Citation Nr: 21061527 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 15-33 761 DATE: October 4, 2021 REMANDED Entitlement to service connection for bilateral eye disability as secondary to the Veteran's service-connected disabilities, to include type two diabetes mellitus, posttraumatic stress disorder (PTSD) and coronary artery disease, is remanded. REASONS FOR REMAND The Veteran served in the United States Army on active duty from January 1968 to January 1971. The issue comes before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The issue was previously before the Board in December 2014. The Board remanded the Veteran's claim to the RO to provide a Statement of the Case. The Board remanded the above claim in March 2019 and May 2021 to provide further development. While the Board regrets further delay, another remand is necessary to ensure substantial compliance with the May 2021 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for bilateral eye disability as secondary to the Veteran's service-connected disabilities, to include type two diabetes mellitus, PTSD and coronary artery disease, is remanded. The Veteran contends that his bilateral eye disability is secondary to his heart disease and other service-connected disabilities. Pursuant to the May 2021 Board remand, in June 2021, the Veteran was provided a VA examination and a VA opinion was obtained. Following a review of the Veteran's claims file, the VA examiner provided the opinion that the Veteran's retinal and macular degeneration were due to the diagnosis of foveomacular degeneration. The VA examiner noted the Veteran's foveomacular degeneration was a hereditary condition capable of deteriorating over time. Additionally, the VA examiner noted the Veteran's diagnosis of nuclear cataracts caused by age related progress. Further, the VA examiner opined that the Veteran's foveomacular retinal degeneration was less likely than not aggravated beyond its natural progression by or proximately due to the Veteran's service-connected diabetes mellitus, heart disease, or PTSD, as it is a hereditary condition. Additionally, the VA examiner noted no documented findings of a retinal artery occlusion or vein occlusion or diabetic or hypertensive retinopathy. Finally, the VA examiner noted the Veteran's cataracts are due to natural aging progression over time and are also not aggravated or due to the service-connected diabetes mellitus, heart disease, or PTSD. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand orders. Stegall, 11 Vet. App. at 271. Where the remand orders of the Board are not complied with, the Board itself errs in failing to ensure compliance. Id. As such, the Board finds that this claim is not ready for appellate review and must be remanded for compliance with the May 2021 remand instructions. Here, the June 2021 examination failed to specifically address the Veteran's contention that his service-connected PTSD, including his hypervigilance, impacted his blood pressure and cardiovascular system, which then caused his eye disabilities. Additionally, the Board finds remand is necessary to provide the Veteran a medical opinion adequately addressing the etiology of the Veteran's bilateral eye disability. VA has a duty to provide the veteran a thorough medical examination, one which takes into account the veteran's prior medical history and describes the disability in sufficient detail so that the Board's evaluation of the claimed disability is fully informed. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Absent a reasoned medical explanation and without supporting data, a medical opinion is inadequate to adjudicate the Veteran's claim. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A mere conclusory medical opinion is insufficient. See Barr, 21 Vet. App. at 312. Without a medical opinion that clearly addresses the relevant facts and medical science, the Board is left to rely on its own lay opinion, which it is forbidden from doing. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The June 2021 examiner failed to address pieces of evidence favorable to the Veteran, including the Veteran's lay evidence regarding his reported medical history and treatment for his eye bleed. As the VA medical opinion is inadequate, remand is needed to provide the Veteran an opinion that accurately addresses the Veteran's lay evidence of record and clearly addresses the Veteran's claimed condition. Miller v. Wilkie, 32 Vet. App. 249, 260 (2020); see also Barr, 21 Vet. App. at 312. The matters are REMANDED for the following action: Obtain an addendum opinion from the June 2021 VA examiner regarding the Veteran's bilateral eye disability, or, if not available, another appropriately qualified VA medical professional. If the examiner determines that an examination is needed to provide the requested opinion, then such examination should be scheduled and may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. The claims file should be reviewed in conjunction with the examination. A copy of this remand should be made available to the examiner. Following a review of the evidence of record, to include the Veteran's lay statements of the onset and continuity of symptoms of his condition, the examiner must opine as to: a. Whether it is at least as likely as not (50 percent probability or more) the Veteran's bilateral eye disability, to include foveomacular degeneration and cataracts, was proximately caused by, or the result of, any of the Veteran's service-connected disabilities (i.e., type two diabetes mellitus, PTSD and coronary artery disease). b. Whether it is at least as likely as not (50 percent probability or more) the Veteran's bilateral eye disability, to include fovemacular degeneration and cataracts, was aggravated by, any of the Veteran's service-connected disabilities (i.e., type two diabetes mellitus, PTSD and coronary artery disease). For the purpose of this examination the VA clinician must address the Veteran's contention that his service-connected PTSD, including his hypervigilance, impacted his blood pressure and cardiovascular system, which then caused his eye disabilities, or that his eye disabilities are secondary to his service-connected coronary artery disease. The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.V. Bona, 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.