Citation Nr: 18155256 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 17-62 802 DATE: December 4, 2018 REMANDED Entitlement to service connection for a bilateral eye disorder, claimed as glaucoma, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran had active duty service from May 1979 to May 1999. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In this regard, the Board notes that a June 2015 rating decision initially denied the Veteran’s claim for service connection for a bilateral eye disorder and, following the receipt of additional evidence and argument in June 2015 and July 2015, reconsidered such claim in the October 2015 rating decision. 38 C.F.R. § 3.156(b). Therefore, the current appeal stems from the Veteran’s original August 2014 claim for service connection. Entitlement to service connection for a bilateral eye disorder, claimed as glaucoma, to include as secondary to hypertension. The Veteran contends that he has a bilateral eye disorder, to include ocular pressure in his right eye and glaucoma in his left eye, related to his military service or, in the alternative, as secondary to his service-connected hypertension. Specifically, in a June 2015 statement, the Veteran contends that, while in service, he had bilateral eye symptoms and was informed that there was a possibility he had glaucoma; however, he was not officially diagnosed with such disorder at that time. He further argues that his service treatment records (STRs) show an onset of visual problems, to include intraocular pressure of the eyes and deformity/cupping of the optic nerve, which he contends are early signs of glaucoma. Additionally, in his December 2017 substantive appeal, the Veteran argued that his service-connected hypertension caused or aggravated his bilateral eye disorder. Furthermore, in her November 2018 Written Brief Presentation, the Veteran’s representative submitted a website address for an article published by Verywell Health (see https://www.verywellhealth.com/high-blood-pressure-and-glaucoma-3422045), which states that long-term high blood pressure increases one’s risk for developing glaucoma. The Veteran’s STRs reveal that he reported eye trouble on a November 1983 Report of Medical History. In March 1984, he was diagnosed with myopic agility. In June 1996, he was assessed with compound myopic astigmatism suspicious cupping. Lastly, in March 1999, he was assessed with several eye disorders, to include myopic/beginning presbyopia and ocular hypertension. The Veteran was afforded a VA examination in April 2015 in order to determine the nature and etiology of his bilateral eye disorder. At such time, the examiner diagnosed glaucoma with an onset date of 2013. However, it was noted that the Veteran reported that his bilateral eye symptoms had their onset in 1984, to include an increase in eye pressure, blurred vision, and eye pain. He also stated that his bilateral eye disorder order worsened with increased pressure. The April 2015 VA examiner concluded that it was less likely than not that the Veteran’s bilateral eye disorder was caused by the claimed in-service injury, event, or illness. While he did not provide a rationale for such opinion, he noted that the Veteran’s eyes were evaluated as normal in March 1982, November 1983, June 1996, and April 2008, and he was diagnosed with primary open angle glaucoma of each eye in April 2013. While his intraocular pressure was elevated in May 2013, his vision was normal in April 2014. However, the examiner did not address the aforementioned findings in his STRs. Further, he did not provide an opinion as to whether the Veteran’s bilateral eye disorder was secondary to his service-connected hypertension. In December 2017, the Veteran submitted a November 2017 opinion from his private physician, Dr. K.S. In this regard, Dr. K.S. indicated that he treated the Veteran for ocular hypertension in the right eye and severe primary open angle glaucoma in the left eye. Dr. K.S. explained that such disorders were not related to his diabetes, but indicated that, according to the Veteran, he had a preceding history of elevated intraocular pressures during his time in the military. Dr. K.S. concluded that elevated intraocular pressure was a major risk factor for glaucoma. However, such opinion was rendered without review of the Veteran’s relevant STRs. Consequently, the Board cannot rely on such opinion to grant service connection for the Veteran’s bilateral eye disorder. Consequently, based on the foregoing, the Board finds that a remand is necessary to obtain an opinion addressing whether the Veteran’s bilateral eye disorder is related to his military service, to include his in-service complaints and treatment in November 1983, March 1984, June 1996, and March 1999. The examiner must also provide an opinion addressing whether the Veteran’s bilateral eye disorder is caused or aggravated by his service-connected hypertension, which includes consideration of the article referenced by the appellant’s representative. The matter is REMANDED for the following action: Return the record to the VA examiner who rendered the opinion in April 2015. The record and a copy of this Remand must be made available to the examiner. If the April 2015 VA examiner is not available, the record should be provided to an appropriate medical professional as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following the review of the record, the examiner should address the following inquiries: (A) The examiner should identify any eye disorder the Veteran has had since shortly before, at the time of, or during the pendency of the August 2014 claim (even if currently asymptomatic or resolved), to include glaucoma. (B) For each diagnosed refractive error, the examiner should opine whether such was subject to a superimposed disease or injury during service, to include experiencing blasts and explosions near his face, that resulted in additional disability. If so, please identify the additional disability. (C) For each diagnosed bilateral eye disorder other than a refractive error, offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, the Veteran’s military service, to include his in-service complaints and treatment in November 1983, March 1984, June 1996, and March 1999. (D) For each diagnosed bilateral eye disorder other than a refractive error, offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such is caused or aggravated by the Veteran’s service-connected hypertension. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner should review the article referenced by the appellant’s representative in his November 2018 submission that indicates that long-term high blood pressure increases one’s risk for developing glaucoma. 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