Citation Nr: 20052936 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 18-32 168 DATE: August 10, 2020 REMANDED Entitlement to service connection for a left eye disability, to include cataracts, claimed to be a residual of injury in service is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from March 1965 to January 1968, and from May 1973 to March 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision. In June 2019 this matter was remanded for additional development. The June 2019 remand also remanded the matter of service connection for a respiratory disability, a June 2020 rating decision granted service connection for COPD (resolving that matter); the agency of original jurisdiction also granted service connection for dry eye (which was only a partial grant of the benefit sought in that matter, and it remains on appeal). Entitlement to service connection for a left eye disability, to include cataracts, claimed to be a residual of injury in service is remanded. The Board has found that there has not been substantial compliance with previous remand directives, and that corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Review of post-remand development in this matter found critical procedural omissions, as well as less than substantial compliance with remand instructions. Specifically, upon obtaining an advisory medical opinion and acknowledging that the Veteran served in the territorial waters of Vietnam, the AOJ granted service-connection for dry eyes (significantly, as secondary to diabetes mellitus), which was considered a partial grant of this benefit sought. The AOJ continued a denial of service connection for residuals; because cataracts were the remaining eye pathology diagnosed, this constituted an implicit, if not expressly stated, denial of service connection for left eye cataracts. Notably, service connection for diabetes mellitus was denied by a prior final April 2012 rating decision (and remains identified as denied on the current, June 2020, Rating Codesheet). The grant of service connection for bilateral dry eye as secondary to diabetes prior to a formal grant of service connection for diabetes mellitus constitutes a legal error or at least a procedural omission which requires correction. The matter of service connection for a left eye disability remaining on appeal is inextricably intertwined with the service connection for diabetes mellitus claim. The Board notes that in a claim of service connection, each theory of entitlement specifically alleged, or raised by the record, must be considered. Consequently, what remained to be expressly addressed here was whether the left eye cataracts diagnosed are due to injuries in service or (as raised by the implicit but not formally granted, acknowledgement of service connection for type 2 diabetes mellitus) are complications of/were caused or aggravated by diabetes. The continued denial of service connection for the remaining claimed left eye disability (cataracts) was based on the January 2020 medical opinion obtained, which merely identified the left eye cataracts as “congenital”, with no explanation why the cataracts are not due to trauma or secondary to/a complication of the (implicitly acknowledged be service-connected) diabetes. The June 2019 remand specifically directed the examiner to include rationale with the opinions reached. Because adequate rationale was not included the Board finds that the January 2020 medical opinion in this matter is inadequate for rating purposes, and noncompliant with the Board’s remand. Accordingly, development for another (fully adequate) medical advisory opinion is necessary. The matter is REMANDED for the following: 1. Arrange for any necessary development, and formalize, by a rating decision, the implicit determination regarding the matter of service connection for type 2 diabetes mellitus (as secondary to the conceded exposure to Agent Orange based on Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23). 2. Arrange for the Veteran’s record to be forwarded to an appropriate clinician (in ophthalmology, other than the January 2020 examiner) for review and an advisory medical opinion (if further specialty eye examination of the Veteran is necessary, such should be arranged) regarding the etiology of the Veteran’s diagnosed left eye cataracts. The provider should: (a.) Identify the likely etiology for the Veteran’s left eye cataracts. Specifically, is it at least as likely as not (a 50% or better probability) that it they (i) are due to injury in service or (ii) were caused or aggravated by/a complication of [any service-connected] diabetes. (b.) If not, identify the etiology for the cataracts that is considered to be more likely, and explain why that is so. [If the rationale is that the left eye cataracts are age-related or congenital the explanation must cite to the clinical findings/pathology and medical principles that support such conclusion (citing to appropriate medical literature).] All opinions must include complete explanation of rationale. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Staskowski, Associate Counsel 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.