Citation Nr: 21003776 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 12-26 820 DATE: January 22, 2021 ORDER Entitlement to service connection for cataracts is granted. REMANDED Entitlement to a disability rating in excess of 10 percent for hypothyroidism, status-post radioactive ablation for Grave’s disease is remanded. INTRODUCTION The Veteran had active service from July 1983 to August 2003. In April 2019, the Veteran attended a hearing before the undersigned Veterans Law Judge. A transcript of that proceeding is of record. When this case was previously before the Board in October 2019, the above-noted issues were remanded for further development. The case has since been returned for additional appellate review. FINDING OF FACT The Veteran’s cataracts are etiologically related to his active service. CONCLUSION OF LAW The criteria for service connection for cataracts have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION Legal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Factual Background and Analysis The Veteran asserts service connection is warranted for his cataracts disability. A review of the record indicates the Veteran has undergone interocular lens replacement surgery (pseudophakia) in both eyes as a result of his cataracts. As such, a current disability is shown. See 38 C.F.R. § 4.79, Diagnostic Code 6027. The central issue that must be resolves is whether the Veteran’s disability was incurred in or caused by some event in service. The Veteran underwent a VA examination in March 2009, wherein the examiner concluded the Veteran’s cataracts disability was at least as likely as not due to his open angle glaucoma. The examiner did not provide an explanation to support this conclusion other than his own “clinical experience.” However, the Veteran’s treating physician provided a separate opinion in November 2009. This physician is a specialist in cornea and refractive eye surgery. The physician explained there was a link between the Veteran’s glaucoma treatment in service and his subsequent development of cataracts. In particular, the physician indicated beta blocker therapy has been shown to have an association to the development of cataracts. A review of the Veteran’s service treatment records shows he was indeed prescribed Xalatan, a beta blocker medication, during his time in service. The Veteran recently underwent a VA examination in February 2020, wherein the examiner again noted the Veteran’s pseudophakic condition. In sum, the examiner found it would be speculative to provide an opinion in this matter, because he was unable to review the Veteran’s cataracts as replacement lenses have already been implanted. As such, the Board affords this opinion little probative value. Nevertheless, the Board is satisfied that the evidence supporting a nexus between the Veteran’s current cataracts, status post interocular lens replacement and his military service is at least in equipoise with the evidence against a nexus. In sum, the evidence indicates the Veteran’s cataracts resulted from an event—the prescription of beta blocker medication—in service. Therefore, the Veteran is entitled to service connection for his disability. REASONS FOR REMAND Though unfortunate, additional development is required before the remaining claim on appeal is decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran recently underwent a VA thyroid examination in January 2020. In the course of his examination the Veteran reported experiencing several manifestations associated with his hypothyroidism, which included fatigue, rapid heart rate, cold intolerance, eye manifestations, and a sore throat. The examiner noted additional manifestations including decreased physical stamina and endurance, as well as motor coordination impairments. However, the examiner curiously failed to complete the appropriate disability benefit questionnaires to include musculoskeletal, skin, and cardiovascular to properly assess these manifestations. Rather, the examiner simply indicated the Veteran did not have such signs and symptoms. Based on the foregoing, the Board finds this examination falls far short of the comprehensive assessment requested in the Board’s October 2019 remand. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, this case is REMANDED for the following actions: Afford the Veteran a VA examination by an Endocrinologist with sufficient expertise to fully assess the severity of the Veteran’s service-connected Grave’s disease and associated hypothyroidism. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. Ensure the examiner provides all information required for rating purposes, to specifically include a complete assessment of all consequentially related disorders and manifestations. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, he or she should be directed to clearly explain why that is so. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Fraser, 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.