Citation Nr: 21063920 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 14-99 817A DATE: October 18, 2021 REMANDED Entitlement to service connection for a bilateral eye disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1981 to July 1985. In November 2020, the Board remanded this case for additional development. The Board finds that there has not been substantial compliance with the Board's previous remand. Another remand for further development is required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a bilateral eye disability is remanded. The Veteran asserts that a bilateral eye disability is the result of service. The Board requested a medical opinion which addressed whether photophobia was at least as likely as not related to documented eye problems in service or a history of welding in service. A medical opinion was provided in February 2021. However, the examiner did not provide the requested medical opinion and VA requested addendum opinions. In a May 2021 addendum opinion, the examiner opined that glaucoma, dry eye, and photophobia were not service-related because "[t]he treatment record d[id] not document any medical evidence to establish a connection between the aforementioned conditions and military service. Lay symptoms: Glaucoma- Essentially the condition has no symptoms until the late stage of the condition. Which includes decreasing visual field and difficulty adjusting going from high light conditions to low light. Dry Eye-Chronic burning, irritation, redness, watering. Excessive blinking, intermittent blurred vision, eye fatigue. Photophobia- excessive light sensitivity." In a June 2021 addendum opinion, the examiner stated that photophobia was "unrelated to the history of welding. The examiner stated that it was "likely the Veteran ha[d] had a history of "flash burn". Ocular UV exposure during welding can result in photokeratitis. A primary symptom of photokeratitis is photophobia. Photophobia is due to inflammation of the cornea that can be observed with corneal staining. The eye exam performed on 2/1/2021 noted no corneal abnormalities. Photokeratitis as a result of welding is not a chronic condition and typically resolves within 24-72 hours. Brozen, Reed; Christian Fromm (February 4, 2008). "Ultraviolet Keratitis". eMedicine. Retrieved 6/15/2021 "Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)". The College of Optometrists. April 4, 2018. Retrieved 6/15/2021." The examiner explained that "[c]omplaints of light sensitivity [we]re common among patients with glaucoma but, photophobia [wa]s not specific for glaucoma. The Veteran's light sensitivity may [be] due to other conditions. Th[e] Veteran's glaucoma is currently being treated with latanoprost. Topical IOP lowering medications can disrupt the environment of the anterior ocular surface causing dry eye symptoms. Complaints of photophobia are common among persons with dry eyes." The Board finds the opinions incomplete. The Board notes that the service medical records show that in June 1982, the Veteran was treated for a first degree burn to the right forearm after a welding accident. In September 1982, aspirin was used to treat left eye redness and irritation which had persisted three days after getting soap into left eye. In August 1984, hot soaks were used to treat possible bacterial conjunctivitis of the right eye which the Veteran reported had been present for two weeks with no known trauma. The examiner opined that the Veteran likely had a history of flash burn or photokeratitis. According to Uptodate.com, photokeratitis is an acute syndrome that occurs after ultraviolet irradiation of the eyes. A dye called fluorescein is placed in the eyes to assess damage. Treatment includes oral analgesics and lubricant antibiotic ointments which act as a prophylaxis against superinfection, and reexamination of the eye to confirm resolution and check for any new or persistent signs or symptoms should be done in one to two days. https://www.uptodate.com/contents/photokeratitis#H7. However, if the flash burn is not treated, an infection may start. That can be serious and may lead to some loss of vision. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/eyes-flash-burns The examiner did not discuss whether the Veteran's four years of welding, in-service eye complaints, and or a likely history of flash burn or photokeratitis caused, contributed to, or aggravated any current eye disability. While the examiner explained that photokeratitis as a result of welding was not a chronic condition, there was no discussion of prolonged and repeated exposure to UV rays or repeated flash burn injuries. The examiner stated that complaints of light sensitivity may be due to other conditions. However, the examiner did not discuss what, if any, of those conditions were specific to the Veteran. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board notes a July 2010 optometrist's note that the Veteran was first seen at the North Carolina VA Clinic two to three years prior. The claims file contains VA medical records which begin in 2009. Therefore, on remand the AOJ should obtain all outstanding VA and private medical records. The matter is REMANDED for the following action: 1. After obtaining any necessary releases, obtain all relevant VA and private treatment records not already associated with the claims file, to include any records prior to July 2010. All attempts to locate records must be documented in the claims file. 2. Then, schedule the Veteran for a VA eye examination with a qualified examiner who has not previously examined the Veteran in conjunction with this claim. The examiner must review the claims file, to include a copy of this Remand, and should note that review in the report. The examiner must consider and discuss the Veteran's lay statements regarding symptoms during and since service. A complete rationale for all opinions must be provided. The examiner should provide the following: (a.) Confirm that the examiner has not previously examined the Veteran in conjunction with this claim. (b.) Diagnose all eye disabilities found, or documented during the appeal period. (c.) Opine whether it is at least as likely as not (50 percent or greater probability) that each current eye disability, or eye disability diagnosed during the appeal period, is related service. If any eye disability is attributed to another etiology, the examiner must explain why the other etiology is more likely. (d.) Opine whether it is at least as likely as not (50 percent or greater probability) that any in-service eye injury, to include possible untreated flash burns, caused, contributed to, or aggravated any current eye disability. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.O., 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.