Citation Nr: 18160164 Decision Date: 12/27/18 Archive Date: 12/26/18 DOCKET NO. 17-04 727 DATE: December 27, 2018 ORDER Entitlement to service connection for diabetic retinopathy is granted. REMANDED Entitlement to service connection for an eye disorder other than diabetic retinopathy, to include retinal detachment and choroidal neovascular membranes (CNVM), is remanded. FINDING OF FACT The Veteran’s diabetic retinopathy was caused by service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for diabetic retinopathy have been met. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1965 to October 1968. The Veteran appeals a February 2014 rating decision by the Agency of Original Jurisdiction (AOJ) denying service connection for retinal detachment and CNVM. In the November 2016 statement of the case, the AOJ additionally denied service connection for Hashimoto’s disease. In January 2017, the AOJ received the Veteran’s VA Form 9, which indicated he only wished to appeal the denial of service connection for an eye disorder. Accordingly, the Board finds the Veteran did not perfect an appeal as to Hashimoto’s disease and thus, that issue is not currently before the Board. 38 C.F.R. §§ 20.200, 20.202. The claim has been expanded to encompass any eye disorder raised by the record. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1131. Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The Veteran contends the issues with his eyes began “only after the diagnosis of diabetes.” See February 2015 Notice of Disagreement. Both VA and private treatment records note a diagnosis of diabetic retinopathy. See, e.g., April 2017 VA examination and April 2016 Dr. E.T. examination. This indicates a link between the Veteran’s currently service-connected type II diabetes mellitus and diabetic retinopathy. There is no evidence counter to a finding that diabetic retinopathy is secondary to diabetes mellitus. Thus, service connection for diabetic retinopathy is warranted on a secondary basis. REASONS FOR REMAND The Veteran contends he underwent a “vitrectomy for an epiretinal membrane” and that such “ocular interventions” lead to his CNVM. See February 2015 Notice of Disagreement. Furthermore, the Veteran alleges that even if his “retinal detachment was caused by a hemorrhage,” his “service related diabetes interfered” with his immune system which caused the infection to be “more severe and prolonged.” Id. A February 2014 VA clinician opined that the Veteran’s CNVM is less likely than not caused by the service-connected diabetes. Although the VA clinician stated that all “other ocular interventions can more likely than not be traced to CNVM or complications from the treatment thereof,” the clinician did not clearly address the Veteran’s retinal detachment. Then the November 2016 VA clinician opined that the Veteran’s retinal detachment was less likely than not “secondary or aggravated by” the service-connected diabetes. Although the November 2016 VA clinician stated the retinal detachment was diagnosed as secondary to peripheral exudative hemorrhagic chorioretinopathy, “a condition that is thought to be a variant of age related macula degeneration,” the clinician did not clearly address aggravation of CNVM as instructed by the AOJ. Furthermore, the Veteran was never afforded an in-person VA examination in connection with the claim on appeal. Therefore, a remand is required to provide the Veteran with a VA examination and an addendum opinion to determine whether the Veteran’s eye disorders are secondary to or aggravated by his service-connected disabilities. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records relevant to treatment the Veteran received for his eye symptoms that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified and the record clearly documented. 2. Schedule the Veteran for an examination with an appropriately qualified clinician to determine the nature and etiology of the Veteran’s eye conditions other than diabetic retinopathy. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. After the record review and examination, the examiner should identify all eye conditions present at any time during the appeal period (other than diabetic retinopathy). Then, for each eye condition other than diabetic retinopathy identified, the reviewing clinician is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran’s eye condition was incurred in, or is otherwise related, to his time on active service? Is it at least as likely as not that the Veteran’s eye condition was caused by his service-connected diabetes mellitus type II? Is it at least as likely as not that the Veteran’s eye condition was aggravated beyond the normal course of the condition by his service-connected diabetes mellitus type II? Is it at least as likely as not that the Veteran’s eye condition was caused by his service-connected diabetic retinopathy? Is it at least as likely as not that the Veteran’s eye condition was aggravated beyond the normal course of the condition by his service-connected diabetic retinopathy? In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Zheng, Associate Counsel