Citation Nr: 20005403 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 17-58 299 DATE: January 22, 2020 REMANDED Entitlement to service connection for pituitary macroadenoma, moderate mass effect on the optic chiasm, also claimed as loss of vision secondary to pituitary cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1965 to June 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. During the hearing, the Veteran stated that his face hit a steel bar in service which knocked him out and caused a hairline fracture in his forehead. The Veteran reportedly developed a tumor and has had several surgeries to remove the tumor as it regrows. Due to the tumor, he is losing his peripheral vision and experience headaches and balance issues. The Veteran stated that he has been told by doctors that the cause of his vision loss could be exposure to herbicide, the in-service injury to the face, or excessive stress. VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board acknowledges that the Veteran is service connected for several disabilities under the Agent Orange presumption. See May 2015 rating code sheet. More Specifically, the Veteran has been service connected for a fractured nose since September 1980 and diabetes March 2011. Service treatment records (STR) indicate the Veteran reported issues with his eyes and his nose. See e.g., December 1966 STR; November 1967 STR; April 1968 STR. Post-service treatment records indicate the Veteran developed vision loss after service. See e.g., May 2004 VA examination (finding the Veteran to be legally blind); March 2016 VA treatment record. In July 2002, the Veteran was afforded a VA examination. The Veteran wanted to know if the growth behind his eye could be related to his nose trauma from his time in service. The Veteran was diagnosed with optic nerve hard drusen bilaterally with vision field defects. The examiner opined that the optic drusen could be caused by many things. It could be idiopathic, congenital, or associated with an acquired disease. However, the examiner opined that the optic drusen was not believed to be related to his in-service nose trauma. The Board finds this examination to be inadequate because it does not express the right degree of certainty. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Speculative opinions cannot be used to support a claim because it doesn’t express a level of confidence that is 50 percent or greater. Hood v. Shinseki, 23 Vet. App. 295, 298 (2009). In this case, the examiner stated that the etiology of the vision’s loss could be many things and it was “believed” to not be related to his in-service trauma. In addition, the examiner did not address the theory that a tumor (a pituitary macroadenoma) developed as a result of service and that this tumor in turn caused the loss of vision. The Board cannot rely on this opinion and a new examination must be afforded to the Veteran. Once VA undertakes to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Obtain outstanding relevant medical records and associated them with the file, if any. 2. Then, schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of his vision loss. The entire claims file must be provided to the examiner for review, including a copy of this remand and any new obtained medical records. The examiner is asked to review the claims and indicate in the record that it was reviewed. The examiner is also asked to render an opinion for the following: Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s vision loss is related to his military service. The examiner should address the theory presented by the Veteran that he has a pituitary macroadenoma that developed as a result of service and that this tumor in turn caused his loss of vision. Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s vision loss is related to his service-connected disabilities, particularly his diabetes, ischemic heart disease and nose fracture. Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s vision loss is related to Agent Orange exposure. 3. A clear rationale must be provided for all opinions expressed. The examiner must consider the Veteran’s lay statements and private treatment records. If the examiner is unable to provide an opinion without resorting to mere speculation then the examiner must state this and provide any information needed to make an opinion, if possible. 4. Thereafter, readjudicate the claim. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Harris, Attorney Advisor 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.