examiner’s opinion rested, in part, on an inaccurate factual premise, namely that the Veteran’s glaucoma and glaucoma damage predated his diabetes mellitus. In this regard, the examiner indicated that the Veteran was diagnosed with glaucoma in 2007 and, in November 2011, he had severe glaucoma damage in his right eye, which preceded his September 2012 diagnosis of diabetes. However, private treatment records show that the Veteran was diagnosed with diabetes in September 2011. See September 2012 private treatment record. As such, the examiner’s opinion was based, at least in part, on an inaccurate factual premise and is therefore without probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (An opinion based upon an inaccurate factual premise has no probative value.). Therefore, a remand is necessary in order to obtain an addendum opinion as to whether the Veteran’s glaucoma was caused or aggravated by his service-connected diabetes mellitus. With regard to the Veteran’s lung disorder, the Board notes that he claimed that he was exposed to asbestos coincident with his duties while in service. In this regard, the Veteran’s DD Form 214 reflects his military occupational specialty (MOS) as a quartermaster, which has a minimal probability of asbestos exposure. Consequently, the Board finds that a remand is necessary in order to obtain an opinion as to whether the Veteran’s lung disorder, to include COPD and/or asbestosis, is related to his in-service exposure to asbestos. Furthermore, the Veteran had service in Vietnam and, therefore, is presumed to have been exposed to herbicide agents coincident with such service, and has alleged that his glaucoma and lung disorder are related to such exposure. While the November 2016 VA examiner addressed such theory of entitlement in regard to the latter disorder, an opinion regarding whether the Veteran’s glaucoma is related to his in-service exposure to herbicide agents has not yet been rendered. Therefore, such should be obtained on remand. The matters are REMANDED for the following actions: 1. The AOJ should obtain an opinion regarding the alleged relationship between the Veteran’s bilateral hearing loss and diabetes mellitus from an appropriate medical professional. The record and a copy of this Remand must be made available to the examiner. If the examiner is unable to provide an opinion, he or she should state why he or she is unable to do so and, thereafter, the AOJ should conduct any necessary development, to include obtaining an opinion from another appropriate medical professional. Based on review of the record, the examiner should offer an opinion as to whether it is at least as likely as not that the Veteran’s bilateral hearing loss is caused or aggravated by his service-connected diabetes mellitus. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. In this regard, the examiner should specifically consider the medical treatises the Veteran’s representative cited in his February 2016 brief. A rationale for any opinion offered should be provided. 2. Return the record to the VA examiner who offered an opinion as to the etiology of the Veteran’s glaucoma in November 2016. The record and a copy of this Remand must be made available to the examiner. If the November 2016 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability that the Veteran’s glaucoma is caused or aggravated by his diabetes mellitus (diagnosed in September 2011)? For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. (B) Is it at least as likely as not (i.e., a 50 percent or greater probability that the Veteran’s glaucoma is related to his acknowledged in-service exposure to herbicide agents? A rationale for any opinion offered should be provided. 3. Return the record to the VA examiner who offered an opinion as to the etiology of the Veteran’s lung disorder in November 2016. The record and a copy of this Remand must be made available to the examiner. If the November 2016 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that his lung disorder, to include COPD and/or asbestosis, is related to his acknowledged in-service exposure to asbestos consistent with his MOS of quartermaster? A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brennae L. Brooks, Associate Counsel