Citation Nr: 21061746 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 16-46 525 DATE: October 5, 2021 REMANDED Entitlement to a compensable disability rating for left eye lattice degeneration and bilateral pinguecula is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Air Force from April 2002 to April 2006. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The case was most recently before the Board in August 2019, at which time it was remanded for additional development. The Board notes that the case previously included claims of entitlement to service connection for a lumbar spine disability, sciatica, and left lower extremity radiculopathy. A July 2020 rating decision awarded service connection for those disabilities; therefore, they are no longer on appeal. The claim of entitlement to an increased rating for left eye lattice degeneration has since returned to the Board for appellate consideration. Regrettably, for the reasons discussed below, another remand is necessary. At the outset, the Board notes that the issue on appeal was originally characterized as a claim of entitlement to a compensable disability rating for left eye lattice degeneration. However, VA examination reports and a recent VA opinion obtained pursuant to the Board's August 2019 remand instructions establish that the Veteran has bilateral pinguecula that is related to active service. The Board finds that this condition is within the scope of the Veteran's appeal for an increased rating for left eye lattice degeneration; therefore, the issue has been recharacterized accordingly. In accordance with the Board's August 2019 remand instructions, the Veteran was afforded a VA examination in connection with her claim in November 2019. In addition to left eye lattice degeneration, the examiner diagnosed bilateral pinguecula, to which she attributed the Veteran's complaints of ocular irritation. As previously discussed, in an accompanying opinion, the examiner determined that the Veteran's pinguecula were at least as likely as not related to service. Unfortunately, however, the examination report does not contain sufficient information to appropriately rate the Veteran's disability. Pinguecula are evaluated under 38 C.F.R. § 4.79, Diagnostic Code 6037, which instructs adjudicators to evaluate pinguecula based on disfigurement, using the criteria set forth in 38 C.F.R. § 4.118, Diagnostic Code 7800. This diagnostic code enumerates eight characteristics of disfigurement, six of which include some reference to the size or total area of the scar(s) under consideration. The Board acknowledges that pinguecula may not be considered "scarring" in the medical sense of the term; however, VA regulations treat them as such for the purpose of evaluating the severity of the disability. Therefore, the sizes of the Veteran's pinguecula are information that is necessary to properly adjudicate her claim. Consequently, as the VA examinations conducted to date address only visual impairment, the Board finds that a remand is necessary to afford the Veteran a VA examination evaluating her bilateral pinguecula based on scarring/disfigurement. The Board also finds that remand is warranted to obtain an addendum opinion concerning the etiology of the Veteran's right eye lattice degeneration, which was diagnosed during a December 2011 VA examination conducted during the period on appeal. The Board acknowledges that the most recent VA examiner did not find evidence of right eye lattice degeneration, but service connection may be granted upon competent evidence that a claimed disability existed at any time during the appeal period, even if the disability resolves prior to VA's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). In its August 2019 remand instructions, the Board requested opinions concerning whether the Veteran's right eye lattice degeneration is related to active service on a direct basis, or to her left eye lattice degeneration on a secondary basis. The November 2019 examiner did not provide an opinion concerning direct service connection, and in response to the question regarding secondary service connection, she wrote only that "[r]ight eye lattice would be independent of left eye lattice findings . . . ." She did not explain this conclusion. Therefore, remand is warranted to obtain an adequate nexus opinion concerning the etiology of the right eye lattice degeneration diagnosed during the period on appeal. The matter is REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate examiner to determine the current severity of his service-connected bilateral pinguecula based on scarring/disfigurement. The record, to include a copy of this Remand, should be provided to the examiner and all indicated tests should be conducted. The examiner should describe the nature and severity of the manifestations of the Veteran's bilateral pinguecula, to include any resulting functional impairment. The examiner should specifically identify the types of scarring/disfigurement caused by the pinguecula, to include a measurement of the approximate size of each pinguecula, as well as individual and combined total areas for the pinguecula in both eyes. In this regard, the Board notes that while pinguecula may not be considered "scarring" or "disfigurement" in the medical sense of the terms, VA regulations treat them as such for the purpose of evaluating and rating the severity of the disability. In addition, the examiner is asked to address the following questions related to the etiology of the Veteran's right eye lattice degeneration, diagnosed during a December 2011 VA examination: (a.) Is it at least as likely as not (50/50 probability or greater) that the Veteran's right eye lattice degeneration began during or is otherwise related to her service? (b.) Is it at least as likely as not (50/50 probability or greater) that the Veteran's right eye lattice degeneration was caused or aggravated by her service-connected left eye lattice degeneration? The Board notes that causation and aggravation are independent concepts and should have separate findings and rationales. As such, the examiner must provide separate findings and rationales relating to causation and aggravation. Aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice connected disability. Ward v. Wilkie, 31 Vet. App. 233 (2019). (Continued on the next page) A complete rationale must be provided for any opinion rendered. 2. Then, readjudicate the Veteran's claim based on the entirety of the evidence. If the claim remains denied, issue the Veteran and her representative a supplemental statement of the case. An appropriate time should be allowed for response. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. T. Raftery, 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.