Citation Nr: 19151908 Decision Date: 07/03/19 Archive Date: 07/03/19 DOCKET NO. 16-17 626 DATE: July 3, 2019 REMANDED Entitlement to service connection for a right eye disability is remanded. REASONS FOR REMAND Entitlement to service connection for a right eye disability is remanded. This claim comes before the Board on appeal of a July 2015 rating decision denying service connection for a right eye disability. The Veteran contends that he has a right eye disability which he described in his March 2019 hearing as poor vision. The Veteran has advanced two theories of entitlement to service connection. The Veteran contends that his right-eye disability is the result of a foreign body injury to his right-eye incurred while in service. The Veteran also contends that his eye disability is secondary to a blood clot caused by his service connected high blood pressure. There is insufficient information in the record currently before the Board to allow it to make a fully informed decision. The Veteran was afforded a VA examination in April 2019 in which the VA examiner opined that the Veteran’s current eye disability was the result both of his in-service foreign body eye injury and a right-eye blood clot. However, the Board finds that the April 2019 VA examination is inadequate. For an opinion to be adequate, it must include consideration of the Veteran’s statements, be based on accurate factual premises, and contain a rationale sufficient to support its conclusions. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As discussed below, the April 2019 VA examination does not articulate a rationale linking its conclusions to information in the Veteran’s service treatment records and post-service medical records. The Veteran contends that he has a right eye disability that he described in his March 2019 hearing as poor vision. To demonstrate entitlement to service connection under either a direct or secondary theory, the Veteran must demonstrate the existence of a current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.310. For the purpose of disability determinations, VA evaluates visual acuity on the basis of corrected vision. 38 C.F.R. § 4.76(b)(1). The April 2019 VA examination documents that the Veteran’s uncorrected vision is 20/200 in the right eye and 20/100 in the left but reflects only that the Veteran’s corrected visual acuity in both eyes is 20/40 “or better”. This is insufficient to allow the Board to determine the existence of a current eye disability based on loss of visual acuity. Therefore, this claim should be remanded for a VA examination to determine the Veteran’s current visual acuity. To establish entitlement to direct service connection for a present disability, a veteran must also show in-service incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The April 2019 VA examination is inadequate with respect to identifying any causal nexus between any current eye disability and the Veteran’s in-service foreign body eye injury. The Veteran’s service treatment records reflect a foreign body in his right eye in December 1984. The April 2019 VA examiner attributed the Veteran’s decreased visual acuity in his right eye both to a corneal scar at the “6 o’clock position”. It is not clear whether this location is the same or similar as the location of the foreign body noted in a December 1984 diagram of the Veteran’s eye in his service treatment records. Thus, on remand, the VA examiner should clarify whether the corneal scar observed in April 2019 is the result of the Veteran’s December 1984 foreign body eye injury. To demonstrate entitlement to secondary service connection a veteran must show evidence that a non-service-connected disability is either proximately due to or the result of a service-connected disability; or aggravated beyond its natural progress by a service-connected disability. 38 C.F.R. § 3.310. The Veteran has been granted service-connection for high blood pressure, effective October 2009. The Veteran contends that his eye disability is the result of a right-eye blood clot caused by his service-connected high-blood pressure. The Veteran’s medical records reflect treatment for a retinal blood vessel occlusion in 2012. The April 2019 examiner stated that the Veteran’s decreased visual acuity was a result of a right-eye blood clot repaired in 2014. The Board can find no record of any clot having been repaired in 2014; an April 2015 optometry note documents that the Veteran reported stopping treatment for his 2012 blood clot due to a family emergency. There is also no medical evidence of record linking the Veteran’s 2012 blood clot to his service-connected high blood pressure. Thus, on remand, the VA examiner should clearly indicate that the Veteran’s entire claims file was reviewed and articulate the rationale supporting any relationship between any current eye disability, any blood clots in the Veteran’s eyes, and the Veteran’s service-connected high blood pressure. Finally, refractive errors of the eye are not subject to compensation. 38 C.F.R. § 3.303 The Board notes that the Veteran’s service treatment records document a series of eye examinations in April 1984, April 1988, May 1994, June 1997, and February 2000, generally reflecting decreasing visual acuity. The April 2019 VA examiner does not address the uncorrected and corrected visual acuity levels documented at these exams and does not discuss their significance with respect to any current eye disability and whether, or how, the Veteran’s in-service foreign body injury or later right-eye blood clot contributed to or aggravated this trend. Finally, the Board notes that the April 2019 VA examiner provided contradictory answers regarding whether the Veteran had experienced anatomical loss of an eye. The Board concludes that any nexus or causation opinions expressed in the April 2019 examination are not based on accurate factual premises and are not supported by a sufficient supporting rationale. Therefore, the claim should be remanded to obtain an adequate nexus opinion addressing whether any current eye disability was either incurred, or had its onset, in-service, or was aggravated by an in-service injury; or was proximately due to or aggravated by a service-connected disability. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file a full and comprehensive listing of all of the Veteran’s periods of service. 2. Following receipt of the records discussed in Remand Directives 1 and 2, forward the claims file, including this remand, to the VA examiner who provided the April 2019 opinion, to provide an addendum medical opinion regarding the Veteran’s eye disability. If the April 2019 VA examiner is unavailable, or is unable to offer the opinion sought, the requested opinions should be obtained from another appropriately qualified clinician. The examiner should indicate in the addendum report that the claims file was reviewed. The need for an additional in person examination is left to the discretion of the medical professional offering the addendum opinion. The examiner should identify with specificity any eye disabilities the Veteran may currently have. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any eye disability is proximately due to the Veteran’s December 1984 foreign body injury to the right eye. If the examiner finds it less likely than not (less than 50 percent probability) that any eye disability is proximately due to the Veteran’s December 1984 foreign body injury to the right eye, the examiner should opine whether it is at least as likely as not (50 percent probability or more) that any eye disability was aggravated by the December 1984 foreign body injury. If the examiner finds it less likely than not (less than 50 percent probability) that any eye disability was either proximately due to, or aggravated by, the Veteran’s December 1984 foreign body injury, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right-eye blood clot was proximately due to his service-connected hypertension, and whether it is at least as likely as not (50 percent probability or more) that any eye disability is proximately due to the right-eye blood clot. If the examiner finds it less likely than not (less than 50 percent probability) that any eye disability was proximately due to the Veteran’s right-eye blood clot, the examiner should opine whether it is at least as likely as not (50 percent probability or more) that any eye disability was aggravated by the Veteran’s right-eye blood clot. If aggravation is found, the examiner should identify baseline level of disability prior to such aggravation. (Continued on the next page)   A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner explain why an opinion cannot be provided and specifically state whether the inability to provide an opinion is due to the limits of the examiner’s knowledge, the limits of medical knowledge in general, or there is additional evidence that would allow for an opinion on this matter. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. C. Sametshaw The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.