Citation Nr: 21064446 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 15-06 951 DATE: October 20, 2021 REMANDED Entitlement to service connection for glaucoma is remanded. Entitlement to total disability due to individual unemployability (TDIU) is remanded. Entitlement to nonservice-connected pension is remanded. Entitlement to special monthly pension based on the need for aid and attendance or housebound status is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1973 to March 1975. In July 2018, the Board remanded the case for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for glaucoma Review of the service treatment records reveal that a pre-discharge examination was conducted; however, it is not included in the available service treatment records. Thus, the evidence indicates that there may be outstanding relevant VA service treatment records for the Veteran's period of service in the United States Navy. As they may contain information regarding the Veteran's claim, a remand is required to obtain them. Additionally, a VA medical opinion was obtained in November 2019. The examiner opined that it is less likely than not that the Veteran's glaucoma is related to his time in service, to include the incident of being poked in the eye in 1974. The examiner noted that the Veteran reported to sick call for a sore eye ten days after being poked and stated the eye did not become sore until the day before the doctor's visit. There was no mention of an injury or trauma to the eye and no documentation that he was seen again. The Board finds this opinion contains an inadequate rationale. 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). As such, a remand is necessary to obtain an addendum opinion. 2. Entitlement to nonservice-connected pension In the March 2013 notice letter, the Regional Office (RO) denied the Veteran entitlement to non-service-connected disability pension benefits finding that his countable income was too excessive. However, in doing so, the RO counted his spouse's income but did not count her as a dependent. Specifically, the RO advised the Veteran that it was not able to count his spouse as a dependent because they lacked sufficient information. Therefore, the Veteran's income limitations were calculated using the Maximum Annual Pension Rate (MAPR) for a veteran with no dependents rather than the higher rate for a veteran with one dependent. A dependent spouse's income is considered part of the veteran's countable annual income for pension purposes. 38 C.F.R. § 3.23 (d)(4). For purposes of determining entitlement to pension under 38 U.S.C. § 1521, a person shall be considered as "living with" his or her spouse even though they reside apart unless they are estranged. 38 C.F.R. § 3.60. A couple is "estranged" if they live apart because of marital discord. If a spouse resides apart from and is estranged from the veteran, the spouse will be considered the veteran's dependent only if the spouse receives reasonable support contributions from the veteran. 38 C.F.R. § 3.23 (d)(1) Based on the review of the record, the Veteran's marital status is unclear. As such information may have a material effect on the outcome of the Veteran's entitlement to pension benefits as of July 2012 when he filed his claim (assuming the income information he filed at that time is accurate), the Board finds that remand is necessary for further development. Additionally, the July 2018 remand requested the Veteran provide evidence of any medical expenses for purposes of determining eligibility for nonservice-connected pension; however, there was no response to the May 2019 correspondence. The Veteran is reminded that the duty to assist is a two-way street, which requires his active participation in a claim for benefits. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). 3. Entitlement to TDIU and special monthly pension based on the need for aid and attendance or housebound status The Veteran's entitlement to a TDIU and special monthly pension are inextricably intertwined with the entitlement to service connection for glaucoma and entitlement to nonservice connected pension claims on appeal. Therefore, the Board finds that the claim for a TDIU must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain the Veteran's complete service treatment records. All attempts to secure this evidence must be documented in the claims file. If, after making reasonable efforts, the records cannot be obtained, notify the Veteran and his representative and (a) identify the specific records that cannot be obtained; (b) briefly explain the efforts made to obtain those records; and (c) describe any further action to be taken with respect to the claim. The Veteran must then be given an opportunity to respond. Requests for the records must continue until it is reasonably certain that further attempts would be futile. If the records are unavailable, the RO should associate a memorandum of unavailability with the claims file and notify the Veteran and his representative pursuant to the procedures outlined in 38 C.F.R. § 3.159(e). 3. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's glaucoma is related to active service or is caused by or aggravated by military service, to include due to the in-service eye injury documented on February 19, 1974. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history. If a negative opinion is offered based primarily on the length of time between separation and the current diagnosis the examiner should explain the medical significance of this fact, i.e., why this is indicative that the Veteran's current glaucoma is not related to service. A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall 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(s). 4. Again, invite the Veteran to submit any additional evidence in support of his nonservice connected pension claim. Specifically, the Veteran should be requested to provide evidence regarding his marital status and of any medical expenses incurred during the pendency of his claim which may be used by the Board to offset his MAPR for purposes of determining eligibility for nonservice-connected pension. 5. Upon completion of the above directives, complete any other necessary development after review of any additionally received records, to include additional VA examinations if warranted. 6. Finally, readjudicate the appeal. If the benefits sought on appeal remains denied, issue a supplemental statement of the case, and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Prinsen 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.