Citation Nr: 21062285 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 17-49 581 DATE: October 6, 2021 REMANDED Entitlement to service connection for an eye disability, to include bilateral degenerative myopathy with other maculopathy and bilateral age-related incipient cataracts, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 27, 1975 to November 15, 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2020, the Veteran testified before the undersigned. In December 2020, the Board remanded this matter for additional development. As noted in the December 2020 Board remand, the Veteran asserts that her current eye disability had its onset during her active duty service, to include as a result of her exposure to tear gas during gas mask training in boot camp. See August 2014 Veteran lay statement, March 2020 Board Hearing Transcript at 4-6. Alternatively, the Veteran argues that if any eye disability is determined to have pre-existed her active duty service, that it was aggravated beyond its normal progression by her exposure to tear gas. Id. In this regard, the Board remanded this matter for a VA examination. At the resultant May 2021 VA examination, a VA optometrist diagnosed the Veteran with bilateral degenerative myopathy with other maculopathy and bilateral age-related incipient cataracts. The VA examiner noted that the Veteran has elongated axial eye dimensions resulting in very early childhood progressing myopia that eventually lead to degenerative myopia affecting the integrity of both maculae. In addressing whether the Veteran's current eye disabilities had on their onset during the Veteran's active duty service, the VA examiner opined that the Veteran's bilateral degenerative myopia is a natural progression "regardless of any claim of tear gas exposure." (Emphasis added) The Board notes that the May 2021 VA examiner was instructed in the December 2020 Board remand that her exposure to tear gas was conceded as the Veteran's report is consistent with the character of her service. Indeed, training in a gas chamber with tear gas is common across all military branches for all recruits as required training. Thus, the VA examiner's language assigning doubt to the Veteran's assertion when specifically directed it was conceded in the December 2020 Board remand renders his opinion inadequate. To be adequate, an examination must take into account an accurate history. Nieves-Rodriguez v. Nicholson, 22 Vet. App. 295 (2008). The examiner was asked to address the May 1975 enlistment report of medical history noting 20/200 vision bilaterally, the October 1975 service treatment record showing "changing" visual acuity, the November 1975 medical discharge report of medical examination noting 30/200 vision bilaterally, the Veteran's lay statements regarding her changing visual acuity while on active duty, and discuss whether it represented an aggravation of the Veteran's eye disabilities. However, the May 2021 VA examiner concluded there was no correlation between the Veteran's conceded exposure to tear gas and these noted changes in service. Such a conclusory medical opinion with no supporting rationale is insufficient for rating purposes. See Nieves-Rodriguez, 22 Vet. App. at 301 (stating that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). Accordingly, this matter must be remanded for an addendum opinion. All outstanding VA treatment records should also be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from an examiner other than the May 2021 VA examiner regarding the etiology of the Veteran's bilateral eye disabilities. No additional examination is needed unless the reviewing examiner deems otherwise. The entire claims file must be made available to and reviewed by the examiner, to include a copy of this Remand. After a review of the claims file, the examiner is requested to opine as to the following: (a.) Please indicate whether any eye disorders diagnosed within the appeal period (from August 8, 2014), to include but not limited to (1) myopia (see STRs), (2) posterior staphyloma, (3) cataracts, (4) refractive error, (5) DES OU (see July 2017 VA treatment records), (6) vitreous floaters OU with (7) dry macular degeneration OU with senile cataract OU (see December 2019 private treatment records) and (8) bilateral degenerative myopathy with other maculopathy and bilateral age related incipient cataracts (see May 2021 VA examination report), are congenital defects or a disease. Generally, for VA purposes, a defect differs from a disease in that the former is more or less stationary in nature while the latter is capable of improving or deteriorating. (b.) If any diagnosed eye disorder identified is determined to be a congenital defect, please opine as to the whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran incurred any superimposed disease or injury on such congenital defect during service, to include any disorder to account for eye irritation due to conceded exposure to tear gas in service, which resulted in additional eye disability. If the answer to the above question is yes, please describe the resultant disability. (c.) If any diagnosed eye disorder identified is determined to be a congenital disease, then is there clear and unmistakable evidence that it preexisted the Veteran's service? Please explicitly discuss the medical evidence and provide a complete medical rationale for each eye disorder identified. (d.) If the answer to (c.) is yes, then is there clear and unmistakable evidence that the preexisting disorder was not aggravated beyond its natural progression during service? Please explicitly discuss the medical evidence and provide a complete medical rationale for each eye disorder identified. (e.) If the answer to (d.) is no, or if the disability diagnosed does not have a congenital origin, then is it at least as likely as not (50 percent or greater probability) that the disorder had its onset in service or is otherwise related to service, to include as a result of eye irritation due to conceded exposure to tear gas therein? In answering these questions, the examiner must address the following: 1. the May 1975 enlistment report of medical examination demonstrating bilateral vision measuring 20/200 and orthophoria; 2. the October 1975 service treatment record showing "changing" visual acuity; 3. the July 2017 VA medical center treatment records demonstrating diagnoses of posterior staphyloma, cataracts, refractive error, DES OU; 4. the November 1975 medical discharge report of medical examination demonstrating the Veteran's vision had changed to 30/200 bilaterally; 5. the December 2019 private treatment records demonstrating dry macular degeneration with myopia and vitreous floaters; 6. the Veteran's June 1991 lay statement that after she was accepted onto active duty, her vision progressively worsened; 7. the Veteran's August 2014 lay statement wherein she reports having "20/20" vision at the time of her enlistment; 8. the Veteran's March 2020 testimony that when accepted onto active duty her vision was easily correctable with glasses, that her current visual disorders began during gas mask confidence training when she was exposed to tear gas and manifested as blurred vision with burning and itchiness that continued to the present; 9. the Veteran's November 2015 lay statement wherein she reports the problems with her eyes began or became much worse immediately after being exposed to tear gas; and 10. the June 2017 lay statements from R.B. and T.W. reporting Veteran never complained of eye problems until after her active duty service. In addressing these questions, the examiner must assume that items (6.), (7.), (8.), (9.) and (10.) are true even despite the absence of "objective documentation." 11. Please state whether a nexus between the Veteran's bilateral eye disorders and service is medically consistent with the symptomatology reported by the Veteran and others in items (6.), (7.), (8.), (9.) and (10.) above. A comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Rouse, 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.