Citation Nr: 21063509 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-17 746 DATE: October 14, 2021 REMANDED Service connection for glaucoma is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1978 to March 2001. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Board remanded the claim for further evidentiary development. The Board notes that in August 2021, the Veteran's representative submitted an Informal Hearing Presentation (IHP) and asked for service connection for hypertension. The RO denied the Veteran's hypertension claim in May 2017 and the Veteran did not file a Notice of Disagreement (NOD) or a Substantive Appeal regarding this issue. The Board has jurisdiction over appeals of VA decisions regarding the provision of benefits to veterans and their dependents or survivors. 38 U.S.C. § 7104(a) (2014); 38 C.F.R. § 20.101(a) (2016). Under the legacy system, an appeal consists of a timely filed NOD, a Statement of the Case, and a timely filed Substantive Appeal. 38 U.S.C. § 7105(a) (2014); 38 C.F.R. § 20.200 (2016). A Substantive Appeal consists of a properly VA Form 9 or correspondence containing the necessary information. 38 C.F.R. § 20.202 (2016). In the present case, the Veteran did not file a NOD or a VA Form 9 concerning the denial of service connection for hypertension. As such, this issue is not before the Board. Additionally, effective March 24, 2015, VA amended its regulations to require that all claims governed by VA's adjudication regulations be filed on a standard form. Prior to March 24, 2015, VA recognized formal and informal claims. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151 and 3.155. As the standard form claim regulations were in effect at the time of August 2021 IHP, the Veteran's representative's statement regarding entitlement to service connection for hypertension cannot be considered as an informal claim. Service connection for glaucoma is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran was afforded a VA examination in November 2019. The examiner diagnosed primary open angle glaucoma and noted the date of diagnosis to be 2002. The examiner provided a negative nexus opinion. The examiner's rationale was that medical research does not support a causal relationship between glaucoma and hexane exposure and specifically the examiner cited to an article in the American Journal of Epidemiology for this proposition. The Board finds the November 2019 VA examination to be inadequate. First, the study relied on by the examiner looked at a possible relationship between color vision defects and hexane exposure and it did not examine if there was a relationship between glaucoma and hexane exposure. Indeed, the study is entitled, "Acquired Color Vision Defects and Hexane Exposure: A Study of San Francisco Bay Area Automotive Mechanics." (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887581/ (last visited October 13, 2021) Thus, the examiner's conclusion that the American Journal of Epidemiology study stands for the proposition that medical research does not support a causal relationship between glaucoma and hexane exposure is misplaced. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). Also, the Veteran contends that his glaucoma is related to in-service high blood pressure and high glucose and the examiner failed to offer an opinion on these matters. For these reasons the Board finds the November 2019 VA examination to be inadequate. This matter is REMANDED for the following actions: 1. Obtain and associate with the claims file VA treatment records from November 2019 to the present. 2. After completing the development above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's glaucoma. The examiner must opine whether the Veteran's glaucoma is at least as likely as not related to an in-service injury, event, or disease, including high blood pressure, high glucose, exposure to hexane, and/or blurred vision in the right eye. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Patel, 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.