Citation Nr: 21069722 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 12-11 368A DATE: November 19, 2021 REMANDED Entitlement to service connection for an eye disability, to include glaucoma and cataracts as secondary to service-connected diabetes mellitus, is remanded. REASONS FOR REMAND The Appellant is the spouse of the Veteran who served on active duty from September 1966 to September 1968, with service in Vietnam. The Veteran died in October 2014. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Although the Appellant initially requested a videoconference hearing, she later cancelled that hearing request. This case was then remanded in February 2019 for further development. In February 2019, the Board also remanded the issue of entitlement to a total disability rating based on individual unemployability (TDIU). A September 2021 rating decision granted entitlement to special monthly compensation (SMC) based on statutory housebound criteria for the entire appeal period. This was based on a 100 percent rating for service-connected post-operative urostomy and additional service-connected disabilities rated at 60 percent. This grant of SMC effectively renders the TDIU claim moot. The issue of entitlement to service connection for an eye disability was then denied in a March 2020 Board decision. The Appellant appealed that decision to the Court of Appeals for Veterans Claims (Court), which vacated the decision pursuant to a November 2020 Joint Motion for Remand (JMR). The Board remanded the issue in June 2021; it is once again before the Board and has been reassigned to the undersigned Veterans Law Judge. Entitlement to service connection for an eye disability, to include glaucoma and cataracts as secondary to service-connected diabetes mellitus, is remanded. To date, the Board finds none of the VA examinations adequate to adjudicate this claim. Specifically, the Board finds it significant that the December 2010 VA examination noted that "[d]iabetes, especially when the blood sugar levels are above the safe range, cause (sic) changes in the eye that can result in cataracts." The examiner noted that "[t]here are studies that have shown an association between glaucoma and diabetes. According to the American Diabetes Association, people with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is." It appears that service connection for the Veteran's eye disability was denied based on the examiner providing other potential causes for cataracts and glaucoma. In its February 2019 remand, the Board noted that this examiner's opinion was vague and did not contain a clear medical nexus opinion. Although additional medical opinions were obtained in August 2019 and July 2021, neither examiner addressed the American Diabetes Association's finding that people with diabetes are more likely to suffer from glaucoma. Additionally, the Board finds that no medical opinion has adequately addressed whether the Veteran's eye disability could have been caused or aggravated by his service-connected diabetes mellitus or otherwise related to service. The medical evidence associated with the record also appears to be incomplete. In August 2016, the Appellant submitted a VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, identifying three private treatment providers of the Veteran. There is no indication in the claim file that such records were sought. As private treatment records are likely to contain pertinent information related to this claim, they should be obtained. The matter is REMANDED for the following action: 1. Obtain, if possible, records of relevant private evaluations and treatment the Veteran received. The Appellant must assist in the matter by identifying the Veteran's private healthcare providers and by submitting releases for VA to obtain any private records identified, to specifically include records from Dr. R.S., Dr. M.M., and University of Miami Hospital. 2. Obtain a VA medical opinion to determine the nature and likely cause of any eye disability diagnosed during the appeal period. The opinion provider should review the claim file (including this remand) and note such review was conducted. Based on review of the record, the opinion provider should provide an opinion with detailed rationale that responds to the following: (a) Please identify, by diagnosis, all eye disabilities present during the appeal period (from May 2010). (b) For each eye disability diagnosed, is it at least as likely as not (50% or greater probability) that the disability was caused by the Veteran's service, to include exposure to herbicide agents? The examiner may not solely rely on an absence of a VA presumption for a diagnosed disability and must discuss the Veteran's specific background. (c) For each eye disability diagnosed, is it at least as likely as not (50% or greater probability) that the disability was caused or aggravated by any of the Veteran's service-connected disabilities? Please explain why. The opinion must address whether the disability increased in severity beyond its natural progression (i.e., was aggravated). If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation. The opinion MUST address both causation and aggravation, and the opinion provider is encouraged to provide separate rationale for each to the extent applicable. (CONTINUED ON NEXT PAGE) 3. If upon completion of the above action the issue remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Matta, 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.