Citation Nr: 21003020 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 15-21 912 DATE: January 19, 2021 REMANDED The issue of entitlement to a separate rating for glaucoma, to include as due to the Veteran’s service-connected diabetes mellitus with diabetic retinopathy and cataracts, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1963 to August 1970, including service in the Republic of Vietnam from March 1968 to March 1969. In May 2018, a Travel Board hearing was held before the undersigned Veterans Law Judge; a transcript is of record. The Board previously remanded the issue for further development in July 2019. The case has now been returned to the Board for appellate review. Unfortunately, another remand is required, for the October 2020 opinion, obtained per July 2019 remand, is not adequate for rating purpose. The October 2020 examiner opined that the Veteran’s glaucoma is unrelated to diabetes or mild nonproliferative diabetic retinopathy. The rationale provided was that the Veteran’s glaucoma is primary open angle glaucoma and is not related to diabetes. This rationale is insufficient, for “primary” simply means that the etiology is unknown and the examiner failed to explain why the Veteran’s glaucoma with unknown etiology is not related to diabetes. Moreover, the examiner failed to opine whether the Veteran’s glaucoma is etiologically related to his cataracts. Lastly, the examiner did not opine whether the Veteran’s glaucoma was aggravated beyond natural progression by his service-connected diabetes mellitus, diabetic retinopathy, or cataracts. Additionally, the Board notes that the examiner’s opinion that the visual field defect was caused by glaucoma appears inconsistent with the evidence of record. The evidence indicates that the visual field test, conducted for a March 2015 VA examination, shows the visual field defect, which worsened in an April 2019 examination; and the initial diagnosis of glaucoma/glaucoma suspect was documented in February 2019, which is after the Veteran had already been diagnosed with diabetic retinopathy and cataracts. Further of note is that risk factors for chronic glaucoma include being over age 60, having family history of glaucoma, and having medical conditions such as diabetes or high blood pressure, as the Veteran’s representative points out in the January 2021 appellate brief. See also, Glaucoma, Mayo Clinic, available at http://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839. The Veteran consistently denied any family history of glaucoma, as shown in the medical treatment records. Thus, the October 2020 opinion is inadequate. Upon remand, an addendum opinion for etiology of glaucoma with sufficient rationale must be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician, who is different from the October 2020 examiner and preferably an ophthalmologist. The examiner must review the claims file, to include this remand in its entirety, The examiner must opine regarding whether the Veteran’s glaucoma is at least as likely as not (1) related to or (2) proximately due to service-connected or otherwise aggravated beyond its natural progression by, service-connected disability, to include diabetes mellitus, nonproliferative diabetic retinopathy, and cataracts. Moreover, the examiner must opine (3) whether the Veteran’s loss in visual field is solely the result of diabetic retinopathy/cataracts, solely the result of glaucoma, or is a combination of diabetic retinopathy/cataracts and glaucoma. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why that is so. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Taylor, 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.