Citation Nr: 21062708 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-18 902 DATE: October 12, 2021 ORDER Entitlement to service connection for bilateral pinguecula is granted. Entitlement to service connection for bilateral cataracts is granted. REMANDED Entitlement to service connection for an eye disability, other than dry eyes syndrome, bilateral pinguecula, and bilateral cataracts, is remanded. FINDINGS OF FACT 1. The Veteran's bilateral pinguecula was caused by his service-connected dry eye syndrome. 2. Resolving doubt in favor of the Veteran, his bilateral cataracts were caused by his service-connected diabetes. CONCLUSIONS OF LAW 1. The criteria to establish service connection for bilateral pinguecula have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. The criteria to establish service connection for bilateral cataracts have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1969 to February 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran service connection for loss of vision. In a July 2021 rating decision, the Veteran was granted service connection for dry eye syndrome. A Board hearing was held in April 2019. A transcript is of record. In January 2020, October 2020, and March 2021, the Board remanded the Veteran's claims to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board's remand directives. Specifically, the Board remanded to afford the Veteran an adequate VA examination that contemplates all of the Veteran's theories of entitlement. The claim is back before the Board for further appellate proceedings. The Board notes that, in July 2021, a VA examiner diagnosed the Veteran with dry eyes syndrome, bilateral pinguecula, bilateral cataracts, arcus senilis, congenital hypertrophy of the retinal pigment epithelium (CHRPE), peripheral corneal scars, and hyperopic astigmatism. As noted above, the Veteran has been service-connected for dry eye syndrome. Accordingly, the Board has characterized the issues as stated on the title page to afford the Veteran a broader scope of review. See Browkowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for bilateral pinguecula is granted. The Veteran has been diagnosed with bilateral pinguecula. See July 2021 VA examination report. He is service connected for dry eye syndrome. His dry eye syndrome is described as a chronic drying of the ocular surface due to a lack of tear production and/or poor tear film quality. Id. A VA examiner opined that the Veteran's bilateral pinguecula was caused, in part, by chronic dryness. Id. As the Veteran's dry eye syndrome causes chronic dryness, a causal chain between the Veteran's dry eye syndrome and bilateral pinguecula has been established. Accordingly, the Board finds that the Veteran's bilateral pinguecula is etiologically related to the Veteran's service-connected dry eye syndrome. Therefore, the criteria for service connection for the Veteran's bilateral pinguecula have been met. 2. Entitlement to service connection for bilateral cataracts is granted. The Veteran has been diagnosed with bilateral cataracts. See July 2021 VA examination report. He is service connected for diabetes. A VA examiner opined that diabetes could cause cataracts but that it was more likely due to an age-related clouding. Id. Significantly, the examiner could not rule-out the etiological link between the Veteran's diabetes and his bilateral cataracts. Id. As such, reasonable doubt exists as to whether the Veteran's bilateral cataracts were caused by his diabetes. Resolving reasonable doubt in favor the of the Veteran, the Board finds that the Veteran's bilateral cataracts were caused by his service-connected diabetes. Therefore, the criteria for service connection for the Veteran's bilateral cataracts have been met. REASONS FOR REMAND As of the order above, the Veteran is now service connected for dry eye syndrome, bilateral pinguecula, and bilateral cataracts. The remaining eye diagnoses of record must be remanded for medical opinions that address the contentions listed in the Board's prior remand directives. Specifically, the Board remanded the Veteran's claim for an examiner to determine whether any eye disability was related to his duties outside as a boatswain's mate. See August 2014 notice of disagreement. Unfortunately, while he was afforded a new VA examination in July 2021, the examiner did not address this specific contention. As such, remand is required. The Board notes that, generally, service connection may not be granted for congenital or developmental defects as they are not considered a disease or injury for VA purposes. See 38 C.F.R. §§ 3.303 (c), 4.9 (2018). The VA examiner opined that the Veteran's CHRPE and hyperopic astigmatism are developmental or congenital but did not opine as to whether they are a disease or defect. An additional opinion addressing these conditions is also needed on remand. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his eyes. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After the above development is completed, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's eye conditions (other than dry eye syndrome, cataracts, and pinguecula), to include arcus senilis, congenital hypertrophy of the retinal pigment epithelium (CHRPE), peripheral corneal scars, and hyperopic astigmatism. The evidentiary record, including a copy of this remand, must be made available and reviewed by the clinician. The opinion should include a notation that this record review took place. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review, and examination if deemed necessary, the reviewing clinician is asked to respond to the following inquiries as to each disability: A. As to any congenital condition, is it at least as likely as not that the Veteran's eye condition is solely attributable to a congenital disease (meaning the condition can improve or deteriorate) instead of a congenital defect (meaning the condition is static in nature, and cannot generally improve or deteriorate)? B. If deemed a congenital disease, is it at least as likely as not that the Veteran's eye condition was aggravated or worsened by the Veteran's time on active duty service, to include exposure to an herbicide agent therein? C. If an eye disability of the Veteran (other than dry eye syndrome, pinguecula, and cataracts) is deemed a congenital defect (meaning the condition is static in nature, and cannot generally improve or deteriorate), does the Veteran have a superimposed eye condition? If so, is it at least as likely as not that the Veteran's superimposed eye condition was either incurred in, or is otherwise attributable to, the Veteran's active duty service, to include herbicide exposure therein? D. If any eye condition of the Veteran (other than dry eye syndrome, pinguecula, and cataracts) is deemed to be non-congenital, is it at least as likely as not that such disability was either incurred in, or is otherwise attributable to, the Veteran's active duty service, to include herbicide exposure therein? The reviewing clinician must address the Veteran's contention that his eye disability is related to being outside as a Boatswain's Mate during service. The reviewing clinician must also address his contention that he had to wear an eye patch on his left eye "for quite a while" during boot camp. E. Is it at least as likely as not that the Veteran's eye disability (other than dry eye syndrome, bilateral pinguecula, and bilateral cataracts), was (a.) caused or (b.) aggravated by his service-connected diabetes? In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Strickland 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.